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Role of fresh-frozen plasma in angioedema: progress and problems.

The treatment of severe attacks requires the early use of specific treatments, icatibant [Firazyr (Boulogne-Billancourt; France); Shire] (a synthetic selective and specific antagonist of bradykinin B2 receptors), or pasteurized C1 inhibitor [Berinert (Marburg, Germany); CSL Behring] [4]. Access to these specific treatments remains insufficient. However, a network of reference centers improves the acquisition and delivery of timely angioedema care. The link with EMS increases availability further, as they are available 24 h a day, with an emergency physician on hand to assess the need for treatment and organize its immediate delivery to the patient. In this case study, only icatibant [Firazyr (Boulogne-Billancourt; France); Shire] was available; however, as its administration in children is not allowed, a transfer was required [4]. It should therefore be questioned whether it is more appropriate to delay the treatment of a potentially life-threatening disease by 2.5 h or use a drug beyond its authorized license. Ever since its use in adults, there is no basis to doubt the efficacy of icatibant [Firazyr (Boulogne-Billancourt; France); Shire] in children. There is no evidence against contraindication or specific side-effects in children. Therefore, we believe that in the presence of severe signs, the risk–benefit balance is in favor of using icatibant [Firazyr (Boulogne-Billancourt; France); Shire] in children. Indeed, untreated laryngeal edema in patients with bradykinin angioedema has a 25% mortality rate. In 30% of attacks, swelling of the face ultimately leads to swelling of the larynx. Further studies in children are, however, recommended [5].