Evaluation of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy in immunotherapy-associated systemic reactions

Carlson, Geoffrey; Wong, Priscilla H.; White, Kevin; Quinn, James A.

doi:10.1016/j.jaip.2017.05.009

Cited by 13 publications

(5 citation statements)

References 9 publications

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“… 27 However, ACEI also appeared to be safe with VIT, 25 and although one small study reported more severe AE in patients taking ACEI, no significant difference in the number of treatment doses of epinephrine was observed. 28 Another study reported an even lower frequency of AE in patients taking antihypertensive treatment, although not statistically significant. 29 This is in agreement with our results; VIT was safe in patients taking ACEI.…”

Section: Discussionmentioning

confidence: 94%

“…Taking ACEI was reported to be an independent predictor for systemic AE 26 and temporary discontinuation of ACEI therapy was recommended 27 . However, ACEI also appeared to be safe with VIT, 25 and although one small study reported more severe AE in patients taking ACEI, no significant difference in the number of treatment doses of epinephrine was observed 28 . Another study reported an even lower frequency of AE in patients taking antihypertensive treatment, although not statistically significant 29 .…”

Section: Discussionmentioning

confidence: 99%

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β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Sturm

Herzog

Aberer

et al. 2021

Allergy

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Background There is controversy whether taking β‐blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β‐blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β‐blockers, 11.9% ACEI, 5.0% β‐blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p = 0.25). The severity of the initial sting reaction was not affected by the intake of β‐blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p = 0.29). In total, 210 (17.7%) patients were re‐stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β‐blockers, none an ACEI. Conclusions This trial provides robust evidence that taking β‐blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629).

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Sturm

Herzog

Aberer

et al. 2021

Allergy

View full text Add to dashboard Cite

show abstract

“…ACEI also appeared to be safe with VIT 25 , and although one small study reported more severe AE in patients taking ACEI, no significant difference in the number of treatment doses of epinephrine was observed. 26 Another study reported an even lower frequency of AE in patients taking antihypertensive treatment, although not statistically significant. 27 This is in agreement with our results; VIT was safe in patients taking ACEI.…”

Section: Discussionmentioning

confidence: 94%

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Sturm¹,

Herzog²,

Aberer³

et al. 2020

Preprint

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Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629)

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“…In the literature, it has been suggested that beta-blockers mask the symptoms of cardiac anaphylaxis and cause severe bronchoconstriction by causing alpha-adrenergic activity whereas angiotensin converting enzyme (ACE) inhibitors increase the degree of anaphylactoid reaction, albeit minimally. 50 In a study demonstrated that aeroallergen immunotherapy is considered relatively safe in patients who routinely take ACE inhibitors compared to those using beta blockers. 51 In a retrospective study including patients who had subcutaneous immunotherapy, it was reported that the degree of anaphylactoid reaction has increased by the use of ACE inhibitors/angiotensin receptor blockers and diuretics, but no significant increase was observed by the use of calcium channel blockers.…”

Section: Management Of Infusion-related Reactionsmentioning

confidence: 99%

Infusion-Related Reactions with Anti-CD20 Monoclonal Antibody Treatments in Multiple Sclerosis: Traditional Review

GÖNCÜOĞLU¹,

ÖKSÜZOĞLU²,

EKİNCİOĞLU³

2022

J Lit Pharm Sci

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Evaluation of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy in immunotherapy-associated systemic reactions

Cited by 13 publications

References 9 publications

β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

β‐blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Infusion-Related Reactions with Anti-CD20 Monoclonal Antibody Treatments in Multiple Sclerosis: Traditional Review

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