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A score for the differential diagnosis of bradykinin- and histamine-induced head and neck swellings

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Acute edema of the head and neck region may lead to life-threatening dyspnea and require quick and targeted treatment. They can be subdivided in bradykinin- and histamine-mediated swellings, which require treatment with different classes of pharmaceuticals. Clinical pathways for differential diagnoses do not exist so far, although it is known that early treatment is decisive for faster symptom relief and reduced expression of the swellings. Aim of the study was the creation of a clinical algorithm for identification of bradykinin-mediated angioedema.

Methods

188 patients that presented to our outpatient department between 2010 and 2016 with an acute, non-inflammatory swelling of the head and neck region were included in our retrospective study. All available anamnestic and clinical parameters were obtained from patient files. Parameters showing significant differences between the two groups were included in our score. Utilization of the Youden’s index allowed determination of an optimal cut-off value.

Results

76 patients could be assigned to the histamine and 112 patients to bradykinin group. The following parameters were included in our score: age, dyspnea, itching or erythema, glucocorticoid response and intake of ACEi/AT-II blockers. The cut-off value is set at three points. The proposed score yielded a sensitivity for identification of bradykinin-mediated angioedema of 96%, a specificity of 84%, a positive predictive value of 91% and a negative predictive value of 93%.

Conclusions

Utilization of the proposed score allows quick and reliable assignment of patients to the correct subgroup and thereby reduces time for treatment.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Technical University of Munich, Munich, Germany

    M. Lenschow, M. Bas, F. Johnson, M. Wirth & U. Strassen

Authors
  1. M. Lenschow
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  2. M. Bas
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  3. F. Johnson
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  4. M. Wirth
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  5. U. Strassen
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Corresponding author

Correspondence to U. Strassen.

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Conflict of interest

M. Lenschow, M. Bas, F. Johnson, M. Wirth and U. Strassen state no conflicts of interest regarding this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

All data were assessed from daily oto-rhino-laryngologic routine. Study data were assessed pseudonymised and published anonymised. Therefore, informed consent was not necessary (in accordance with the local institutional review board guidance).

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Lenschow, M., Bas, M., Johnson, F. et al. A score for the differential diagnosis of bradykinin- and histamine-induced head and neck swellings. Eur Arch Otorhinolaryngol 275, 1767–1773 (2018). https://doi.org/10.1007/s00405-018-4989-1

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  • DOI: https://doi.org/10.1007/s00405-018-4989-1

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