The Definition, Acronyms, Nomenclature, and Classification of Angioedema: AAAAI, ACAAI, ACARE, and APAACI DANCE Consensus

https://www.sciencedirect.com/science/article/abs/pii/S009167492400407X

Journal of Allergy and Clinical Immunology, Available online 25 April 2024

Avner Reshef, Thomas Buttgereit, Stephen D. Betschel, Teresa Caballero, Henriette Farkas, Anete S. Grumach, Michihiro Hide, Ankur K. Jindal, Hilary Longhurst, Jonathan Peter, Marc A. Riedl, Yuxiang Zhi, Werner Aberer, Mohamed Abuzakouk, Tariq Al Farsi, Nashat Al Sukaiti, Mona Al-Ahmad, Sabine Altrichter, Emel Aygören-Pürsün, Maria Luisa Baeza, Noemi Anna Bara, Andrea Bauer, Jonathan A. Bernstein, Isabelle Boccon-Gibod, Hanna Bonnekoh, Laurence Bouillet, Zenon Brzoza, Anette Bygum, Oscar Calderon, Regis de Albuquerque Campos, Freya Helena Campos Romero, Mauro Cancian, Herberto Jose Chong-Neto, George Christoff, Stefan Cimbollek, Danny M. Cohn, Timothy Craig, Inna Danilycheva, Razvigor Darlenski, Aurélie Du-Thanh, Luis Felipe Ensina, Daria Fomina, Luz Fonacier, Atsushi Fukunaga, Asli Gelincik, Pedro Giavina-Bianchi, Kiran Godse, Mark Gompels, Margarida Goncalo, Maia Gotua, Guillermo Guidos-Fogelbach, Mar Guilarte, Alicja Kasperska-Zajac, Constance H. Katelaris, Tamar Kinaciyan, Pavel Kolkhir, Kanokvalai Kulthanan, Marcin Kurowski, Elena Latysheva, Antti Lauerma, David Launay, Ramon Lleonhart, William Lumry, Alejandro Malbran, Ramzy Mohammed Ali, Iman Nasr, Sandra Nieto-Martinez, Claudio Parisi, Ruby Pawankar, Macarena Piñero-Saavedra, Todor A. Popov, Grzegorz Porebski, Alicia Prieto Garcia, Polina Pyatilova, Michael Rudenko, Bulent Enis Sekerel, Faradiba Sarquis Serpa, Farrukh Sheikh, Frank Siebenhaar, Angèle Soria, Maria Staevska, Petra Staubach, Marcin Stobiecki, Simon Francis Thomsen, Massimo Triggiani, Anna Valerieva, Solange Valle, Nguyen Van Dinh, Carolina Elisa Vera Ayala, Anna Zalewska-Janowska, Andrea Zanichelli, Markus Magerl, Marcus Maurer

Abstract

Background

Angioedema (AE) manifests with intermittent, localized, self-limiting swelling of the subcutaneous and/or submucosal tissue. AE is heterogeneous, can be hereditary or acquired, occurs only once or be recurrent, with or without wheals, due to mast cell mediators, bradykinin or other mechanisms. Currently, different taxonomic systems are used, making it difficult to compare the results of studies, develop multicenter collaboration, and harmonize treatments of AE patients.

Objective

To develop a consensus on the definition, acronyms, nomenclature, and classification of angioedema (DANCE).

Methods

The initiative involved 91 experts from 35 countries and was endorsed by 53 scientific, medical societies, and patient organizations. A consensus was reached by online discussion and voting using the Delphi process over a period of 16 months (June 2021 to November 2022).

Results

The DANCE initiative resulted in an international consensus on the definition, classification and terminology of AE. The new consensus classification features five types and endotypes of AE and a harmonized vocabulary of abbreviations and acronyms.

Conclusion

The DANCE classification complements current clinical guidelines and expert consensus recommendations on the diagnostic workup and treatment of AE. DANCE does not replace current clinical guidelines and expert consensus algorithms and should not be misconstrued in a way that affects reimbursement of medicines prescribed by a physician using sound clinical judgment. We anticipate that the new AE taxonomy and nomenclature will harmonize and facilitate AE research and clinical studies, thereby improving patient care.

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