Prevention of acute systemic reaction during LDL apheresis post COVID-19 by icatibant pretreatment

Abstract

Lipoprotein apheresis is used as a treatment to lower levels of low-density lipoprotein cholesterol (LDL-C) in patients with familial hypercholesterolemia when LDL-C is not adequately controlled on maximally tolerated medications. Although it raises circulating levels of bradykinin, it is generally well tolerated and systemic reactions to lipoprotein apheresis are rare. Icatibant treats bradykinin-induced angioedema. We describe the first documented case of angioedema-like systemic reactions occurring post COVID-19 in a patient who previously tolerated lipoprotein apheresis and the prevention of such reactions with icatibant. Knowledge of successful treatment of severe bradykinin-induced reactions to lipoprotein apheresis with icatibant may help other patients with such reactions.