Angioedema Induced By Angiotensin-converting Enzyme Inhibitors: Two Cases Of Successful Treatment With A Novel B2 Bradykinin Antagonist

Pérez, David Vila; Infante, Sonsoles; Martín, G.; Zubeldia, José Manuel

doi:10.1016/j.jaci.2010.12.420

Cited by 4 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For that reason, agents shown to be effective in HAE, including the plasma kallikrein inhibitor ecallantide and the bradykinin receptor antagonist icatibant, are currently being investigated in clinical studies as treatments for acute ACEI-induced angioedema [27,28]. Several small case studies have reported on the use of icatibant for the treatment of ACEI-induced angioedema [29-31]. …”

Section: Reviewmentioning

confidence: 99%

Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema

2012

View full text Add to dashboard Cite

Angioedema is a sudden, transient swelling of well-demarcated areas of the dermis, subcutaneous tissue, mucosa, and submucosal tissues that can occur with or without urticaria. Up to 25% of people in the US will experience an episode of urticaria or angioedema during their lifetime, and many will present to the emergency department with an acute attack. Most cases of angioedema are attributable to the vasoactive mediators histamine and bradykinin. Histamine-mediated (allergic) angioedema occurs through a type I hypersensitivity reaction, whereas bradykinin-mediated (non-allergic) angioedema is iatrogenic or hereditary in origin.Although their clinical presentations bear similarities, the treatment algorithm for histamine-mediated angioedema differs significantly from that for bradykinin-mediated angioedema. Corticosteroids, and epinephrine are effective in the management of histamine-mediated angioedema but are ineffective in the management of bradykinin-mediated angioedema. Recent advancements in the understanding of angioedema have yielded pharmacologic treatment options for hereditary angioedema, a rare hereditary form of bradykinin-mediated angioedema. These novel therapies include a kallikrein inhibitor (ecallantide) and a bradykinin β2 receptor antagonist (icatibant). The physician’s ability to distinguish between these types of angioedema is critical in optimizing outcomes in the acute care setting with appropriate treatment. This article reviews the pathophysiologic mechanisms, clinical presentations, and diagnostic laboratory evaluation of angioedema, along with acute management strategies for attacks.

show abstract

Section: Reviewmentioning

confidence: 99%

Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema

2012

View full text Add to dashboard Cite

show abstract

“…8,9,15,35,43 Several case reports and case series illustrate the efficacy of icatibant in the management of these events. 34-45 In the majority of these patients, icatibant was used as a second- or third-line therapy with successful symptom resolution ranging from 10 to 30 minutes or 4 to 10 hours. Intubation and tracheotomy were avoided in several cases following icatibant administration.…”

Section: Discussionmentioning

confidence: 99%

“…16,33 Case reports/series involving the management of ACEI-IA with icatibant are summarized in Table 3. [34][35][36][37][38][39][40][41][42][43][44][45] Icatibant successfully resolved symptoms in 25 of the 26 cases (96%). Treatment with standard therapy and icatibant did not improve symptoms in one case leading to intubation and ICU management with eventual resolution and discharge a few days after presentation.…”

Section: Icatibantmentioning

confidence: 99%

See 1 more Smart Citation

Off-Label Use of Agents for Management of Serious or Life-threatening Angiotensin Converting Enzyme Inhibitor–Induced Angioedema

2015

View full text Add to dashboard Cite

ACEI-IA is typically a self-limiting event. First-line therapies include ACEI discontinuation, observation, and supportive medications (eg, corticosteroids, antihistamines, and epinephrine). Symptom progression can be life-threatening and may require interventions such as tracheotomy and intubation. Off-label use of FFP and medications approved for hereditary angioedema have resulted in rapid resolution of symptoms and avoidance of intubation. Among these agents, icatibant has the most supporting evidence and has been incorporated into practice guidelines and algorithms as a second-line agent for serious life-threatening ACE-IA.

show abstract

“…Additionally, icatibant is a potent, highly selective antagonist of the bradykinin B2 receptor, which may be a useful therapeutic approach for the treatment of ACEI-A [ 17 , 19 – 21 ]. A recently completed double-blind, randomized, controlled phase II trial evaluated a 30 mg dose of sub-cutaneously administered icatibant in patients with ACEI-A.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of the angiotensin-converting enzyme inhibitor (ACEI) induced angioedema investigator rating scale and proposed discharge criteria

Bonner

Panter

Kimura

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundThe use of angiotensin-converting enzyme inhibitors (ACEI) has been associated with the development of bradykinin-mediated angioedema. With ever-widening indications for ACEI in diseases including hypertension, congestive heart failure and diabetic nephropathy, a concomitant increase in ACEI-Angioedema (ACEI-A) has been reported. At present there is no validated severity scoring or discharge criteria for ACEI-A. We sought to develop and validate an investigator rating scale with corresponding discharge criteria using clinicians experienced in treating ACEI-A.MethodsIn-depth, 60-min qualitative telephone interviews were conducted with 12 US-based emergency physicians. Beforehand, clinicians were sent four case studies describing patients experiencing different severities of angioedema attacks. Clinicians were initially asked open-ended questions about their experience of patients’ symptoms, treatment and discharge decisions. Clinicians then rated each patient case study and discussed patient diagnoses, ratings of symptom severity and discharge evaluation. The ratings were used to assess inter-rater reliability of the scale using the intra-class correlation coefficient (ICC) using IBM SPSS analysis Version 19 software.ResultsThe findings provide support focusing on four key symptoms of airway compromise scored on a 0–4 scale: 1) Difficulty Breathing, 2) Difficulty Swallowing, 3) Voice Changes and 4) Tongue Swelling and the corresponding discharge criteria of a score of 0 or ‘No symptoms’ for Difficulty Breathing and Difficulty Swallowing and a score of 0 or 1 indicating mild or absence of symptoms for Voice Change and Tongue Swelling. Eleven clinicians agreed the absence of standardized discharge criteria supported the use of this scale. All physicians concurred with the recommended discharge criteria. The clinician ratings provided evidence of strong inter-rater reliability for the rating scale (ICC > 0.80).ConclusionThe investigator rating scale and discharge criteria are clinically valid, relevant and reliable. Moreover, both address the current unmet need for standardized ED discharge criteria.

show abstract

Angioedema Induced By Angiotensin-converting Enzyme Inhibitors: Two Cases Of Successful Treatment With A Novel B2 Bradykinin Antagonist

Cited by 4 publications

References 0 publications

Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema

Emerging concepts in the diagnosis and treatment of patients with undifferentiated angioedema

Off-Label Use of Agents for Management of Serious or Life-threatening Angiotensin Converting Enzyme Inhibitor–Induced Angioedema

Development and validation of the angiotensin-converting enzyme inhibitor (ACEI) induced angioedema investigator rating scale and proposed discharge criteria

Contact Info

Product

Resources

About