Anabolic Androgenic Steroids in Hereditary Angioedema

Diagnosis and Treatment

The British Journal of Dermatology recommends screening for hereditary angioedema with serum C4 levels in patients presenting with recurrent angioedema without wheals, as low C4 has very high sensitivity for C1 inhibitor deficiency 2
The British Journal of Dermatology suggests confirming diagnosis with quantitative and functional C1 inhibitor assays if C4 is low 2
Anabolic steroids are first-line maintenance therapy for symptomatic recurring angioedema or related abdominal pain in adults, according to the British Journal of Dermatology 1
The British Journal of Dermatology advises using only low doses for long-term maintenance, but virilizing side-effects may still occur 1
Mandatory monitoring, including regular liver function tests and imaging for hepatocellular adenomas, is essential due to hepatotoxicity risk, as recommended by the British Journal of Dermatology 1
The British Journal of Dermatology recommends avoiding anabolic steroids in children whenever possible due to virilizing effects 1

Tranexamic acid may be used instead of anabolic steroids, but is contraindicated in patients with thrombosis history, according to the British Journal of Dermatology 1
Regular eye examinations and liver function tests are required with long-term tranexamic acid use, as recommended by the British Journal of Dermatology 1
For acute attacks or surgical prophylaxis, C1 inhibitor concentrate is preferred over maintenance therapy, according to the British Journal of Dermatology 1

Non-sedating H1-antihistamines are the mainstay of therapy for chronic urticaria with or without angioedema, as recommended by the British Journal of Dermatology 2
Over 40% of patients show good response to antihistamines alone, according to the British Journal of Dermatology 1
The British Journal of Dermatology suggests adding H2-antihistamines or antileukotrienes for resistant cases 1
Restrict oral corticosteroids to short courses (3-4 weeks) for severe acute urticaria or life-threatening angioedema, as recommended by the British Journal of Dermatology 1

Avoid aspirin (ASA) and NSAIDs in urticaria patients, as they inhibit cyclooxygenase and can exacerbate symptoms, according to the British Journal of Dermatology 2
ACE inhibitors must be avoided in patients with angioedema without wheals and used cautiously when angioedema accompanies urticaria, as recommended by the British Journal of Dermatology 2