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Hypersensitivity reactions to recombinant tissue plasminogen activator
  1. Vafa Alakbarzade1,2,
  2. Declan O’Kane3,
  3. Anthony C Pereira4
  1. 1 Department of Neurology, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2 Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
  3. 3 Department of Neuroscience, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  4. 4 Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Vafa Alakbarzade, Royal Cornwall Hospitals NHS Trust, Truro TR1 3LQ, UK; vafa.alakbarzade.10{at}


Recombinant tissue plasminogen activator (rtPA) is currently the only approved thrombolytic agent for treating acute ischaemic stroke that is widely used in clinical practice. However, it may cause haemorrhage and hypersensitivity reactions. Orolingual angioedema is an infrequent, usually mild but potentially life threatening, hypersensitivity reaction to rtPA. Our understanding of the basic biology of angioedema has increased in recent years. There is growing evidence that rtPA-induced orolingual angioedema is driven mainly by bradykinin generation rather than it being an anaphylactic response. Monitoring is important because orolingual angioedema may evolve and compromise airways and a small number do have angioedema as part of systemic anaphylaxis. There are no published guidelines for treating rtPA-induced orolingual angioedema, although some evidence suggests that those refractory to standard antianaphylactic agents may resolve with bradykinin B2 receptor antagonists. It is important that responses to orolingual angioedema are proportionate and that patients are closely monitored.

  • orolingual angioedema
  • hypersensitivity reactions
  • recombinant tissue plasminogen activator
  • acute ischemic stroke
  • bradykinin
  • b2-receptor antagonists

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  • Contributors VA and DO wrote the manuscript; ACP reviewed, edited and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned. Externally peer reviewed by Joe Unsworth, Bristol, UK.