Angiotensin Converting Enzyme Inhibitor-induced Gastrointestinal Angioedema

Benson, Brian C.; Smith, Carin; Laczek, Jeffrey

doi:10.1097/mcg.0b013e318299c69d

Cited by 30 publications

(31 citation statements)

References 19 publications

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“…A lump in the throat, drooling, stridor and a hoarse voice or aphonia are possible symptoms, when the airways are involved, signalling a severe situation with the need to act immediately and secure the airway (16,22). Abdominal pain might be a rare and sometimes the only sign of ACEi-induced angioedema, since the swellings can be present solely in the abdominal organs, most often the intestines (29,30).…”

Section: Clinical Presentationmentioning

confidence: 98%

Angiotensin-converting Enzyme Inhibitor-induced Angioedema – A Dangerous New Epidemic

Rasmussen

Mey²,

Bygum³

2014

Acta Derm Venerol

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Angioedema is a sudden localised and often asymmetric swelling of the skin or mucous membranes caused by transient increased endothelial permeability causing plasma extravasation. In the last decades the incidence of severe angioedema involving the upper airways and even fatal outcome due to asphyxia has increased. This is mainly due to pharmaceuticals such as angiotensin converting enzyme-inhibitors, which are extensively used worldwide. Some aspects of the pathophysiology have been elucidated and the vasoactive molecule bradykinin is shown to be one of the main causative agents. The diagnosis is often delayed and traditional treatment usually ineffective. Complement C1 inhibitor concentrate and bradykinin receptor antagonists, normally used to treat patients with hereditary angioedema, have shown good results when used in patients with bradykinin-mediated angioedema. This review discusses the disease, prognosis and treatment options.

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Section: Clinical Presentationmentioning

confidence: 98%

Angiotensin-converting Enzyme Inhibitor-induced Angioedema – A Dangerous New Epidemic

Rasmussen

Mey²,

Bygum³

2014

Acta Derm Venerol

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“…Symptoms of ACEi-induced angioedema are usually localized in the face or upper aerodigestive tract; the main characteristic is erythema (without itching) lasting 24–72 h, followed by spontaneous remission [27]. Reports of rare abdominal involvement have been published [28]. ACEi-induced angioedema has been reported as a side effect affecting 0.1–0.7% of patients and up to 1.6% in some studies [29]; a large US study reported an incidence of 0.2% [30].…”

Section: Reviewmentioning

confidence: 99%

Angioedema in the emergency department: a practical guide to differential diagnosis and management

et al. 2017

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BackgroundAngioedema is a common presentation in the emergency department (ED). Airway angioedema can be fatal; therefore, prompt diagnosis and correct treatment are vital.Objective of the reviewBased on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED.ReviewThe most common pathophysiology underlying angioedema is mediated by histamine; however, ED staff must be alert for the less common bradykinin-mediated forms of angioedema. Crucially, bradykinin-mediated angioedema does not respond to the same treatment as histamine-mediated angioedema. Bradykinin-mediated angioedema can result from many causes, including hereditary defects in C1 esterase inhibitor (C1-INH), side effects of angiotensin-converting enzyme inhibitors (ACEis), or acquired deficiency in C1-INH. The increased use of ACEis in recent decades has resulted in more frequent encounters with ACEi-induced angioedema in the ED; however, surveys have shown that many ED staff may not know how to recognize or manage bradykinin-mediated angioedema, and hospitals may not have specific medications or protocols in place.ConclusionED physicians must be aware of the different pathophysiologic pathways that lead to angioedema in order to efficiently and effectively manage these potentially fatal conditions.

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“…Using search terms “intestinal angioedema,” “visceral angioedema,” “ACE‐inhibitor side effects,” and the names of ACE inhibitors such as lisinopril, captopril, enalapril, benazepril, a list of articles were compiled from 1980 to 1 August 2016. Thirty‐four individual reports of ACE inhibitor induced visceral angioedema fit the criteria in question . Signature features to assist in diagnosing ACEi‐induced intestinal type angioedema are denoted in Table and are discussed below.…”

Section: Discussionmentioning

confidence: 99%

“…From the information gathered, there are several trends throughout the case reports. There is a disproportionate number of women affected (85%) compared to men . The age of patients ranged from 26 to 92 years, with the average age being 49.5 years (SD = 15.3) Ethnicity was only reported in 15 cases, nine of which reported the patient being African American .…”

Section: Discussionmentioning

confidence: 99%