Icatibant rapidly relieves acute hereditary angioedema attacks in pediatric patients, showing favorable safety and feasibility

Hereditary angioedema (HAE) is a rare, life-threatening genetic disorder characterized by recurrent episodes of severe tissue swelling. It is a bradykinin-mediated condition, where uncontrolled bradykinin production leads to increased vascular permeability. Pediatric patients with HAE face limited treatment options, and comparative evidence for existing therapies is scarce. Icatibant, a synthetic peptidomimetic, functions as a selective bradykinin B2 receptor antagonist, blocking the action of bradykinin and thereby reducing swelling. This mechanism offers a targeted approach to managing acute HAE attacks, addressing a critical unmet need in children.

This systematized review synthesized clinical evidence on the efficacy and safety of icatibant for acute HAE attacks in pediatric patients (0-17 years). A comprehensive literature search was conducted across medical databases, clinical trial registries, and key journals through January 2026. The primary outcome assessed was the time to onset of symptom relief. Secondary outcomes included time to minimum symptoms, pain scores, adverse events, and feasibility of self- or caregiver administration. The review identified three open-label, phase III clinical studies, collectively involving 43 pediatric patients. Due to heterogeneous designs and outcome definitions across these nonrandomized, single-arm trials, a formal meta-analysis was not performed, and all studies were descriptively evaluated.

Icatibant demonstrated rapid and effective symptom relief for acute HAE attacks in pediatric patients. The median time to onset of symptom relief was approximately ~1 hour, with patients reaching minimum symptoms within 2 hours. While repeated dosing showed some variability, the overall response was consistent. > Icatibant was well tolerated across all reviewed studies, with injection-site reactions being the most common adverse events, reported in a significant proportion of patients but generally mild and transient. Crucially, no serious treatment-related adverse events were observed. The review also highlighted the practical benefit of icatibant, confirming that self- or caregiver administration was feasible and effective, particularly in adolescents. This supports its utility as an accessible treatment option for acute attacks in a home setting.