Enalapril-Induced Nasal Blockage

Fennerty, A. G.; Littley, M D; Reid, P.

doi:10.1016/s0140-6736(86)92035-0

Cited by 10 publications

(4 citation statements)

References 1 publication

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“…In particular, for patients on chronic ACE inhibitor therapy, it remains possible that increased kinin levels may be chronically main tained and could exacerbate allergic symptoms dur ing repeated seasonal exposure to allergen. Such an effect of chronic captopril administration would be consistent with the tendency of ACE-inhibitor-induced side effects to manifest only after several days of treatment [6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 53%

“…In recent years, however, an increasing number of reports have drawn attention to a variety of reversible side effects related to ACE in hibitor therapy. These have included cough [6][7][8][9], ex acerbation of asthma [7,10], angioedema [11] and na sal blockage [12]. Since ACE (peptidyl dipeptidase; EC 3.4.15.1) is also a major enzyme responsible for the degradation of the potent proinflammatory pep tides, bradykinin and lysylbradykinin [13], it has been suggested that some of the side effects associated with ACE inhibitor therapy may be due to the actions of increased concentrations of kinins that would result from a reduced rate of degradation.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a Single-Dose Pretreatment with Captopril on the Immediate Response to Nasal Challenge with Allergen

Naclerio

Meyers

Kagey‐Sobotka

et al. 1990

Int Arch Allergy Immunol

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We performed a double-blind, placebo-controlled, crossover study using 12 subjects to determine the effects of a single 50-mg dose of captopril on the response to nasal challenge with increasing doses of allergen. Levels of kinins, histamine and N-α-p-tosyl-L-arginine methyl ester (TAME)-esterase activity were measured in nasal lavages, and symptom scores and the number of sneezes were recorded. Captopril had no significant effects on histamine, TAME-esterase, sneezing or symptom scores. Peak postchallenge kinin levels, however, were significantly elevated (p < 0.05) compared to placebo, while an increase in the magnitude of the dose-response curve was of marginal significance (p = 0.058). Thus, captopril causes increases in the kinin levels in nasal secretions during the allergic response. If increased kinin levels persist or worsen with chronic therapy, it is possible that they could exacerbate allergic symptoms during repeated seasonal exposure.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Effects of a Single-Dose Pretreatment with Captopril on the Immediate Response to Nasal Challenge with Allergen

Naclerio

Meyers

Kagey‐Sobotka

et al. 1990

Int Arch Allergy Immunol

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show abstract

“…Adverse reactions of ACE inhibitors were studied in 36 Swedish patients who had been taking captopril, enalapril or lisinopril for hypertension or heart failure where cough, dyspnoea and bronchospasm were the most commonly reported. A case of enalapril-induced nasal blockage was reported: a 45-year-old woman with severe nasal obstruction who had been taking enalapril as treatment for hypertension presented complete resolution after enalapril discontinuation 10. Captopril-induced lymphocytic interstitial pneumonia and rhinorrhoea have been reported as well, in an 8-month-old patient with heterotaxy syndrome 11…”

Section: Discussionmentioning

confidence: 97%

ACE inhibitors: upper respiratory symptoms

2014

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Cough and angioedema are well-known adverse reactions of ACE inhibitors. However, other adverse effects of upper airways such as postnasal drainage, rhinitis and nasal blockage, are less frequently recognised. These might share the same pathophysiological mechanism: bradykinin accumulation. We present two patients with ACE inhibitor-induced upper respiratory symptoms that improved after the discontinuation of ACE-inhibitors and substitution with angiotensin II receptor blockers. The incidence of these adverse events is not accurately known, since these are not required to be reported, but it is estimated to be low. This presents challenges to the physician and demonstrates the importance of keeping it as a differential diagnosis. Most physicians are aware of ACE inhibitor-induced cough but not of ACE inhibitor-induced nasal blockage, rhinitis or postnasal drainage. Identifying these can avoid unnecessary diagnostic tests and inappropriate treatment.

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“…The potential for ACE inhibitors to cause nasal obstruction is well recognized 4,17 . By inhibiting the angiotensin converting enzyme, ACE inhibitors cause a build up of bradykinin which is a potent vasodilator.…”

Section: Cardiovascular Systemmentioning

confidence: 99%

The rhinological side-effects of systemic drugs

Bateman

Woolford

2003

Clin Otolaryngol

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Patients often present to otolaryngologists with nasal symptoms where no cause is apparent. A number of patients seen in outpatient departments are taking medication for other conditions and the adverse affects of these drugs may potentially be the source of these symptoms. In this short review, we present an overview of the more common drugs that may be responsible and outline the possible mechanisms where these are known.

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Enalapril-Induced Nasal Blockage

Cited by 10 publications

References 1 publication

Effects of a Single-Dose Pretreatment with Captopril on the Immediate Response to Nasal Challenge with Allergen

Effects of a Single-Dose Pretreatment with Captopril on the Immediate Response to Nasal Challenge with Allergen

ACE inhibitors: upper respiratory symptoms

The rhinological side-effects of systemic drugs

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