Clinical features of angioedema induced by renin-angiotensin-aldosterone system inhibition: a retrospective analysis of 84 patients

Abstract

Background and objectives: Bradykinin-mediated angioedema (AE) induced by antihypertensive drugs primarily affect the head and neck region and may occur even after several years of uneventful treatment. Many facts about the clinical course remain unknown. Diagnosis is not easy, as the clinical appearance resembles allergic AE. No specific diagnostic markers are known and no officially approved treatment is currently available. Methods: All patients who presented to the ORL department between 2010 and 2016 with acute AE were included. Those with a history of renin-angiotensin-aldosterone system (RAAS) blocker intake were defined as RAE and their pathophysiological characteristics and clinical course of the disease were analyzed. Results: A total of 84 patients (median age of 71 years) with RAE was identified. The majority (80%) was on ACE inhibition. The oral cavity was most often affected. Nearly 60% were medicated for more than 1 year before AE occurred. RAE occurred more often during the morning hours. The necessity for emergency intubation and/or tracheostomy was nine times higher in patients with acute RAE compared to patients with AE due to other reasons. Conclusions: Event-free, long-term therapy with an RAAS blocker before the first development of edema does not exclude RAE. RAE is associated with an increased risk for emergency airway management.

Angioedema associated with dipeptidyl peptidase-IV inhibitors

“…In the series of 84 patients with angioedema induced by renin–angiotensin–aldosterone system inhibitors described by Pfaue et al [ 36 ], four patients were treated with both an ACEI and a DPP-IV inhibitor.…”

Case Report: Compromised Airway Following Anesthesia and Its Correlation With the Use of ACE Inhibitors—An Unexpected Clinical Event and Review of Literature

“…ACEI-IA is a rare side effect (0.2–0.5%), but the large number of people taking these medications makes it the leading cause of drug-induced angioedema ( 5 ). The incidence is underestimated as many physicians misdiagnosed it as an anaphylactic reaction, which delays the diagnosis, leading to poor initial management, deleterious to the patient ( 6 ).…”

“…It may be a beneficial treatment modality in the management of ACE-IA and warrants further investigation ( 16 ). The current therapeutic options of ACE-IA are insufficient and unsatisfying as only off-label therapy options are available and previous study results are incongruent ( 5 ). Despite the potential severity of this disease state, there is no consensus regarding emergency pharmacological management of these episodes ( 13 ).…”

Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers

“…The latter can occur in 0.7–1% of patients. 2 , 6 , 7 , 8 , 9 , 10 , 11 Angioedemas are more likely to occur in people over 65 years, African Americans, and smokers, 12 , 13 , 14 and whenever ACEI are prescribed for cardioprotection rather than for hypertension. 4 Angioedemas may also occur with angiotensin II receptor blockers (ARB).…”