Angiotensin converting enzyme inhibitor-related angioedema: onset, presentation, and management

• Published in: Annals of otology, rhinology & laryngology Vol. 124; no. 2; p. 89
• Main Authors: Chan, Norman J, Soliman, Ahmed M S
• Format: Journal Article
• Language: English
• Published: United States 01.02.2015
• Subjects: Academic Medical Centers - statistics & numerical data; Airway Management - methods; Angioedema - chemically induced; Angioedema - complications; Angioedema - diagnosis; Angioedema - physiopathology; Angioedema - therapy; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - classification; Anti-Allergic Agents - administration & dosage; Female; Hospitals, Urban - statistics & numerical data; Humans; Intubation, Intratracheal - methods; Laryngeal Edema - diagnosis; Laryngeal Edema - etiology; Laryngeal Edema - physiopathology; Laryngeal Edema - surgery; Laryngoscopy - methods; Male; Middle Aged; Otorhinolaryngologic Surgical Procedures - methods; Pennsylvania; Retrospective Studies; Risk Factors; Time Factors; Pennsylvania; angioedema; intubation; ACE inhibitor; airway intervention
• ISSN: 0003-4894
• DOI: 10.1177/0003489414543069

This study aimed to determine the duration of use, presentation, and management of angiotensin converting enzyme (ACE) inhibitor-related angioedema patients at an urban academic medical center. Retrospective chart review. Eighty-eight patients who presented with ACE inhibitor-related angioedema between January 1, 2012, and December 31, 2012, were identified. They presented anywhere from 1 day to 20 years after starting an ACE inhibitor. About half the patients (50.7%) presented after taking an ACE inhibitor for at least 1 year. Fifty-five patients were female (62.5%). Twenty-eight patients (31.8%) had an airway intervention with 27 intubated and 1 requiring cricothyroidotomy. Six patients were intubated after more than 1 flexible laryngoscopy. The percentage of patients with involvement of the face, lips, tongue, floor of mouth, soft palate/uvula, and larynx were 12.5%, 60.2%, 39.7%, 6.8%, 17.0%, and 29.5%, respectively. Sixty-eight percent of patients with laryngeal edema were intubated. The majority of patients were treated with a corticosteroid and H1 and H2 receptor antagonists. Angioedema can occur at any time after starting ACE inhibitor use, with nearly half occurring after 1 year of use. Laryngeal involvement occurred in a minority of patients, but most of these patients were felt to require airway protection.