L’angiœdème à travers les âges : considérations pratiques

Challenges associated with angioedema differ with patient's age. In children, the most frequent one is bradykinin-related hereditary angioedema (HAE). Diagnosis might be difficult when signs and symptoms are not evocative, such as isolated abdominal crises, in the absence of familial context. Management by multidisciplinary team should be organized rapidly, preferably in an expert center, to allow children living a normal life and experiencing satisfactory development. Adolescence, often characterized by an increase in frequency and severity of crises, must be the period of patient's empowerment in disease management. But it is also a period of instability and turbulences with a possible decreased compliance to treatment. Contraception must be discussed in young female patients due to the relationship between estrogen secretion and HAE attacks. In adults, follow-up and treatment are pursued without any remarkable feature. If HAE appears during adulthood, differential diagnoses should be considered, such as acquired C1 inhibitor deficiency, and associated hemopathies should be detected (monoclonal gammopathy or lymphoproliferative syndrome). Pregnancy requires increased surveillance because of specific risks arising in this situation. Finally, in elderly patients, preexisting HAE is often associated with other comorbidities that can interfere with its evolution, especially because of drug intake. Attacks management may become more difficult and compliance may decrease. Occurrence of HAE after 65 years of age being exceptional, it is important to diagnose iatrogenic angioedema (related in particular to conversion enzyme inhibitors) or thrombolysis of a stroke.