[Cross-sensitivity between angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonist].
BACKGROUND
Cross-sensitivity between angiotensin-converting enzyme inhibitor-induced angioedema and cough, and angiotensin II receptor antagonist has been reported in the literature. Eczema-like skin reactions have never been documented. We report the first two cases.


METHODS
Two patients, aged 79 and 88 years, with a history of hypertension, were treated with angiotensin-converting enzyme inhibitors, which had been discontinued because of an eczematiform rash. In spite of substitution with an angiotensin II receptor antagonist, the patients had developed the same eruption. The outcome was favourable after discontinuation of the angiotensin II receptor antagonist. The pharmacologic study suggested the possibility of a cross-sensitivity reaction between these two drugs.


CONCLUSIONS
We report the first two cases of a cross-sensitivity between angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonist presenting as an eczematiform rash. The exact mechanism is unknown, but clinicians must be aware that angiotensin II receptor antagonist is not a safe alternative in patients who have a history of eczematiform rash secondary to angiotensin-converting enzyme inhibitors, as has been always reported with angioedema.
Touraud
J P
JP
Service de Dermatologie, CHU de Dijon, France. jean.pierre-tourand@chu-dijon.fr
Collet
E
E
Louguet
C
C
Sgro
C
C
Dalac
S
S
Dutronc
Y
Y
Lambert
D
D
D000368:Aged; D000369:Aged, 80 and over; D000804:Angiotensin II / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000502:physiology; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001713:Biphenyl Compounds / Q000009:adverse effects*; D002216:Captopril / Q000009:adverse effects*; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects; D000077405:Irbesartan; D008297:Male; D007703:Peptidyl-Dipeptidase A / Q000276:immunology / Q000502:physiology; D011945:Receptors, Angiotensin / Q000276:immunology / Q000502:physiology; D012882:Skin Tests; D013777:Tetrazoles / Q000009:adverse effects*; D013997:Time Factors
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001713:Biphenyl Compounds; D007211:Indoles; D011945:Receptors, Angiotensin; D013777:Tetrazoles; D000804:Angiotensin II; C052035:trandolapril; D002216:Captopril; D007703:Peptidyl-Dipeptidase A; D000077405:Irbesartan