Life-threatening angioedema induced by angiotensin-converting enzyme inhibitor: two case reports
Abstract
Background. Angioedema is a rare but potentially very serious complication of treatment with angiotensin converting enzyme inhibitors (ACEI). Angioedema is due to the accumulation of bradykinin, because angiotensin converting enzyme is the key enzyme for its degradation.
Case reports. We present two patients with life-threatening angioedema while taking ACEI. Both patients had already had episodes of angioedema. Angioedema didn't respond to adrenaline. In both patients intubation was difficult.
Conclusion. In the acute phase of angioedema due to ACEI it is necessary to protect the airways. Bradykinin receptor inhibitors shorten the duration of episodes of angioedema. In the long term it is essential to permanently avoid ACEI.
Downloads
References
Kaplan AP, Greaves MW. Angioedema. J Am Acad Dermatol. 2005; 53: 373-88.
Kostis JB1, Packer M, Black HR, Schmieder R, Henry D, Levy E. Omapatrilat and enalapril in patients with hypertension: the Omapatrilat Cardiovascular Treatment vs. Enalapril (OCTAVE) trial. Am J Hypertens. 2004; 17: 103-11.
Miller DR, Oliveria SA, Berlowitz DR, Fincke BG, Stang P, Lillienfeld DE. Angioedema incidence in US veterans initiating angiotensin-converting enzyme inhibitors. Hypertension. 2008; 51: 1624-30.
Stauber T, Confino-Cohen R, Goldberg A. Life-threatening angioedema induced by angiotensin-converting enzyme inhibitors: characteristics and risk factors. Am J Rhinol Allergy. 2014; 28: 54-8.
Sondhi D, Lippmann M, Murali G. Airway compromise due to angiotensin-converting enzyme inhibitor-induced angioedema: clinical experience at a large community teaching hospital. Chest. 2004; 126: 400-4.
Al-Khudari S, Loochtan MJ, Peterson E, Yaremchuk KL. Management of angiotensin-converting enzyme inhibitor-induced angioedema. Laryngoscope. 2011; 121: 2327-34.
Zingale LC, Beltrami L, Zanichelli A, Maggioni L, Pappalardo E, Cicardi B, et al. Angioedema without urticaria: a large clinical survey. CMAJ. 2006; 175: 1065-70.
Campo P, Fernandez TD, Cantoc G, Mayorgaa C. Angioedema induced by angiotensin-converting enzyme inhibitors. Curr Opin Allergy Clin Immunol. 2013; 13: 337-44.
Brown NJ, Byiers S, Carr D, Maldonado M, Warner BA. Dipeptidyl peptidase-IV inhibitor use associated with increased risk of ACE inhibitor-associated angioedema. Hypertension. 2009; 54: 516-23.
Mahmoudpour SH, Leusink M, van der Putten L, Terreehorst I, Asselbergs FW, de Boer A, et al. Pharmacogenetics of ACE inhibitor-induced angioedema and cough: a systematic review and meta-analysis. Pharmacogenomics. 2013; 14: 249-60.
Hoover T, Lippmann M, Grouzmann E, Marceau F, Herscu P. Angiotensin converting enzyme inhibitor induced angio-oedema: a review of the pathophysiology and risk factors. Clin Exp Allergy. 2010; 40: 50-61.
Banerji A, Oren E, Hesterberg P, Hsu Y, Camargo CA, Wong JT. Ten-year study of causes of moderate to severe angioedema seen by an inpatient allergy/immunology consult service. Allergy Asthma Proc. 2008; 29: 88-92.
Sarkar P, Nicholson G, Hall G. Brief review: angiotensin converting enzyme inhibitors and angioedema: anesthetic implications. Can J Anesth. 2006; 53: 994-1003.
Smet BS, De Kock I, De Backer AI, Verstraete K. Angioedema of the small bowel caused by angiotensin converting enzyme inhibitor. JBR–BTR. 2013; 96: 41.
Chase MP1, Fiarman GS, Scholz FJ, MacDermott RP. Angioedema of the small bowel due to an angiotensin-converting enzyme inhibitor. J Clin Gastroenterol. 2000; 31: 254-7.
Dean DE, Schultz DL, Powers RH. Asphyxia due to angiotensin converting enzyme (ACE) inhibitor mediated angioedema of the tongue during the treatment of hypertensive heart disease. J Forensic Sci. 2001; 46: 1239-43.
Baş M, Greve J, Stelter K, Havel M, Strassen U, Rotter N, et al. A randomized trial of icatibant in ACE-inhibitor-induced angioedema. N Engl J Med. 2015; 372: 418-25.
Brown NJ, Snowden M, Griffin MR. Recurrent angiotensin-converting enzyme inhibitor-associated angioedema. J Am Med Assoc. 1997; 278: 232-3.
Caldeira D, David C, Sampaio C. Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors: a systematic review and meta-analysis. Am J Cardiovasc Drugs. 2012; 12: 263-77.
Malde P, Regalado D, Greenberger PA. Investigation of angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Ann Allergy Asthma Immunol. 2007; 98: 57-63.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.