Life-threatening angio-oedema after the first dose of an ACE inhibitor—not an anaphylactic reaction

Nielsen, Troels Krogh; Bygum, Anette; Rasmussen, Eva Rye

doi:10.1136/bcr-2016-214364

Cited by 6 publications

(10 citation statements)

References 18 publications

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“…Acquired angioedema related to the use of an ACE inhibitor can present even after a single dose. A 60-year-old woman was reported to have presented with swollen tongue and face with impending airway obstruction [13] having taken a single dose the day before. No other signs of anaphylaxis were present.…”

Section: Discussionmentioning

confidence: 99%

Management of acute tongue swelling

Min¹,

Mohammad²,

Vallamkondu³

et al. 2020

Heighpubs Otolaryngol Rhinol

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Acute tongue swelling can present as an upper airway obstruction. There are a number of pathologies which potentially can cause tongue swelling include angioedema, anaphylaxis, drug rash with eosinophilia and systemic symptom (DRESS) syndrome, local allergic reaction, trauma resulting in tongue haematoma or lingual abscess, viral infections (herpes simplex virus, herpes zoster virus, Coxsackie virus), bacterial infection, foreign body and neoplasia. Aim To present a case series of patients presenting with an acute tongue swelling sharing our experience in managing these patients.

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Section: Discussionmentioning

confidence: 99%

Management of acute tongue swelling

Min¹,

Mohammad²,

Vallamkondu³

et al. 2020

Heighpubs Otolaryngol Rhinol

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“…Angioedema can develop within a few minutes, blocking the respiratory tract. This requires emergency treatment including intubation or in very severe cases, acute tracheotomy[7].…”

Section: Introductionmentioning

confidence: 99%

Genetic susceptibility to angiotensin-converting enzyme-inhibitor induced angioedema: A systematic review and evaluation of methodological approaches

Ali

Lomholt²,

Mahmoudpour

et al. 2019

PLoS ONE

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Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II which causes vasoconstriction. ACE inhibitors reduce blood pressure by inhibiting ACE. A well-known adverse drug reaction to ACE inhibitors is ACE inhibitor-induced angioedema (ACEi-AE). Angioedema is a swelling of skin and mucosa, which can be fatal if the airway is compromised. We have performed a systematic review of the evidence suggesting that genetic polymorphisms are associated with ACEi-AE and evaluated the methodological approaches of the included studies. The Cochrane Database of Systematic Reviews, Google Scholar, and PubMed were searched. Studies investigating the association between genetic markers and ACEi-AE were included. The Q-genie tool was used to evaluate the quality of the study methodologies. Seven studies were included. With the exception of one whole genome study, all of the included studies were candidate gene association studies. Study quality assessment scores ranged from 36 to 55. One study was found to be of good quality, suggesting that the detected associations may be unreliable. The inferior quality of some studies was due to poor organization, lack of analyses and missing information. Polymorphisms within XPEPNP2, BDKRB2–9/+ 9 and neprilysin genes, were reported to be associated with increased risk of ACEi-AE. However, due to low quality, these associations need to be confirmed in larger studies.

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“…The late onset as well as variable clinical pattern of ACEI-AE can be confusing for both patients and medical professionals, who should take into consideration the potential role of risk factors and triggers (22). Depending on associated risk factors or concomitant diseases and medications, patients may have an increased risk for severe forms, even fatal angioedema due to laryngeal edema (23). This life-threatening reaction is possible even after the first dose of an ACEI, with higher risk in female patients and in African-American population (24).…”

Section: Discussionmentioning

confidence: 99%

Acquired angioedema induced by angiotensin‑converting enzyme inhibitors ‑ experience of a hospital‑based allergy center

et al. 2020

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Angiotensin-converting enzyme inhibitors (ACEIs) represent an important group of pharmacological compounds, largely prescribed for more than 30 years. They have been extensively evaluated in clinical trials, demonstrating significant reduction of morbidity and mortality of patients with cardiovascular diseases, mainly high blood pressure, myocardial infarction, heart failure and stroke. Besides their beneficial effects and a general good safety profile, it was proven that ACEIs might also induce adverse effects in some patients, most notably angioedema (AE) and chronic cough. The occurrence rate of adverse events induced by ACEIs is low, but the number of suffering patients is relatively high, since ACEIs is one of the most frequently prescribed medication worldwide. The aim of our study was to evaluate clinical pattern, risk factors and general management of ACEI-induced angioedema in a cohort of patients addressed for allergist evaluation in one university hospital in Romania, during a period of 32 months. It was found that ACEI-induced angioedema (ACEI-AE) represented more than half of the total number of patients addressed for angioedema without urticaria, with variable clinical and time-patterns. Most of the patients were referred by general practitioners (GPs) with diagnosis of urticaria or other skin allergy and continued to take ACEIs for months and years after onset of angioedema. We concluded that the awareness of acquired, non-allergic angioedema induced by ACEI therapy in medical practice is still low and there is a need for improved knowledge and interdisciplinary collaboration in this field.

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Life-threatening angio-oedema after the first dose of an ACE inhibitor—not an anaphylactic reaction

Cited by 6 publications

References 18 publications

Management of acute tongue swelling

Management of acute tongue swelling

Genetic susceptibility to angiotensin-converting enzyme-inhibitor induced angioedema: A systematic review and evaluation of methodological approaches

Acquired angioedema induced by angiotensin‑converting enzyme inhibitors ‑ experience of a hospital‑based allergy center

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