The role of ace gene polymorphism in the development of angioedema secondary to angiotensin converting enzyme inhibitors and angiotensin II receptor blockers

Güleç, Mustafa; Çalışkaner, Zafer; Tunca, Yusuf; Öztürk, Sami; Bozoğlu, Ergün; Gül, Davut; Erel, Fuat; Özgür, Kemal; Karaayvaz, Mehmet

doi:10.1016/s0301-0546(08)72537-0

Cited by 25 publications

(15 citation statements)

References 32 publications

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“…In Chinese patients there is evidence that genetic polymorphism is associated with a structural alteration in ACE [19]. However, recent data showed no relationship between ACE gene polymorphism and the occurrence of angioedema with ACE and ARB [20]. One study analyzed the metabolism of endogenous bradikinin (B2 receptor agonist) and its active metabolite, des-Arg9-Bradikinin (B1 receptor agonist) in the presence of an ACE-inhibitor during in vitro contact activation of plasma from hypertensive patients who presented angioedema and these kinetic parameters were compared with those measured in a control group (without angioedema) of hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Allergic reaction related to ramipril use: a case report

Alencar¹,

Cobas²,

Gomes³

2010

Diabetol Metab Syndr

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BackgroundAngiotensin-converting enzyme (ACE) inhibitors are widely prescribed for patients with diabetes as a nephroprotector drug or to treat hypertension. Generally they are safe for clinical practice, but the relationship between these drugs and angioedema is known. The exact mechanism for ACE inhibitors-induced angioedema is not clear and it is still a matter of discussion.Case ReportWe reported a case of a 23-year-old black female with an 11 year history of type 1 diabetes, regularly monitored in the department of diabetes, in use of 0,98 UI/kg/day of human insulin, which presented an allergic reaction 24 h after ramipril use. The drug had been prescribed to treat diabetic nephropathy. There was no previous history of drug induced or alimentary allergy. The patient was instructed to discontinue the use of ramipril and oral antihistaminic drug and topical corticosteroid were prescribed. Skin biopsies were performed and confirmed the clinical hypothesis of pharmacodermy. The evaluation of ACE polymorphism identified DD genotype. Six months after the withdrawal of ramipril the patient was prescribed the angiotensin-II receptor blocker (ARB) losartan as nephroprotector. She remained well without adverse reactions.ConclusionsACE inhibitors-induced angioedema is uncommon and the clinical presentation is variable with lips, tongue, oropharinge, and larynge as the most common locations. The presence of angioedema during treatment requires the immediate cessation of treatment due to the risk of possible severe complications. The case reported presented moderate symptoms, with the development of early onset edema in uncommon regions. ACE DD genotype had been associated with angioedema-ACE inhibitors induced. In patients who have experienced ACE inhibitor-related angioedema, ARB should be used cautiously used. However in the case of our patient, the prescription of losartan as nefroprotector did not result in any recurrent adverse effect.

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Section: Discussionmentioning

confidence: 99%

Allergic reaction related to ramipril use: a case report

Alencar¹,

Cobas²,

Gomes³

2010

Diabetol Metab Syndr

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“…ACEİ'e bağlı gelişen anjioödemde dudaklar, dil, yüz ve üst solunum yolu daha sık etkilenir. Bununla birlikte nadir de olsa intestinal anjioödem gelişimine de neden olabilmektedirler (6). Direk kinin üzerine etkileri olmamasına rağmen ARB de intestinal anjioödemle ilişkili bulunmuştur (7).…”

Section: Discussionunclassified

“Abdominal pain” due to angiotensin converting enzyme inhibitor and angiotensin receptor blocker treatment

Arslan¹,

Uçar²,

Uçar³

et al. 2016

Van Med J

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ÖZETAmaç: Anjiotensin konverting enzim inhibitörleri (ACEİ) ve anjiotensin reseptör blokerleri (ARB) hipertansiyon tedavisinde ilk sırada reçete edilen ilaçlar arasındadır. Bu grup ilaçların farkındalık düzeyi düşük bir yan etkisi de; intestinal ödeme bağlı olarak ortaya çıkan karın ağrısı ataklarıdır. Bu advers etki ile ilgili yayınlar olgu sunumu ve literatür taramaları şeklindedir. Gereç ve Yöntem: Necmettin Erbakan ÜniversitesiMeram Tıp Fakültesi etik kurulundan onay alınarak, aynı hastanenin iç hastalıkları polikliniklerine herhangi bir şikayetle müracaat etmiş 8736 hastadan hipertansiyon endikasyonu ile ACEİ ve ARB kullanmakta olduğu tespit edilen 1010 hasta çalışmaya dahil edildi. Hastaların bu ilaçları kullanmaya başladıktan sonra oluşan dil-dudakta şişlik, öksürük ve karın ağrısı semptomları sorgulandı. Karın ağrısı şikayeti olup herhangi bir patoloji saptanamayan hastalar, çalışmanın hedefini oluşturacak grup olarak belirlendi. Abdominal pain due to intestinal edema is another adverse effect which is not well recognized and so with lower levels of awareness. Data about this adverse effect is insufficient and limited with case reports. Materials and Methods:This study was approved by the Local Ethics Committee conducted at Meram Faculty of Medicine, Necmettin Erbakan University. A total of 8736 patients were evaluated who were admitted to outpatient clinic of internal medicine, Meram Faculty of Medicine. A total of 1010 patients were included in the study who were on ACEI or ARB therapy. The new symptoms of angioedema on lips and tongue, cough and abdominal pain were questioned after usage of these drugs. The patients with abdominal pain but without any pathology were selected as the study group.Results: 650 (64.3%) of the patients were female and 360 (35.6%) of them were male. The mean age was 52±8.02. 553 (55.3%) of patients were on ARB and 447 (44.7%) of them were on ACEI therapy. The mean duration of drug usage was 60±7.4 months for ACEI and 56±8 months for ARB. A total of 12 patients (ACEI=7, ARB=5) were found with abdominal pain. Conclusion:Abdominal pain due to intestinal angioedema may be seen during ACEI and/or ARB usage. The gastrointestinal adverse effects of these drugs may be better recognized by physicians as the level of awareness as increased.

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“…[96][97][98] One of these studies reported a 50% lower ACE activity in ACEi-A cases compared to controls taking the same drug, and independent of the presence of the insertion/deletion variation 98 and, the two other studies failed to replicate this finding. 96,97 No other variants in ACE gene have been studied in association with ACE-A. The only GWAS also did not find any significant associations with variants in this gene.…”

Section: Ace Genementioning

confidence: 99%

Pharmacogenetics of angiotensin‐converting enzyme inhibitor‐induced angioedema

Liau

Chua

Kennedy

et al. 2019

Clin Experimental Allergy

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Angioedema is a rare adverse effect of the commonly used angiotensin-converting enzyme inhibitors (ACEi) and is reported to occur with a prevalence of 0.1%-0.7%.Although most ACEi-induced angioedema (ACEi-A) cases are mild, severe cases requiring intensive care and even resulting in death have been reported in the literature. The mechanisms underlying ACEi-A are not yet fully understood, but bradyki-

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The role of ace gene polymorphism in the development of angioedema secondary to angiotensin converting enzyme inhibitors and angiotensin II receptor blockers

Abstract: Our results showed that ACE gene polymorphism has no effect on ACEi or ATRB induced angioedema.

Cited by 25 publications

References 32 publications

Allergic reaction related to ramipril use: a case report

Allergic reaction related to ramipril use: a case report

“Abdominal pain” due to angiotensin converting enzyme inhibitor and angiotensin receptor blocker treatment

Pharmacogenetics of angiotensin‐converting enzyme inhibitor‐induced angioedema

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