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Hereditary Angioedema with C1Inh Deficiency

Hereditary Angioedema (HAE) with C1 inhibitor (C1Inh) deficiency is a rare genetic disorder characterized by recurrent episodes of severe swelling (angioedema). This condition is caused by a deficiency or dysfunction of the C1 inhibitor protein, which plays a crucial role in regulating the immune system and inflammation. The swelling can affect various parts of the body, including the skin, gastrointestinal tract, and airways, potentially leading to life-threatening complications.

Presentation

Patients with Hereditary Angioedema typically experience episodes of swelling that can last from several hours to a few days. Commonly affected areas include the face, extremities, gastrointestinal tract, and airways. Swelling in the gastrointestinal tract can cause severe abdominal pain, nausea, and vomiting, while airway involvement can lead to breathing difficulties and requires immediate medical attention. Unlike allergic reactions, these episodes are not associated with itching or hives.

Workup

Diagnosing Hereditary Angioedema involves a combination of clinical evaluation and laboratory tests. A detailed patient history and physical examination are essential to identify characteristic symptoms and family history. Laboratory tests include measuring the levels and function of C1 inhibitor protein, as well as complement components C4 and C1q. Genetic testing may also be conducted to identify mutations in the SERPING1 gene, which is responsible for the condition.

Treatment

The management of Hereditary Angioedema focuses on preventing and treating acute attacks. Acute attacks are treated with C1 inhibitor replacement therapy, which can be administered intravenously. Other treatments include bradykinin receptor antagonists and kallikrein inhibitors, which help reduce swelling. Long-term prophylaxis may be necessary for patients with frequent or severe attacks, using medications such as androgens or antifibrinolytics. Lifestyle modifications and avoiding known triggers can also help manage the condition.

Prognosis

With appropriate treatment and management, individuals with Hereditary Angioedema can lead relatively normal lives. However, the condition can be life-threatening if not properly managed, particularly when the airways are involved. Early diagnosis and treatment are crucial to improving outcomes and reducing the frequency and severity of attacks.

Etiology

Hereditary Angioedema is caused by mutations in the SERPING1 gene, which provides instructions for making the C1 inhibitor protein. This protein is essential for controlling inflammation and the immune response. Mutations in the gene lead to a deficiency or dysfunction of the C1 inhibitor, resulting in uncontrolled activation of the complement and contact systems, which causes the characteristic swelling.

Epidemiology

Hereditary Angioedema is a rare condition, affecting approximately 1 in 50,000 people worldwide. It affects both males and females equally and is typically inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene from an affected parent can cause the disorder. However, spontaneous mutations can also occur in individuals with no family history of the condition.

Pathophysiology

The pathophysiology of Hereditary Angioedema involves the deficiency or dysfunction of the C1 inhibitor protein, leading to excessive activation of the complement and contact systems. This results in the overproduction of bradykinin, a peptide that increases vascular permeability and causes fluid to leak into tissues, leading to swelling. The lack of C1 inhibitor regulation also affects other pathways, contributing to the symptoms of the disease.

Prevention

While Hereditary Angioedema cannot be prevented due to its genetic nature, individuals can take steps to reduce the frequency and severity of attacks. Avoiding known triggers, such as stress, trauma, certain medications, and infections, can help manage the condition. Prophylactic treatments and regular follow-up with healthcare providers are essential for preventing severe episodes.

Summary

Hereditary Angioedema with C1 inhibitor deficiency is a rare genetic disorder characterized by recurrent episodes of severe swelling. It is caused by mutations in the SERPING1 gene, leading to a deficiency or dysfunction of the C1 inhibitor protein. Diagnosis involves clinical evaluation and laboratory tests, while treatment focuses on managing acute attacks and preventing future episodes. With appropriate management, individuals can lead relatively normal lives, although the condition can be life-threatening if not properly treated.

Patient Information

Hereditary Angioedema is a genetic condition that causes episodes of severe swelling in various parts of the body. It is important for patients to recognize the symptoms and seek medical attention during an attack, especially if the airways are involved. Treatment options are available to manage the condition and prevent future episodes. Patients should work closely with their healthcare providers to develop a personalized management plan and avoid known triggers to reduce the risk of attacks.

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