Angioedema of the airway: an unusual case

Abstract

We report a case of angioedema caused by angiotensin-converting enzyme inhibitor and topical lignocaine spray, administered during nasendoscopy. Angioedema induced by angiotensin-converting enzyme inhibitors is a rare but well known entity. Allergy to topical lignocaine has been acknowledged as a rare phenomenon when used for dental surgery and for skin anaesthesia, but it has not previously been reported after topical administration prior to nasendoscopy. In the reported case, our patient was unfortunate enough to be allergic to both lisinopril and lignocaine. The result was life-threatening airway obstruction, and the continued use of lignocaine spray sustained the laryngeal oedema. We advise that patients are asked about any and every allergy--specifically, any previous problems with dental procedures--before administration of local anaesthetic spray to the upper aerodigestive tract.

Morbidity and Patient Perception of Flexible Laryngoscopy

“…Nonetheless, rare cases of allergic reactions to topical anesthetics have been described previously. 21 As with any other procedure, patients should be asked about previous allergic reactions before administration of any medication.…”

Angiotensin converting enzyme inhibitor induced angio‐oedema: a review of the pathophysiology and risk factors

“…This may be related to decrease DPPIV activity that has been associated with cyclosporine and other immunosuppressive drugs [88]. Multiple case reports have also suggested Lidocaine may be another trigger for ACE-I-related AE [85,89].…”

“…Age 465 [19] Smoking [7] History of ACE-I-related cough [7] Aspirin [86] Absence of diabetes mellitus [54,81] NSAIDS [86] History of drug rash [19] Immunosuppressive agents [84,88] Seasonal allergies [19] Etramustine phosphate [91] Food/contact allergies [82,83] Lidocaine [85,89] DPPIV inhibitors [90] ACE-I, angiotensin converting enzyme inhibitor; AE, angio-oedema; C1INH, C1 esterase inhibitor; CPG, Clinical Prediction Guides; DPPIV, dipeptidyl peptidase IV.…”

Life‐threatening anaphylactic reaction after the administration of airway topical lidocaine

“…The most common complication from topical lidocaine is a self‐limited, mild, local reaction. Although the use of lidocaine rarely causes a hypersensitive reaction, acute anaphylactic accidents may rarely occur and potentially can lead to severe cardiopulmonary collapse resulting in death 2–6…”

“…Lidocaine is the most commonly used local anesthetic agent and is known to be safe and effective use in the airway mucosa. There are some reports on lidocaine‐induced anaphylaxis 2–6. However, anaphylactic reaction due to the application of topical lidocaine to the airway has not been reported.…”