Angiotensin-Converting Enzyme Inhibitor–Induced Angioedema

Enalapril‐induced angioedema: A forgotten adverse event

“…7 The average duration for the appearance of the first crisis was 720 days, being of greater presentation in the first week with an incidence of 1:1000. 3 A median duration of symptoms of 36.5 h has been reported. 41% of patients had recurrences despite discontinuation of medication.…”

“…9 Several risk factors have been described for the development of this adverse event, such as age >65 years, female gender, black race, coronary heart disease, heart 4 Other risk factors include airway narrowing, obesity, and interruption of treatment, as well as hemodialysis, because the membranes used activate bradykinins and potentiate the effect of ACE inhibitors. 3,4 To achieve an adequate diagnosis, this requires the exclusion of other causes of angioedema without urticaria, mainly hereditary angioedema or caused by other drugs. 5 There are useful screening methods, such as skin tests and measurement of specific IgE in blood; however, the gold standard for diagnosis is the double-blind placebocontrolled challenge test.…”

“…4,9 The efficacy of molecules for hereditary angioedema is being evaluated. 3 In severe cases with airway compromise, icatibant, a bradykinin B2 receptor inhibitor, can be administered 30mg subcutaneously, which is usually effective in most patients. 3,6 The use of human plasma derived C1 inhibitor concentrates could also be effective.…”

“…Angioedema is observed more frequently in treatments lasting more than 3 months, especially with long‐acting ACE inhibitors 3 . Usually occurs within the first year of exposure, although there are reports of late‐onset cases 4 .…”

“…2 Its safety profile is well established; however, one of its feared adverse events is angioedema with a reported incidence of 0.1%-0.7%. 3,4 Angioedema is characterized by asymmetric edema of the skin and mucous membranes (including the gastrointestinal and respiratory tracts), secondary to increased vascular permeability extravasation plasma. 5 Is an entity of multifactorial etiology and non-specific symptomatology, for which clinical suspicion and exploration of differential diagnoses are of great importance.We describe a patient with heart failure with reduced ejection fraction (LVEF), of unknown cause, who received treatment with enalapril as a drug to optimize ventricular function and as a mortality modifier and developed symptoms suggestive of angioedema.…”