Purpose of Review
This study aims to examine current knowledge on the occurrence, pathophysiology, and treatment of angioedema among patients who receive angiotensin-converting enzyme inhibitors.
Angiotensin-converting enzyme inhibitors (ACE-I), a medication class used by an estimated 40 million people worldwide, are associated with angioedema that occurs with incidence ranging from 0.1 to 0.7%. The widespread use of ACE-I resulted in one third of all emergency department visits for angioedema. Angioedema occurs more frequently in African Americans, smokers, women, older individuals, and those with a history of drug rash, seasonal allergies, and use of immunosuppressive therapy. The pathophysiology of ACE-I-induced angioedema involves inhibition of bradykinin and substance P degradation by ACE (kininase II) leading to vasodilator and plasma extravasation. Treatment modalities include antihistamines, steroids, and epinephrine, as well as endotracheal intubation in cases of airway compromise. Patients with a history of ACE-I-induced angioedema should not be re-challenged with this class of agents, as there is a relatively high risk of recurrence.
ACE-I are frequently used therapeutic agents that are associated with angioedema. Their use should be avoided in high-risk individuals and early diagnosis, tracheal intubation in cases of airway compromise, and absolute avoidance of re-challenge are important.
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The authors declare no conflict of interest relevant to this manuscript.
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No human or animal data were collected in writing this review.
This article is part of the Topical Collection on Guidelines/Clinical Trials/Meta-Analysis
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Kostis, W.J., Shetty, M., Chowdhury, Y.S. et al. ACE Inhibitor-Induced Angioedema: a Review. Curr Hypertens Rep 20, 55 (2018). https://doi.org/10.1007/s11906-018-0859-x
- Angiotensin II
- Angiotensin-converting enzyme inhibitors