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Angioneurotische Ödeme des Kopf-Hals-Bereiches unter der Therapie mit ACE-Hemmern

Katamnestische Studie 1988 bis 2001

Angioneurotic edema of the head and neck in association with ACE inhibitors

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Zusammenfassung

Hintergrund

ACE-Hemmer sind mögliche Auslöser für angioneurotische Ödeme. Im HNO-Fach ist bisher wenig über Häufigkeit, Rezidivrisiko und klinische Bedeutung von ACE-Hemmer-assoziierten Angioödemen bekannt.

Patienten und Methoden

Die Krankenunterlagen aller im Zeitraum vom 01.01.1988–31.12.2001 in der HNO-Klinik des Lukaskrankenhauses Neuss wegen eines akuten Angioödems behandelten Patienten wurden ausgewertet. Die so gewonnenen Daten wurden mit einer standarisierten Nachbefragung der betroffenen Patienten sowie einer Kontrollgruppe ergänzt.

Ergebnisse

Insgesamt wurden im genannten Zeitraum 121 Patienten mit akuten Angioödemen im Kopf-Hals-Bereich behandelt. Dabei stellten die ACE-Hemmer-assoziierten Angioödeme mit 28,1% die größte Gruppe. Die Häufigkeit aller Angioödeme und der Anteil unter ACE-Hemmer-Therapie nahmen im Beobachtungszeitraum zu. Bei Langzeitbehandlung mit ACE-Hemmern beobachteten wir Latenzzeiten bis zu 13 Jahren bis zum erstmaligen Auftreten eines ACE-Hemmer-assoziierten Angioödems. Das Rezidivrisiko war in dieser Gruppe gegenüber derjenigen ohne ACE-Hemmer verdreifacht. Von Rezidiven waren Frauen häufiger betroffen. Eine individuelle Risikoabschätzung für das Auftreten eines angioneurotischen Ödems unter ACE-Hemmer-Einnahme ist jedoch bisher nicht möglich.

Abstract

Background

ACE-inhibitors are said to cause angioneurotic edema. In spite of the fact that patients with acute angioedema of the head and neck region are usually admitted to an ENT department, there is only limited information available in the otorhinolaryngological literature on the frequency, risk of recurrent episodes and clinical significance of ACE inhibitor related angioedema.

Material and methods

The medical histories of all patients admitted to our hospital due to acute angioneurotic edema during the period from 1 January 1988 to 31 December 2001 were reviewed. These were supplemented with the results of a standardized questionnaire filed out by the affected patients and of a non-affected control-group.

Results

During the observation period. 121 patients were treated for acute angioneurotic edema of the head and neck region. In 34 patients (=28.1%), edema was related to permanent treatment with ACE inhibitors. The overall frequency of angioedema and the percentage of ACE inhibitor related angioedema showed a continuous increase during the study period. There was a latency from the beginning of ACE inhibitor treatment until the first manifestation of angioedema of up to 13 years. In comparison with the group of edema patients without ACE inhibitor treatment, we found a threefold risk of recurrent edema in the ACE group. Women were affected by recurrent episodes more often than men. Until now, any individual assessment of the probable risk of developing an angioneurotic edema during ACE inhibitor treatment appears to be impossible.

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Author notes

  1. L. Wahbe

    Present address: Klinik für Anästhesie und operative Intensivmedizin, Städt. Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Deutschland

Authors and Affiliations

  1. Klinik für Herz- und Thoraxchirurgie, Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland

    L. Wahbe

  2. Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, plastische Operationen, Phoniatrie und Pädaudiologie, Städt. Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Deutschland

    H.-J. Schultz-Coulon

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Correspondence to L. Wahbe.

Additional information

Auszug aus der Inauguraldissertation L. Wahbe: „Angioneurotische Ödeme im HNO-Bereich unter der Therapie mit ACE-Hemmern“, Universität Düsseldorf, 2005

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Wahbe, L., Schultz-Coulon, HJ. Angioneurotische Ödeme des Kopf-Hals-Bereiches unter der Therapie mit ACE-Hemmern. HNO 55, 709–715 (2007). https://doi.org/10.1007/s00106-006-1511-7

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