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SELECTED ARTICLES FROM THE RECENT LITERATURE 2006
10/31/06
Treatment of ACE inhibitor induced angioedema
Summary
Background - Angioedema reactions occur in less than 1% of those treated with angiotensin-converting enzyme (ACE) inhibitor agents. Such reactions, sometimes life-threatening, are usually not controlled impressively by antihistamines, epinephrine or corticosteroids
Findings - Nielsen and Gramstad of the Nordland Hospital in Tromco, Norway described a case of ACE-inhibitor induced angioedema involving the laryngeal mucosa and tongue in a 61 year old woman who had taken ramipril daily for the previous 7 years. Her swellings increased despite treatment with injected epinephrine, hydrocortisone and an antihistamine. Then a C1 INH concentrate (Beninert, 1500 units) was injected IV.
Within 20 minutes, the patient's stridor decreased and she could talk normally.
Reference
Acta Anethesiol Scand 2006;50:120-22
Editor's Comments
Although this is a single case report, I have reviewed it because the findings may be teaching us something about the pathogenesis of ACE inhibitor-induced angioedema. Such angioedema is thought to involve increased levels of bradykinin since ACE is also a kininase. However, unlike hereditary angioedema C1 INH protein levels and function are not decreased in ACE inhibitor-induced angioedema. Then why should infusion of C1 INH concentrate control ACE inhibitor- induced angioedema? For that matter, why does the angioedema occur in <1% of ACE-inhibitor treated individuals, sometimes only after year or so of such treatment?
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