Late onset ace inhibitor induced angioedema

Orolingual angioedema is a rare adverse effect (1%-5%) of tissue plasminogen activator (tPA) that can lead to significant morbidity in patients with acute ischemic stroke. It is thought that increased levels of bradykinin and histamine resulting from tPA administration can result in angioedema. Angiotensin-converting enzyme (ACE) inhibitors can also lead to increased levels of bradykinin and appear to be a risk factor for tPA-associated angioedema. A literature review was conducted to examine previous cases of orolingual angioedema associated with tPA administration in patients also taking ACE inhibitors to better understand the relationship between ACE inhibitors and tPA-induced angioedema...

Background: Angioedema due to acquired deficiency of C1-inhibitor (C1-INH-AAE) is a rare disease sharing some clinical and laboratory similarities with hereditary angioedema, but with late onset and no positive family history. The underlining cause may be malignant or due to autoimmune diseases, but some cases remain idiopathic. Case presentation: We report a case of a 75 year old woman suffering from recurrent episodes of angioedema since the age of 66, considered first induced by treatment with angiotensin-converting-enzyme inhibitors (ACEI)...

The effects of angiotensin converting enzyme (ACE) inhibitors result from the inhibition of the ACE (kininase II) to ultimately influence both the renin-angiotensin system and the degradation of the bradykinin (BK) metabolism. ACE inhibitors block the degradation of BK and substance P by ACE. In addition, an active metabolite of BK (Des-Arg9-BK) is catalysed by kininase I and its degradation is controlled in part by the conversion enzyme. These molecules have been associated with increased plasma extravasation associated with ACE inhibitors...

RATIONALE: Angiotensin-converting enzyme (ACE) inhibitors are one of the most used medication among patients with arterial hypertension. In most cases, ACE inhibitors caused side effects are mild; however, from 0.1% to 0.7% of patients can develop life threatening adverse effect, angioedema. Unlike histamine mediated, ACE inhibitor-related angioedema can develop at any time during the treatment course. PATIENT CONCERNS: An 89-year-old woman with a medical history for arterial hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation developed ACE inhibitor-induced angioedema after 5 years of daily ramipril administration...

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) target the renin-angiotensin system and are used in the management of hypertension. Both classes of drugs have similar side effects. ARBs are considered to be much better tolerated than ACE inhibitors with lesser incidence of side effects. Angioedema is a very rare side effect associated with ACE inhibitors (ACEI) and even rarer so with ARBs. The cause for angioedema in ACE inhibitors is said to be the rise in bradykinin levels...

Angiotensin-converting enzyme inhibitors (ACEIs) have replaced diuretics and Β-blockers as first-line agents for treating hypertension. Cough is a recognised side effect of ACEI treatment, and because of this, patients often have their medication changed to an angiotensin II receptor blocker (AIIRB). Both ACEIs and AIIRBs are associated with angioedema. We present a case of a late-onset angioedema associated with pyrexia and raised levels of inflammatory markers. We also discuss the causes and treatments of angioedema, and current controversies surrounding ACEIs and AIIRBs and their relation to anaphylaxis and angioedema...

PURPOSE: To investigate the incidence and clinical characteristics of angioedema associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) in an outpatient allergy department. METHODS: A retrospective review of medical records of new patients seen in an allergy clinic. Demographic and clinical data of patients with ACEI-induced angioedema were analyzed. RESULTS: Nine (0.37%) out of 2,421 new patients attending the allergy clinic developed ACEI-associated angioedema...

OBJECTIVE: To report a case of angioedema associated with losartan administration. CASE SUMMARY: A 45-year-old white man with a history of hypertension and gout was treated with losartan/hydrochlorothiazide, allopurinol, and colchicine. The patient experienced two episodes of angioedema within a 10-hour period. On both occasions the symptoms resolved after treatment. DISCUSSION: Angiotensin-converting enzyme (ACE) inhibitors are associated with a relatively high incidence of angioedema...

BACKGROUND: Angioedema in association with angiotensin converting enzyme inhibitor (ACEI) use is rare, but serious. Which patients are predisposed to the reaction and whether it involves an immune mechanism remain unclear. OBJECTIVES: To determine the frequency of ACEI angioedema in immunosuppressed cardiac and renal transplant patients. METHODS: This was a retrospective chart review of all adult cardiac (n = 156) and renal (n = 341) transplant patients followed at our hospital (years 1985 to 1995)...

Angiotensin-converting enzyme inhibitors (ACEI) such as enalapril, captopril, and lisinopril are well established as effective treatments of arterial hypertension and congestive heart failure. They are widely used and generally well tolerated. Angioedema is a rare but serious adverse effect of ACEI therapy. Most frequently, edema involves the face, oral cavity, and the glossopharyngeal or glottic area. Visceral edema induced by ACEI has also occurred. Life threatening and even fatal cases associated with ACEI have been reported...

1. Early and late onset of angio-oedema. The report reviews angio-oedema as a rare but potential life threatening adverse effect associated with angiotensin converting enzyme (ACE) inhibitors. This class of drugs, widely used in the treatment of hypertension and congestive heart failure, may often induce mild angio-oedema of the skin (face, lips, cheeks) but may rarely involve tongue, subglottis, pharyngeal and laryngeal tissues. Angio-oedema has been previously reported to occur early after start of treatment, mostly within the first 3-4 weeks...

Available information from 1980 to 1997 on angiotensin converting enzyme (ACE) inhibitor-induced angioedema and its underlying mechanisms are summarised and discussed. The incidence of angioedema is low (0.1 to 0.2%) but can be considered as a potentially life-threatening adverse effect of ACE inhibitor therapy. This adverse effect of ACE inhibitors, irrespective of the chemical structure, can occur early in treatment as well as after prolonged exposure for up to several years. The estimate incidence is quite underestimated...

Angioedema is a rare but potentially life-threatening adverse effect of angiotensin-converting enzyme inhibitors (ACEI) which usually occurs within the first weeks of therapy. We report three patients in whom ACEI-induced angioedema began with a late onset of 12-33 months, and who had an irregular, unpredictable course under ACEI therapy. In two patients, other drugs or trauma appeared to trigger some of the episodes. After withdrawal of the ACEI, the trigger drugs were well tolerated in provocation tests and upon re-exposure...

Angioedema of the face and neck is a rare but potentially fatal complication of angiotensin-converting enzyme inhibitor (ACEI) use. We retrospectively reviewed five cases of ACEI angioedema seen at our institution over the past 2 1/2 years. Four of the cases occurred with enalapril and one with lisinopril. Onset of symptoms varied from two days to ten months. Importantly, three of the five patients had been receiving medication three months or longer, suggesting clinicians must consider this complication during long-term administration of these agents...