Icatibant in the Treatment of Acute Attacks of Hereditary Angioedema (HAE) in Adults

Introduction: Hereditary Angioedema (HAE) is a potentially life-threatening condition consisting of recurrent episodes of limb, abdominal, genital, facial or laryngeal swelling. Unregulated bradykinin activity is known to be the main driving mechanism for the characteristic edema flares in HAE. Thus, a bradykinin receptor antagonist is a sensible treatment for acute attacks of HAE. Methods: A Pubmed literature search was conducted from 2005-present using the search terms icatibant, HOE 140, angioedema, and hereditary angioedema singly and in combination. Non-English articles were excluded. Results: Overall, there have been a total of 116 patients (314 attacks) treated with icatibant. Of these attacks, the majority reported the onset of symptom relief within two hours and the resolution of symptoms within 12–24 hours. Thirty patients (9.6%) had recurrent symptoms; five were treated with rescue Berinert, seven were treated with an additional dose of icatibant, and the remainder 18 were given either C1-INH concentrate, anti-emetics, or opiates. The most reported adverse effect from icatibant was a local reaction (swelling, burning, erythema, and itching). Icatibant use has also been reported with ACE-inhibitor induced, acquired, and HAE type III angioedema as well as in one case as prophylaxis. Conclusion: The numerable new treatments for HAE now gaining favor, including icatibant, provide an exciting opportunity for both patients and providers to take swift control of this disease process.