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We read with interest the scholarly review on hereditary angioedema by Nzeako et al.¹ However, the authors do not mention the association of Turner syndrome with angioedema. Fletcher and Weetman² have reported a patient with Turner syndrome and hereditary type II angioedema. She had marked worsening of angioedema attacks when she received estrogen replacement to attain necessary physiologic levels. Therefore, estrogen treatment, even at physiologic replacement doses, worsens attacks of hereditary angioedema in estrogen-deficient patients. Also, attacks of angioedema may be precipitated by hypogonadism or antiandrogen treatment.³

Ajit Singh Kashyap, MD; Surekha Kashyap, MD
Pune, India

1. Nzeako UC, Frigas E, Tremaine WJ. Hereditary angioedema: a broad review for clinicians. Arch Intern Med. 2001;161:2417-2429. FREE FULL TEXT 2. Fletcher A, Weetman AP. Coexistence of hereditary angioedema and Turner's syndrome. Postgrad Med J. 1998;74:41-42. FREE FULL TEXT 3. Pichler W, Lehner R, Spath PJ. Recurrent angioedema associated with hypogonadism or anti-androgen therapy. Ann Allergy. 1989;63:301-305. PUBMED

In reply

We appreciate and welcome the comments of Drs Kashyap. Based on the pathophysiologic and therapeutic principles provided in our review,¹ and the series of 6 cases reported by Pichler et al,² antiandrogen use should be avoided in individuals with hereditary angioedema, particularly when therapeutic alternatives are available. The case report of type . . . [Full Text of this Article]

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