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Hereditary Angio-Oedema Dental — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementHereditary Angio-Oedema DentalORE Part 1

A patient with hereditary angio-oedema caused by C1-esterase inhibitor deficiency is booked for a surgical dental extraction under local anaesthesia. Which pre-operative plan is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange C1-esterase inhibitor prophylaxis with the specialist team because upper-airway oedema may follow the procedure

The correct answer is A. Trauma and stress from dental extraction can trigger hereditary angio-oedema (HAE-C1-INH), including potentially fatal oropharyngeal or laryngeal oedema. Current NHS England guidance states that these patients are eligible for pre-procedure prophylaxis with C1-esterase inhibitor before dental procedures, within specialist immunology care. Antihistamines and adrenaline are treatments for histamine-mediated allergic reactions; HAE-C1-INH is bradykinin-mediated and responds poorly to them. Tranexamic acid does not address the immediate extraction-triggered airway risk and is not the appropriate procedural prophylaxis. Local anaesthesia and necessary dental care are not contraindicated, but treatment should be planned with the patient’s HAE specialist and appropriate prophylaxis/rescue arrangements.

Reference: NHS England. Commissioned treatment options for patients with hereditary angioedema secondary to C1 esterase inhibitor deficiency, section “Pre-procedure prophylaxis”, April 2026. https://www.england.nhs.uk/wp-content/uploads/2026/04/commissioned-treatment-options-for-patients-with-hereditary-angioedema-secondary-to-c1-esterase-inhibitor-deficiency-algorithm.pdf