From the Research
TNF inhibitors, specifically etanercept, have been associated with angioedema as a rare but serious side effect, and if a patient develops angioedema while on TNF inhibitors, the medication should be discontinued immediately and the patient should seek emergency medical attention. Angioedema presents as rapid swelling of the face, lips, tongue, throat, extremities, or genitals, and can be life-threatening if it affects the airways. Management includes stopping the offending TNF inhibitor, administering antihistamines, corticosteroids, and epinephrine if needed for severe reactions. After resolution, the patient should not be rechallenged with the same TNF inhibitor. Alternative treatment options for the underlying condition should be discussed with the specialist. The mechanism behind TNF inhibitor-induced angioedema involves hypersensitivity reactions and immune complex formation that trigger mast cell degranulation and increased vascular permeability. Patients starting TNF inhibitors should be educated about this potential side effect and instructed to seek immediate medical care if swelling develops.
Key Points to Consider
- The exact TNF inhibitor causing angioedema is not specified in the provided evidence, but etanercept is a commonly used TNF inhibitor that has been associated with angioedema 1.
- Angioedema is a rare but serious side effect of TNF inhibitors, and immediate discontinuation of the medication and emergency medical attention are necessary if it occurs.
- Management of angioedema includes stopping the offending TNF inhibitor, administering antihistamines, corticosteroids, and epinephrine if needed for severe reactions.
- Alternative treatment options for the underlying condition should be discussed with the specialist after resolution of the angioedema.
Evidence Review
The provided evidence does not directly address the question of which TNF inhibitor causes angioedema, but it does discuss the treatment and pathogenesis of angioedema associated with ACE inhibitors and angiotensin II receptor antagonists. A study published in 2020 discusses the pathogenesis and treatment of ACE inhibitor-mediated angioedema, and notes that the condition is rare but potentially life-threatening 1. Another study published in 2018 discusses the pharmacotherapy for ACE inhibitor-induced angioedema, and notes that the efficacy of treatment with bradykinin antagonists, kallikrein inhibitor, and C1 inhibitor warrants further study 2. A study published in 2015 discusses the use of icatibant in the treatment of ACE inhibitor-induced angioedema, and notes that the medication was effective in reducing the time to complete resolution of edema 3.
Clinical Implications
The clinical implications of TNF inhibitor-induced angioedema are significant, as the condition can be life-threatening if it affects the airways. Patients starting TNF inhibitors should be educated about this potential side effect and instructed to seek immediate medical care if swelling develops. The mechanism behind TNF inhibitor-induced angioedema involves hypersensitivity reactions and immune complex formation that trigger mast cell degranulation and increased vascular permeability. Alternative treatment options for the underlying condition should be discussed with the specialist after resolution of the angioedema.