Acute,
drug-induced
angioedema may not respond to standard
therapies, because the pathogenetic mechanism that induces the pathology is not always mediated by
histamine but, in certain instances, by
bradykinin. A case of
angioedema is reported here, in which allergic etiology was excluded by the non-response to
antihistamines. Considering the clinical history (repeated use of drugs) and the ineffectiveness of standard
therapy, it was decided to administer a beta2 receptor antagonist,
icatibant. After 20 minutes, the patient reported a subjective improvement. The only form of
angioedema for which this type of medication is licensed is the hereditary deficiency of C1 inhibitor. The use of
icatibant for the treatment of other types of
angioedema (which can also be life-saving if the airway is involved) is off label. The
off-label use of a
drug is allowed in the absence of a viable alternative
therapy, if there is scientific evidence in the literature and if the prescriber takes responsibility. The case here reported draws attention to this therapeutic problem and underlines the fact that a life-threatening emergency can justify the use of
icatibant.