Angioedema of the Lips and Tongue Induced by Angiotensin-Converting Enzyme Inhibitor. A Report of Two Cases

Abstract

The following case reports describe the clinical presentation, diagnosis and management of two patients who attended Liverpool University Dental Hospital with rapidly increasing swelling of the lips and tongue. Both patients were suffering from angioedema and were taking an angiotension-converting enzyme (ACE) inhibitor (ACEI). A provisional diagnosis of ACEI-induced angioedema was made. An intramuscular injection of chlorpheniramine maleate was given to both patients and they were immediately transferred to the local accident and emergency department. These cases illustrate the potential role of the general dental practitioner in the early recognition and management of this potentially life-threatening condition.

A case report looking at ACE inhibitors as the cause of angioedema during dental treatment

“…Angioedema secondary to ACE inhibitors is a serious complication and some deaths have been reported. [11][12][13] There are a few selected cases in the literature of angioedema developing and presenting in the dental setting, 14 which reports a wellestablished link between angioedema and ACE inhibitors. 4 Angioedema is a much less common side effect of ACE inhibitors compared to other side effects such as a non-productive cough that is seen in about 10% of patients treated with them.…”

Angiotensin converting enzyme inhibitors and delayed onset, recurrent angioedema of the head and neck

“…[1][2][3] The swelling is usually of acute onset and subsides after a couple of days. The clinical picture can vary and ranges from mild localised symptoms to extensive upper airway obstruction, which can be fatal.…”

“…[4][5][6] Although allergy is sometimes the cause, many patients develop the problem for nonallergic reasons and it is a well described complication of angiotensin converting enzyme (ACE) inhibitors. [1][2][3][4][5][6] It is estimated that 35-40 million patients worldwide are currently prescribed ACE inhibitors for treatment of hypertension, heart failure and postmyocardial infarction. 7 In this population group 0.1-0.2% are affected by angioedema.…”