In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Dr. Priya Bowry Sikand from Nairobi, Kenya, leader of one of the newest ACARE centers in Africa. Together, they discuss the unique challenges of diagnosing and managing angioedema in East and Central Africa, as well as the opportunities to improve care through education and collaboration.

They discuss:

🔹 Which types of angioedema are most commonly seen in Kenya and the surrounding region?

🔹 How do chronic infections contribute to angioedema and urticaria presentations?

🔹 Why are food-related and aeroallergen-associated angioedema cases particularly relevant in this setting?

🔹 What are the current challenges in diagnosing hereditary angioedema (HAE) in Africa?

🔹 How limited is access to specialized testing and modern HAE therapies?

🔹 What role do education, awareness, and ACARE play in improving patient outcomes?

Dr. Bowry Sikand shares insights from her clinical experience and highlights the significant unmet needs in HAE care across sub-Saharan Africa. The conversation emphasizes the importance of physician education, improved diagnostic pathways, and equitable access to effective treatments for patients living with recurrent angioedema.

Key Learnings from the Episode:

Chronic infections are a common cause of angioedema and urticaria in East Africa.

Food-related angioedema is frequently encountered in clinical practice.

House dust mite allergy can contribute to recurrent facial angioedema.

HAE remains significantly underdiagnosed across sub-Saharan Africa.

Access to C1 inhibitor testing is limited and often expensive.

Modern HAE treatments are not widely available in many African countries.

Many patients rely on older therapies such as danazolandrogens and tranexamic acid.

Education and awareness are essential for improving HAE diagnosis.

International collaboration helps expand access to expertise and training.

Patients with HAE could achieve much better outcomes with improved access to diagnostics and treatment.

Chapters:

00:00 Introduction to the episode and guest

00:42 Guest introduction and regional context

02:30 Common angioedema cases in Kenya

03:28 Diverse patient population and regional differences

04:27 Infections and their role in angioedema

05:24 Food allergies, especially meat, in Kenya

06:24 Environmental factors and aeroallergens

07:11 Infectious disease testing and treatment strategies

08:33 Treatment options and access challenges

11:28 Hereditary angioedema (HAE) in Kenya

12:03 Diagnostic challenges and resource limitations

14:03 Treatment access and regional disparities

16:42 Training, education, and future prospects

18:05 Final thoughts and call for global support

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Dr. Isabelle Boccon-Gibod from the French ACARE center in Grenoble about the new European expert consensus on applying a treat-to-target (T2T) approach in hereditary angioedema (HAE). The discussion explores how goal-oriented care can improve consistency and patient outcomes in daily clinical practice.

They discuss:

🔹 What does a treat-to-target approach mean in HAE management?

🔹 How does T2T differ from traditional guideline-based treatment?

🔹 What are the short-term and long-term goals in HAE care?

🔹 Why are patient-reported outcome measures (PROMs) so important?

🔹 What challenges exist when implementing T2T in clinical practice?

🔹 How could this consensus influence future guidelines and research?

Dr. Boccon-Gibod explains how structured monitoring, shared decision-making, and clearly defined treatment goals can help move HAE care closer to the ultimate aim of “normalization of life.” The episode highlights the importance of individualized care and practical strategies for improving disease control and quality of life.

Key Learnings from the Episode:

Treat-to-target introduces a structured, goal-oriented approach to HAE care.

The approach combines short-term symptom control with long-term quality-of-life goals.

Normalization of life is the ultimate treatment target in HAE.

Patient-reported outcome measures are central to monitoring disease control.

The AECT is an important tool for assessing HAE control in practice.

Shared decision-making plays a key role in treatment planning.

Clinical practice and access to therapies still vary across countries.

Structured follow-up can improve consistency of care.

T2T may influence future HAE guidelines and clinical research.

The approach aims to improve long-term outcomes for patients with HAE.

Chapters:

00:00 Introduction to Angioedema and the Podcast

01:04 Understanding the Treat-to-Target Approach

02:15 The Role of Patient-Reported Outcome Measures

10:19 Challenges in Implementing the T2T Approach

12:16 Impact of Consensus on Future Research and Guidelines

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Patricia Karani, patient advocate from Kenya, about her personal journey with hereditary angioedema (HAE) and her work supporting patients across sub-Saharan Africa. Recorded in the context of the Global Angioedema Leadership Conference (GALC), this episode brings a powerful patient perspective to the discussion.

They discuss:

🔹 What is it like to live with undiagnosed HAE for decades?

🔹 Why is delayed diagnosis still a major challenge worldwide?

🔹 What barriers do patients face in accessing life-saving treatments?

🔹 How can patient advocacy help improve awareness and healthcare systems?

🔹 Why is collaboration with governments essential for access to therapies?

🔹 How can patients become advocates and drive change in their regions?

Patricia shares her story of nearly 30 years without proper diagnosis or treatment, and how this experience shaped her mission to support others. The episode highlights the importance of awareness, building patient networks, and advocating for better access to treatment—especially in regions where rare diseases are often overlooked.

Key Learnings from the Episode:

HAE diagnosis can be delayed for decades, leading to significant suffering.

Misdiagnosis as allergies is common and delays proper treatment.

Access to HAE therapies remains a major challenge in many regions.

Patient advocacy is essential to raise awareness and improve care.

Collaboration with governments is key to making treatments affordable.

Building patient networks helps identify and support affected individuals.

Education of healthcare professionals is critical for earlier diagnosis.

Living with controlled HAE enables patients to live a full life.

Personal experiences can be a powerful driver for advocacy.

Global collaboration strengthens patient support and healthcare improvements.

Chapters:

00:00 Introduction to Angioedema and the Podcast

01:51 Patient Advocacy and the Global Angioedema Leadership Conference

06:40 Patricia's Journey with Hereditary Angioedema

10:15 Challenges in Patient Advocacy and Awareness

17:03 Motivation Behind Patient Advocacy and Living Fully

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Dr. Lili Voloncs-Mindszenthy from Semmelweis University, Hungary, recipient of the Young Investigator Award at the Global Angioedema Leadership Conference (GALC) 2026. They discuss her groundbreaking research on improving the early diagnosis of hereditary angioedema (HAE) in newborns.

They discuss:

🔹 Why is diagnosing HAE in newborns particularly challenging?

🔹 Which complement biomarkers can reliably indicate HAE from birth?

🔹 Why are C1 inhibitor levels and function more informative than other complement factors?

🔹 What are the limitations of current diagnostic approaches, including genetic testing?

🔹 How can early diagnosis improve patient outcomes and family screening?

🔹 What are the next steps in validating these findings for clinical use?

Dr. Voloncs-Mindszenthy shares insights from her study using umbilical cord blood samples, identifying consistent patterns in C1 inhibitor levels and function that may allow for much earlier diagnosis of HAE. The episode highlights the potential to move diagnosis closer to birth and improve early intervention strategies.

Key Learnings from the Episode:

Diagnosing HAE in newborns is challenging due to an immature complement system.

Early diagnosis is crucial, especially in families with known HAE history.

C1 inhibitor antigenic levels and function show consistent patterns in HAE newborns.

These parameters may serve as reliable early biomarkers for HAE.

Other complement factors such as C3 and C4 show high variability and are less reliable.

Genetic testing is useful but not always readily available or practical.

Umbilical cord blood testing offers a practical early diagnostic opportunity.

Larger studies are needed to establish newborn-specific reference ranges.

Early detection can improve patient management and enable family screening.

The research highlights a promising step toward diagnosing HAE from birth.

Chapters:

00:00 Introduction to Angioedema and the Conference Highlights

05:15 Lily's Background and Research Journey

09:55 Insights from the Global Angioedema Leadership Conference

14:07 Research on Diagnosing HAE in Newborns

18:29 Future Directions and Conclusion

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Prof. Maohamed Abuzakouk, Chair of Allergy and Clinical Immunology at Cleveland Clinic Abu Dhabi, about the evolving landscape of hereditary angioedema (HAE) care in the United Arab Emirates and the wider Middle East region. With more than three decades of experience in allergy and immunology across Ireland, the UK, and the Gulf region, Prof. Abuzakouk shares valuable insights into how awareness, diagnosis, and treatment of HAE have developed in recent years.

They discuss:

🔹 How does hereditary angioedema typically present in patients in the UAE and are there regional differences compared to Europe or North America?

🔹 What challenges contribute to delayed diagnosis, including misdiagnosis as allergic angioedema or surgical abdominal emergencies?

🔹 How do cultural and genetic factors, such as higher rates of consanguinity, influence HAE detection and family clustering?

🔹 What initiatives have improved physician awareness and education across the region in the past decade?

🔹 How do regional consensus statements help adapt international HAE guidelines to local healthcare systems?

🔹 Which modern therapies for on-demand treatment and long-term prophylaxis are currently available in the UAE?

🔹 Why are national and regional HAE registries essential for improving diagnosis and patient care in the Middle East?

Prof. Abuzakouk highlights the remarkable progress made in the UAE, including improved access to diagnostic testing, modern therapies, and international collaborations with networks such as GA²LEN and ACARE. At the same time, he emphasizes the importance of continuing efforts to identify undiagnosed patients, establish regional registries, strengthen patient advocacy groups, and expand education for healthcare providers. The discussion concludes with a clear vision for the future: eliminating diagnostic delays, improving quality of life for all patients with HAE, and ultimately achieving zero preventable mortality from the disease.

Key Learnings from the Episode:

Hereditary angioedema in the UAE presents clinically similar to cases in Europe and North America.

Higher rates of consanguinity may contribute to larger affected families and genetic clustering.

Delayed diagnosis remains a challenge, particularly in older generations of patients.

Abdominal HAE attacks are frequently misdiagnosed as surgical emergencies.

Educational initiatives and small-group training programs have significantly improved awareness among clinicians.

Improved laboratory access to C4 and C1 inhibitor testing has facilitated earlier diagnosis.

Regional consensus guidelines emphasize early diagnosis and universal access to on-demand therapy.

Specialized allergy and immunology centers remain limited across the region.

Chapters:

00:00 Introduction to HAE in the UAE

06:58 Challenges and Regional Differences in HAE

09:52 Awareness and Education Efforts

11:12 Regional Consensus on HAE Management

14:05 Future Steps for HAE Care in the UAE

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Dr. Maria Bova, allergist and clinical immunologist from Naples, Italy, about a rare but potentially life-threatening form of angioedema: angioedema induced by thrombolytic therapy, particularly tissue plasminogen activator (tPA).

They discuss:

🔹 What is tPA-induced angioedema and how often does it occur in stroke patients?

🔹 Why is this condition frequently underrecognized in emergency and intensive care settings?

🔹 What clinical features distinguish it from histaminergic and hereditary angioedema?

🔹 Which pathophysiological mechanisms are likely involved, including bradykinin activation?

🔹 What new research findings suggest immune cell dysregulation in affected patients?

🔹 Which patient- and treatment-related risk factors may increase susceptibility?

🔹 How should clinicians approach diagnosis and acute management in the absence of clear guidelines?

Dr. Bova shares novel insights from her group’s research, including evidence for activation of the kallikrein-kinin system and elevated cleaved high-molecular-weight kininogen during attacks. The discussion highlights the urgent need for greater awareness, interdisciplinary collaboration between neurologists and immunologists, and clearer treatment algorithms, especially given the limitations of standard antihistamine and corticosteroid therapy in this condition. The episode concludes with a look toward future thrombolytic agents and their potential role in reducing angioedema risk.

Key Learnings from the Episode:

tPA-induced angioedema is a rare but serious complication of thrombolytic therapy.

Prevalence varies widely and is likely underestimated in emergency settings.

Angioedema typically develops within two hours after tPA administration.

Common sites include lips, tongue, face, eyelids, and upper airways.

The condition occurs without urticaria or itching and may last up to 24 hours.

Evidence suggests a predominantly bradykinin-mediated mechanism.

Immune cell activation and kallikrein-kinin system dysregulation play a role.

Standard treatments (antihistamines, corticosteroids, adrenaline) are often ineffective.

Bradykinin-targeted therapies such as icatibant or C1 inhibitor may be beneficial.

Awareness among neurologists significantly increases detection rates.

Multidisciplinary collaboration is essential for early recognition and management.

New thrombolytic agents may reduce angioedema risk, but data are still limited.

Chapters:

00:00 Introduction to Angioedema and TPA

01:43 Meet Dr. Maria Bova: Expert Insights

03:00 Prevalence and Recognition of TPA-Induced Angioedema

04:58 Pathophysiology of TPA-Induced Angioedema

08:55 Risk Factors for Angioedema in Stroke Patients

11:53 Clinical Presentation and Symptoms

13:12 Treatment Approaches for Angioedema

16:00 Awareness and Multidisciplinary Strategies

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In this episode of All Things Angioedema, Dr. Thomas Buttgereit speaks with Dr. Mark Kačar from Slovenia about the practical, clinical, and organizational steps required to establish a dedicated angioedema center within the ACARE network. Drawing from Mark’s unique experience of helping build angioedema services in multiple countries, the conversation offers valuable insights for clinicians worldwide. 

They discuss:

🔹 Why are specialized angioedema centers essential for optimal patient care? 
🔹 What clinical expertise, diagnostics, and infrastructure are truly required? 
🔹 Which ACARE criteria are most challenging for smaller or emerging centers? 
🔹 How can education, registries, and collaboration strengthen national care pathways? 

Dr. Kačar shares lessons from Slovenia’s healthcare system, where centralized expertise is key for managing rare and complex diseases like angioedema. He discusses the importance of clinical experience, multidisciplinary teamwork, access to diagnostics and genetics, patient education initiatives, and the realities of meeting ACARE requirements. Together, they highlight how international collaboration, training fellowships, and strong doctor–patient relationships form the foundation of sustainable centersof excellence in angioedema care. 

Key Learnings from the Episode:

Dedicated angioedema centers improve care by centralizing expertise and experience for rare diseases. 

Small countries such as Slowenia benefit from national referral structures rather than fragmented outpatient care. 

ACARE certification requires fulfillment of 32 defined criteria, many embedded in daily clinical practice. 

Key challenges include staffing specialized nurses, participation in registries, and access to clinical trials. 

Strong diagnostic capabilities, including complement studies and genetics, are essential. 

Training experiences at established centers accelerate knowledge transfer and best practices. 

Patient education events and collaboration with international patient organizations enhance care quality. 

Building an ACARE center is a gradual process driven by teamwork, commitment, and global networking. 

Chapters:

00:00 Introduction to Angioedema and ACARE

01:39 Mark's Journey in Allergy and Immunology

05:06 Importance of a Dedicated Angioedema Center

07:56 Experiences from Charité and Clinical Insights

11:16 Challenges in Establishing the Center

16:11 Patient Education and Resources

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In this episode of All Things Angioedema, Thomas Buttgereit speaks with Dr. Vesna Trajkova, dermatologist and researcher from Skopje, North Macedonia, about the clinical relevance of angioedema in chronic spontaneous urticaria (CSU) and what its presence reveals about disease severity and underlying mechanisms. 

They discuss:

🔹 How common is angioedema in patients with CSU? 
🔹 Is angioedema linked to more severe or longer-lasting disease? 
🔹 What is the role of autoimmunity and autologous serum skin testing? 
🔹 How should these findings influence everyday clinical practice? 

Dr. Trajkova presents data from her recent study showing that 70% of CSU patients experience angioedema, with the vast majority occurring in those with severe disease. The discussion highlights associations between angioedema, higher disease activity, longer disease duration, and autoimmune markers, emphasizing that angioedema should nobe viewed as a minor accompanying symptom. Together, they explore how recognizing angioedema as a clinically meaningful marker can improve risk stratification, monitoring, and treatment decisions in CSU. 

Key Learnings from the Episode:

Angioedema is highly prevalent in CSU, affecting around 70% of patients the CSU population investigated in the study.

The presence of angioedema is strongly associated with severe CSU, occurring in over 80% of severe cases.

CSU patients with angioedema tend to have a longer disease duration, indicating a higher cumulative burden.

Autoimmune markers and comorbid autoimmune diseases are more frequent in CSU patients with angioedema.

Autologous serum skin test positivity shows a trend toward higher angioedema prevalence, supporting an autoimmune component.

Angioedema does not merely coexist with CSU but acts as a marker of disease severity and complexity.

Routine CSU assessment should actively include angioedema evaluation, not just wheals and itch.

Recognizing angioedema can help guide earlier treatment escalation and closer follow-up in clinical practice.

Chapters:

00:00 Introduction to Angioedema and CSU

02:30 Guest Introduction: Vesna Trejkova

04:50 Research Rationale and Study Overview

10:34 Key Findings on Angioedema in CSU

13:15 Study Limitations and Future Directions

15:32 Clinical Implications of Research Findings

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In this episode, Dr. Thomas Buttgereit welcomes Mats de Lange, medical doctor and PhD candidate at Amsterdam UMC, to discuss one of the rarest and most challenging forms of angioedema – acquired angioedema (AAE) due to C1 inhibitor deficiency (AAE-C1INH). 

They discuss

🔹 What causes AAE, and how does it differ from hereditary angioedema? 
🔹 Why is treatment still off-label for most patients? 
🔹 What did the Amsterdam investigator-initiated trial reveal about Deucrictibant, a new bradykinin B2 receptor antagonist? 
🔹 How could this research pave the way for the first approved AAE therapy? 

Mats de Lange shares insights from his team’s investigator-initiated trial on the long-term use of Deucrictibant, showing remarkable results – three out of four patients remained attack-free for 20 months. The discussion also highlights the unique challenges of studying such an ultra-rare condition and the hope for future phase III trials. 

Join us as we explore how collaborative research and patient participation are advancing the field of bradykinin-mediated angioedema. 

Key Learnings from the Episode:

Acquired angioedema (AAE) is an extremely rare disorder caused by C1 inhibitor deficiency. Patients often have underlying hematologic diseases, making trials complex. Deucrictibant showed strong efficacy and safety in an investigator-initiated trial. All participants became attack-free during treatment, without major adverse events. Off-label access remains a challenge – approved therapies are urgently needed. Future multi-center studies and regulatory approval could transform patient care.

Chapters

00:00 Introduction to Angioedema and Guest Introduction

03:06 Understanding Acquired Angioedema due to C1 Inhibitor Deficiency

06:05 Current Treatment Landscape and Challenges

07:16 Investigator-Initiated Trials and Droycriptiband

11:05 Trial Design and Patient Characteristics

11:52 Promising Results from the Trial

13:06 Key Learnings and Future Directions

15:44 Next Steps in Research and Treatment Approval

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In this episode, Dr. Thomas Buttgereit welcomes Dr. Alexis Bocquet from the French National Center for Angioedema in Grenoble to discuss one of the most challenging forms of drug-induced angioedema — ACE inhibitor–induced angioedema. 

They discuss

🔹 Why are ACE inhibitors among the most prescribed cardiovascular drugs worldwide? 
🔹 How can physicians distinguish bradykinin-mediated from mast-cell-mediated angioedema? 
🔹 What are the key risk factors for developing ACE inhibitor–induced angioedema? 

🔹 How can the new diagnostic core support clinicians in practice? 

Dr. Bocquet shares findings from a French multicenter study conducted in Grenoble and Réunion Island, where he and his colleagues identified four clinical criteria that accurately differentiate ACE inhibitor–induced angioedema from other forms. He also explains the score they developed — a five-point tool that predicts diagnosis with more than 90% accuracy — and offers practical advice on treatment, including when to use icatibant or C1 inhibitor concentrate in acute care. 

Join us for a scientifically rich and practical conversation on how to diagnose and manage one of the most life-threatening but underrecognized types of angioedema. 

Key Learnings from the Epesode: