Angiotensin Converting Enzyme Inhibitor-Related Angioedema: Onset, Presentation, and Management. (February 2015)

• Record Type: Journal Article
• Authors: Chan, Norman J.; Soliman, Ahmed M.S.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 124:Number 2(2015:Feb.)
• Page Start: 89
• Page End: 96
• Publication Date: 2015-02
• Subjects: ACE inhibitor -- angioedema -- airway intervention -- intubation; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489414543069
• Languages: English
• ISSNs: 0003-4894

Abstract

Objective: 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. Methods: Retrospective chart review. Results: 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. Conclusion: 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.