Allergy Asthma Immunol Res.  2010 Jul;2(3):195-198. 10.4168/aair.2010.2.3.195.

Angiotensin-Converting Enzyme Inhibitors and Angioedema

• Sanchez-Borges M
• Gonzalez-Aveledo LA

• KMID: 2133808
• DOI: http://doi.org/10.4168/aair.2010.2.3.195

Abstract

PURPOSE
To investigate the incidence and clinical characteristics of angioedema associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) in an outpatient allergy department.
METHODS
A retrospective review of medical records of new patients seen in an allergy clinic. Demographic and clinical data of patients with ACEI-induced angioedema were analyzed.
RESULTS
Nine (0.37%) out of 2,421 new patients attending the allergy clinic developed ACEI-associated angioedema. Enalapril was the drug most frequently incriminated. The onset of the angioedema was as early as after the first dose or as late as 2 years after beginning treatment. Six patients experienced life-threatening angioedema involving the tongue, oropharynx, or larynx, and two patients required transfer to the intensive care unit. One patient required a tracheostomy.
CONCLUSIONS
Angiotensin-converting enzyme inhibitor treatment is often responsible for angioedema, especially involving the upper airways. Due to the high proportion of the population exposed to ACEIs and to the severity of this adverse effect, it is important that physicians consider ACEIs as possible inducers when evaluating patients with acute or recurrent angioedema.

Keyword

Angiotensin-converting enzyme inhibitors; angioedema; bradykinin; captopril; enalapril

MeSH Terms

Angioedema
Angiotensin-Converting Enzyme Inhibitors
Bradykinin
Captopril
Cinnarizine
Enalapril
Humans
Hypersensitivity
Incidence
Intensive Care Units
Larynx
Medical Records
Oropharynx
Outpatients
Retrospective Studies
Tongue
Tracheostomy
Angiotensin-Converting Enzyme Inhibitors
Bradykinin
Captopril
Cinnarizine
Enalapril

Figure

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  Fig. 1 (A) A male, 51 years old black patient who experienced diffuse facial and lip angioedema during treatment with enalapril. (B) The same patient as in (A). Notice angioedema resolution after 6 days of enalapril discontinuation.

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