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An Osteopathic Approach to Hereditary Angioedema Attacks with Predominant Gastrointestinal Features and Concomitant Back Pain: A Case Report
Rowane, M. J. [3]
Petro, J. [1]
Shilian, R. [3]
Rajan, J. [2]
Rowane, M. P [7]
Hostoffer, R. W. [7]

Journal: The AAO Journal Date: 2026/03, 36(1):Pages: 22–28. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/36/1/article-p22.xml)

Keywords:

abdominal pain [21]
angioedema [2]
back pain [597]
case report [708]
male [767]
OMT [3751]
osteopathic manipulative treatment [3771]

Abstract:

Acute back and abdominal pain are among the most common symptoms managed by various Osteopathic Manipulative Treatment (OMT) techniques. Severe abdominal pain with concomitant back pain can derive from the broad spectrum of episodic mucosal surface edema involved in bradykinin-mediated angioedema disorders, including C1q esterase inhibitor (C1-INH) deficiency. The management of C1-INH deficiency, also known as hereditary angioedema (HAE)., traditionally involves on-demand therapy to treat acute attacks, short-term prophylaxis before exposure to known triggers of attacks, and consideration of long-term prophylaxis to prevent future attacks. Although HAE has not been specifically addressed in the osteopathic literature, the acute lymphatic congestion in this edematous disease states may be amenable to OMT. We describe the first reported case of abdominal angioedema episodes with back pain resolved with OMT in our patient with HAE. Our patient is a 53-year-old male, with known diagnosis of HAE, who presented with a 5-week history of severe gastrointestinal angioedema and back pain. He re-presented 3 months later with a 24-hour history of the same symptoms. During both encounters, our patient was treated with myofascial release (MFR) and high-velocity-low-amplitude (HVLA) for thoracic somatic dysfunction. During his subsequent encounter, MFR and HVLA were also applied to lumbar somatic dysfunction, followed by counterstrain and soft tissue for cervicothoracic somatic dysfunction of his right shoulder. After both OMT encounters, our patient reported symptomatic relief of abdominal angioedema and back pain within 24 hours, a decreased symptom duration compared to his typical episodes. Our patient remained without recurrent gastrointestinal angioedema attack for 4 years thereafter, prior to recent follow-up after a recurrent episode. An osteopathic structural clinical examination on recent follow-up specified segmental and somatic dysfunction at our patient’s baseline, asymptomatic state. OMT provides a rapid, non-invasive approach to reduce angioedema exacerbations, by targeting the sequelae of C1-INH deficiency and dysregulated bradykinin that characterizes HAE attacks. The successful OMT application in the present case suggests that it may complement pharmacotherapies designed to reduce the frequency and severity of acute attacks. Further research is needed to investigate the efficacy of OMT for acute HAE exacerbations in more patients and with other OMT techniques.

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