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Angioedema Due to ACE Inhibitors

  • Urticaria and Atopic Dermatitis (M Ferrer-Puga, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Opinion statement

Angiotensin-converting enzyme inhibitors (ACEIs) are widely used for treatment of hypertension, congestive heart failure, and cardiovascular and renal protection in patients with heart failure, among others. Angioedema is a rare but potentially fatal adverse event (ACEI-AAE), whose prevalence is under 0.5 % among patients taking ACEIs and is higher among African Americans and female patients. There is no biomarker that allows diagnosis of ACEI-AAE, and the diagnosis is based on clinical history and the intake of ACEIs. Differential diagnosis with other causes of edema/angioedema must be considered. Recent classifications of angioedema can be of great help in the diagnosis process. The management of ACEI-induced angioedema involves the withdrawal of the causative drug and the treatment of the acute angioedema with different off-label drugs (icatibant, plasma-derived human C1 inhibitor protein). This manuscript will review the epidemiology, pathophysiology, genetics, clinical symptoms, diagnosis, and treatment of ACEI-AAE.

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Abbreviations

AE:

Angioedema

AAE:

Acquired angioedema

ACE:

Angiotensin-converting enzyme

ACEI:

Angiotensin-converting enzyme inhibitor

ACEI-AAE:

Acquired angioedema related to angiotensin-converting enzyme inhibitor intake

APP:

Aminopeptidase P

ARB:

Angiotensin receptor blocker

BK:

Bradykinin

CPN:

Carboxypeptidase N

DPPIV:

Dipeptidyl peptidase IV

DRI:

Direct renin inhibitors

ICU:

Intensive care unit

NEP:

Neprilysin

NK1:

Neurokinin 1

NSAIDs:

Non-steroidal anti-inflammatory drugs

RAAS:

Renin–angiotensin–aldosterone system

RB1:

Bradykinin receptor type I

RB2:

Bradykinin receptor type II

SNP:

Single nucleotide polymorphism

SP:

Substance P

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Hospital La Paz Institute for Health Research (IdiPaz), Madrid, Spain

    Teresa Caballero M.D., Ph.D. & María Pedrosa M.D., Ph.D.

  2. Biomedical Research Network on Rare Diseases (CIBERER, U754), Madrid, Spain

    Teresa Caballero M.D., Ph.D.

  3. Servicio de Alergia, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Teresa Caballero M.D., Ph.D. & María Pedrosa M.D., Ph.D.

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  1. Teresa Caballero M.D., Ph.D.
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Dr. María Pedrosa reports personal fees from Shire HGT and CSL-Behring and was a subinvestigator in clinical trials for CSL-Behring and Shire HGT, outside the submitted work. Dr. Teresa Caballero reports speaking, consulting, and funding for meeting attendance from Shire HGT, CSL-Behring, and Novartis. She also reports funding for manuscript writing from Shire HGT and CSL Behring, and she was the principal investigator in clinical trials for Shire HGT and CSL Behring.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Urticaria and Atopic Dermatitis

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Caballero, T., Pedrosa, M. Angioedema Due to ACE Inhibitors. Curr Treat Options Allergy 3, 401–415 (2016). https://doi.org/10.1007/s40521-016-0099-8

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  • DOI: https://doi.org/10.1007/s40521-016-0099-8

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