Management of Hereditary Angioedema Type 1 and 2 for Canadian Allergy and Immunology Practitioners

Authors

  • Arun Dhir, MD Division of Allergy and Immunology, University of British Columbia
  • Amin Kanani, MDCM, FRCPC Division of Allergy and Immunology, University of British Columbia

DOI:

https://doi.org/10.58931/cait.2023.3142

Abstract

It is imperative for allergists and immunologists to accurately confirm the diagnosis of HAE and coordinate individualized, patient-centred treatment. The 2019 International/Canadian Hereditary Angioedema Guideline, provides an evidence-based approach to managing HAE patients. The objective of this article is to further assist healthcare providers in caring for patients with a confirmed diagnosis of HAE by outlining an approach to patient counselling and reviewing the principles of therapy. We propose 5 essential items to consider in the management of all HAE patients: 1) Patient education; 2) On-demand therapy; 3) Short-term prophylaxis (STP); 4) Long-term prophylaxis (LTP); and 5) Genetic testing. We will also discuss special considerations for pregnant patients.

Author Biographies

Arun Dhir, MD, Division of Allergy and Immunology, University of British Columbia

Dr. Arun Dhir is an Adult Allergy and Clinical Immunology fellow in Vancouver, British Columbia, where he is undergoing training. He received his medical degree and completed his core Internal Medicine residency at the University of British Columbia. Dr. Dhir has previously published and presented his work on inborn errors of immunity and drug allergy, and he is currently working on ongoing projects related to hereditary angioedema and perioperative anaphylaxis. Dr. Dhir aspires to become a clinician-scientist in the future.

Amin Kanani, MDCM, FRCPC, Division of Allergy and Immunology, University of British Columbia

Dr. Amin Kanani is a Clinical Associate Professor in Medicine at the University of British Columbia and the Head of the Division of Allergy and Clinical Immunology at St. Paul’s Hospital and University of British Columbia. Dr. Kanani completed his medical degree at McGill University. He then went on to complete Internal Medicine training at UBC and Clinical Immunology and Allergy Fellowship Training at the University of Toronto. He has held several leadership positions including President of the BC Society of Allergy and Immunology, Board of Directors forthe Canadian Hereditary Angioedema Society, and Interim Program Director for the UBC Allergy and Clinical Immunology training program. His clinical and research interests include chronic urticaria, hereditary angioedema and primary immunodeficiency.

References

Kanani A, et al. Urticaria and Angioedema. Allergy Asthma Clin Immunol. 2018 Sep;14(2):59. doi:10.1186/s13223-018-0288-z

Cicardi M, Agostoni A. Hereditary angioedema. N Engl J Med. 1996 Jun 20;334(25):1666-7. doi:10.1056/NEJM199606203342508

Zuraw BL. Hereditary angioedema. N Engl J Med. 2008 Sep 4;359(10):1027-36. doi:10.1056/NEJMra0801636

Betschel S, et al. The International/Canadian Hereditary Angioedema Guideline. Allergy Asthma Clin Immunol. 2019 Nov;15(1):72. doi:10.1186/s13223-019-0376-8

CSL Behring Canada Inc. Berinert Product Monograph. Mississauga, ON: CSL Behring Canada Inc., 2022.

Takeda Canada Inc. Firazyr Product Monograph. Oakville, ON: Takeda Canada Inc., 2022.

Betschel S, et al. Canadian hereditary angioedema guideline. Allergy Asthma Clin Immunol. 2014 Oct;10(1):50. doi:10.1186/1710-1492-10-50

Shire Pharma Canada ULC. Cinryze Product Monograph. Toronto, ON: Shire Pharma Canada ULC, 2022.

Pharming Healthcare Inc. Kalbitor Product Monograph. Mississauga, ON: Pharming Healthcare Inc., 2021.

Longhurst HJ. Emergency treatment of acute attacks in hereditary angioedema due to C1 inhibitor deficiency: what is the evidence? Int J Clin Pract. 2005 May;59(5):594-599. doi:10.1111/j.1368-5031.2005.00553.x

Zuraw BL, et al. Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N Engl J Med. 2010 Aug 5;363(6):513-22. doi:10.1056/NEJMoa0805538

CSL Behring Canada Inc. Haegarda Product Monograph. Mississauga, ON: CSL Behring Canada Inc., 2022.

CADTH. Canadian drug expert committee recommendation: lanadelumab (Takhzyro-Shire Pharma Canada ULC): indication: for the routine prevention of attacks of hereditary angioedema (HAE) in adolescents and adults. Canadian Agency for Drugs and Technologies in Health, 2019.

Takeda Canada Inc. TAKHZYRO Product Monograph. Oakville, ON: Takeda Canada Inc., 2022.

BioCryst Pharmaceuticals, Inc. Orladeyo Product Monograph. Mississauga, ON: BioCryst Pharmaceuticals, Inc.; 2021.

Roach B, Stiehm ER, Borte M, et al. Influence of age and sex on serum complement components in children. Am J Dis Child. 1981 Oct;135(10):918-920.

Management of Hereditary Angioedema Type 1 and 2 for Canadian Allergy and Immunology Practitioners

Downloads

Published

2023-05-01

How to Cite

1.
Dhir A, Kanani A. Management of Hereditary Angioedema Type 1 and 2 for Canadian Allergy and Immunology Practitioners. Can Allergy Immunol Today [Internet]. 2023 May 1 [cited 2024 Jul. 14];3(1):19–23. Available from: https://canadianallergyandimmunologytoday.com/article/view/3-1-dhir_et_al

Issue

Section

Articles

Most read articles by the same author(s)