Cholinergic Urticaria & Angioedema: What You Need to Know
In this episode, Thomas welcomes Dr. Sabine Altrichter, urticaria expert and physician at Kepler University Hospital in Linz, Austria, to discuss a fascinating and underrecognized condition: cholinergic urticaria — especially in patients who also experience angioedema.They discuss:🔹 What makes cholinergic urticaria different from other urticaria types? 🔹 Why do some patients develop angioedema in addition to wheals?🔹 How can we distinguish between cholinergic urticaria and exercise-induced anaphylaxis?🔹 What are current and emerging treatment options? Dr. Altrichter shares insights from clinical research and experience, including findings that show nearly half of cholinergic urticaria patients may develop angioedema.She explains the two main subtypes — allergy-related and sweat gland-related — and what this means for diagnosis and treatment. The discussion also covers new treatment options like anti-IgE therapies, mast cell-depleting agents, and drugs in the clinical pipeline like remibrutinib. Join us for a practical and engaging conversation on how to better diagnose and manage this unique condition.Key Learnings from the Episode:Cholinergic urticaria is triggered by body heating (e.g., exercise, sauna, passive warmth), leading to small, itchy wheals. Nearly 50% of patients also experience angioedema, often around the eyes or lips, indicating more severe disease.Patients with angioedema tend to have longer-lasting and more intense symptoms than those without. Two subtypes are emerging: one IgE/allergy-related and another with sweat gland dysfunction. Angioedema in cholinergic urticaria is not typically life-threatening, but may be accompanied by mild systemic symptoms. Provocation testing (e.g., exercise or stair running) helps confirm diagnosis. Antihistamines are first-line, but often insufficient in patients with angioedema. Omalizumab (anti-IgE) is effective in about two-thirds of patients. Mast cell-depleting therapies and remibrutinib are promising treatments in development. Differentiating from exercise-induced anaphylaxis is key: the latter causes more unpredictable and systemic reactions.Ongoing trials may reshape how we treat both mild and severe forms of the disease. Chapters 00:00 Introduction to Chronic Inducible Urticaria 03:03 Understanding Cholinergic Urticaria 04:57 Angioedema and Its Connection to Cholinergic Urticaria 07:23 Subtypes of Cholinergic Urticaria 08:17 Mechanisms Behind Cholinergic Urticaria 09:56 Diagnosis of Cholinergic Urticaria 11:17 Treatment Options for Cholinergic Urticaria 13:10 Differentiating from Exercise-Induced Anaphylaxis 14:34 Future Treatments and Research 16:41 Mast Cell Depletion and Its Implications Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr
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AI & Data Science in Angioedema Research
In this episode, Thomas welcomes Felix Aulenbacher, a bioinformatician and statistician from ACARE Berlin, to discuss the role of data science, machine learning, and artificial intelligence (AI) in angioedema research. They discuss:🔹 How does data analysis help classify different types of angioedema? 🔹 What role do AI and machine learning play in identifying disease patterns? 🔹 How does the "10 Questions" tool assist in diagnosing angioedema? 🔹 How is AI revolutionizing medical research, and what are its limitations? Felix shares insights on the intersection of bioinformatics and medicine, the challenges of medical data analysis, and how AI is transforming the field of angioedema research. Key Learnings from the Episode Bioinformatics plays a crucial role in medical research, analyzing large datasets to uncover hidden patterns in diseases. Data standardization is essential—poorly formatted data can make analysis difficult and lead to incorrect conclusions. Machine learning models like Random Forest help classify different types of angioedema based on patient questionnaires. The "10 Questions" tool has been developed to quickly differentiate different types of angioedema including HAE, mast cell-mediated angioedema, and drug-induced angioedema. AI can enhance data analysis, but it requires careful validation—incorrect use can lead to misinformation. ChatGPT and AI tools assist with coding and data analysis, but human oversight is still essential. AIDUOS, a ChatGPT-based tool, has been developed for urticaria research, relying on verified medical publications. AI is not a threat to data analysts, but professionals must adapt to its evolving capabilities. Chapters 00:00 Introduction to Angioedema and Bioinformatics 02:20 Felix's Journey into Bioinformatics 04:26 The Role of Data Management in Medical Research 06:54 Statistical Methods and Their Applications 09:21 Machine Learning in Angioedema Research 11:43 The Impact of AI on Data Analysis 14:05 Future of Data Management and AI in Medicine Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr
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Mortality in HAE: The Silent Threat
In this episode, Thomas welcomes Dr. Fernanda Minafra, allergist and immunologist at the Federal University of Minas Gerais, Brazil, to discuss one of the most concerning aspects of hereditary angioedema (HAE): mortality. They discuss:🔹 How often do HAE-related deaths occur? 🔹 Why is undiagnosed HAE a major risk factor? 🔹 What do global studies say about mortality rates? 🔹 What can be done to reduce HAE deaths worldwide? Dr. Minafra shares insights from her research, including a systematic review on HAE-related deaths and a study on mortality rates in Brazil. She highlights the urgent need for better diagnosis, access to treatment, and public health policies to prevent avoidable deaths. Join us for this crucial discussion on why early diagnosis and proper treatment are key to saving lives. Key Learnings from the Episode HAE-related deaths are often caused by asphyxiation due to laryngeal angioedema. HAE mortality rates remain high in many parts of the world, especially in developing countries. A systematic review found that 1 in 20 HAE patients has died from asphyxia. Undiagnosed patients are at much higher risk of fatal outcomes. Many death certificates fail to properly identify HAE as the cause of death. HAE patients who die from asphyxiation typically lose 20 years of life expectancy. Access to diagnostic tests and effective treatments is essential for preventing deaths. Global collaboration through ACARE centers is needed to improve mortality data collection and patient outcomes. Chapters 00:00 Introduction to Angioedema and Mortality 03:13 Understanding Hereditary Angioedema (HAE) and Its Risks 05:34 Research Insights on Mortality in HAE 08:21 Findings from Brazil: A Closer Look at HAE Deaths 10:47 The Impact of Diagnosis and Treatment on HAE Mortality 13:41 Current Status and Future Directions in HAE Research Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr
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Dried Blood Spot: A Game Changer for HAE Diagnosis
In this episode, Thomas welcomes Dr. Jane Wong from Queen Mary Hospital, Hong Kong, to discuss a groundbreaking method for diagnosing hereditary angioedema (HAE) in regions with limited laboratory access. Traditional tests like complement C4, C1 inhibitor levels and C1 inhibitor function are crucial but not widely available in many parts of the world, delaying diagnosis and treatment.They discuss:🔹 What is dried blood spot (DBS) testing? 🔹 How does DBS compare to conventional lab tests? 🔹 Can DBS be used for large-scale screening and family testing? 🔹 What are the limitations and future applications of DBS? Join us for an in-depth discussion on how this simple, cost-effective method can revolutionize HAE diagnosis and patient care worldwide. Key Learnings from the Episode:Traditional HAE testing (C4, C1 inhibitor levels and function) is limited in many regions, delaying diagnosis and treatment. Dried blood spot (DBS) testing offers a reliable, cost-effective alternative, requiring only a few drops of blood. DBS showed strong correlation with conventional lab results, making it a promising screening tool. DBS allows for easy at-home or community-based sample collection, overcoming logistical barriers. DBS can be used for family screening, identifying undiagnosed relatives in high-risk groups. The method is stable and easy to transport, requiring minimal laboratory infrastructure. More extensive studies are needed to validate DBS for broader population screening. Future applications may include genetic testing for HAE with normal C1 inhibitor cases. Chapters 00:00 Introduction to HAE and Diagnostic Challenges 03:12 Conventional Testing Methods for HAE 05:44 Exploring Alternative Diagnostic Methods 08:25 Validation of the Dried Blood Spot Method 10:40 Family Screening and Community Engagement 13:29 Limitations and Future Directions 16:07 The Future of HAE Diagnostics in Asia-Pacific Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr
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Unraveling Angioedema: The Complexity of HAE and Unknown Variants in Canada
In this episode, Dr. Thomas Buttgereit speaks with Dr. Adil Adatia about the latest findings on hereditary angioedema (HAE) in Canada, focusing on the challenges in diagnosing and treating patients with normal C1 inhibitor levels. They explore the differences between well-known genetic variants, discuss the average diagnostic delay of over 10 years, and examine treatment approaches, including long-term prophylaxis and the role of estrogen as a trigger. Additionally, they highlight the need for standardized guidelines in diagnosing and managing this condition to better treatment response.Key Learnings from the EpisodeThe average diagnostic delay for hereditary angioedema with normal C1 inhibitor levels exceeds 10 years in Canada.Patients with normal C1 inhibitor function often experience different triggers, with estrogen and stress being more prominent compared to other angioedema variants. A significant heterogeneous group of patients exists, where genetic mutations have yet to be identified.Many patients require multiple long-term prophylaxis treatments, indicating a more severe disease course.Genetic testing has historically been limited, but recent efforts are increasing its role in diagnosis.The lack of standardized diagnostic criteria across Canada makes it difficult to classify and treat patients uniformly.Insurance coverage for treatments like omalizumab varies by province and county, making access to care inconsistent.There is a need for clear definitions of treatment trials and treatment failures to improve clinical decision-making.Chapters 00:00 Introduction to HAE and the Guest 02:27 Understanding HAE with Normal C1 Inhibitor 05:30 Diagnostic Challenges and Delays 08:21 Comparative Analysis of HAE Types 11:32 Limitations of Current Research 14:34 Treatment Responses and Variability 17:16 Conclusion and Future Directions Do you have suggestions for future episodes? Please provide feedback and offer your suggestions for future topics and expert selection here.Feedback form ATA: https://forms.office.com/e/ZWxx3D4Cmr
Acerca de All Things Angioedema – Learning about angioedema with Dr. Thomas Buttgereit
Started by ACARE in 2023 within the ACARELevelUp program this podcast is an invaluable resource for health care professionals, and anyone interested in learning more about angioedema. Dr. Thomas Buttgereit, Head of the Study Center at Charité Berlin, discusses all forms of angioedema, their pathophysiology, burden and treatment strategies with experts from all over the world. All opinions expressed are those of the faculty. This content should not be taken as medical advice and is for informational purposes only. Learn more about ACARE here: https://acare-network.com/
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