Sease could vary from a few months to eight years [35]. When
Sease could vary from a few months to eight years [35]. When a physician takes care of women with a HAE, some issues have to be addressed: the choice of contraception, management of pregnancies and deliveries and the selection of an effective prophylactic treatment without side effects.ContraceptionCombined contraceptive pills exacerbate symptoms in 63-80 of women [3,36-38]. This method of contraception is, therefore, contra-indicated in women with hereditary angioedema. A progestogen pill (mini or full dose) should be advised in this situation. However, if a patient is not having problems with the combined pill, there is no need to stop it. An intra-uterine device is a good alternative method and is generally very well tolerated [36].PregnancyFertility and the rate of spontaneous abortion are the same as those found in the normal population. In one third of cases, pregnancy worsens symptoms, but in another third the symptoms are improved [36]. Attack rates increase Naramycin AMedChemExpress Actidione during pregnancy especially during the third trimester [39,40]. During pregnancy it is acceptable to continue background treatment with tranexamic acid [41]. Danazol is contra-indicated. Treatment of severe attacks is based on the use of C1Inh concentrate [40-42]. The management of labour depends on how the pregnancy has progressed. If the patient has suffered worsening PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26866270 of the condition with frequent severe episodes, then labour must be covered with C1 Inh concentrate (20U/kg by IV infusion). If the disease has been less severe, there is no need for prophylaxis with C1 Inh concentrate. However, this should be available in the delivery room in case it is required. Epidural analgesia is not PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/25746230 only acceptable, but is strongly recommended. The Caesarean section rate is no higher in these patients than in the general population.LactationThere is no problem with breast-feeding. However, tranexamic acid and danazol should not be taken as they are secreted in maternal milk. For the same reason icatibant should be avoided and only C1Inh concentrate should be used in the treatment of severe episodes [39].MenopauseIn most patients (55 ) the menopause does not alter the disease. One third is worse while only 13 improve [36]. Menopausal hormone replacement therapy should not be given because oestrogen can exacerbate the condition [5].Breast cancerThe incidence of breast cancer is no higher than in the rest of the population. Tamoxifen should not be used as it may worsen symptoms [43]. Women need also specific management for treatment of HAE.Bouillet Allergy, Asthma Clinical Immunology 2010, 6:17 http://www.aacijournal.com/content/6/1/Page 3 ofShort term prophylaxis: three options are available: attenuated androgens, tranexamic acid or C1Inh concentrate. There is no specific problem for the use of theses drugs for short course in female patients. In case of short term prophylaxis with attenuated androgens, no virilisation has been observed [44,45]. Acute attack treatment: there is no specific problem for the use of C1inh concentrate, tranexamic acid, icatibant; or ecallantide in female patients.Long term prophylaxis8.9.10.11.12.Antifibrinolytiques (acid tranexamic) are the first best choice for HAE women because of good tolerance. The limits are a moderate efficacy and adverse effects as nausea, diarrhea and theoretical risk about thromboembolism. These products present no specific effect for women. Only few women have reported mild dysmenorrhea [46,47]. Attenuated androgens are highly.
