title: Fresh frozen plasma in the treatment of resistant angiotensin-converting enzyme inhibitor angioedema.
abstract: BACKGROUND
  Angioedema, particularly of the head and neck, is a well-recognized adverse effect of angiotensin-converting enzyme (ACE) inhibitors. Most cases respond to conventional therapy, including antihistamines and corticosteroids. Severe episodes may require epinephrine and intubation.
  
  
  OBJECTIVE
  To report the case of a patient with ACE inhibitor-induced angioedema treated with fresh frozen plasma (FFP).
  
  
  METHODS
  The patient is a 43-year-old, white woman who first received the ACE inhibitor ramipril in March 2002. After 3 weeks, she developed angioedema of her lips and fingers, which resolved with antihistamines, corticosteroids, and one dose of epinephrine. A low dose of ramipril was restarted 4 days later, which was increased throughout 4 days. In late August 2002, she developed severe upper lip and tongue edema recalcitrant to conventional therapy. Her C1 esterase inhibitor level was normal.
  
  
  RESULTS
  After 4 days of treatment with antihistamines, corticosteroids, epinephrine, antileukotrienes, cyclosporine, and intravenous immunoglobulins, the patient's tongue swelling continued to recur and became more severe. Two units of intravenous FFP was given, with rapid improvement and no further recurrence of tongue swelling.
  
  
  CONCLUSIONS
  In our patient, FFP was highly successful in the treatment of resistant, life-threatening angioedema due to an ACE inhibitor. The benefit of FFP in this setting might be due to the effect of kininase II in breaking down accumulated bradykinin.
authors.affiliation: Division of Allergy, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA. warrierm@slu.edu
authors.forename: Manoj R
authors.initials: MR
authors.lastname: Warrier
authors.forename: Cori A
authors.initials: CA
authors.lastname: Copilevitz
authors.forename: Mark S
authors.initials: MS
authors.lastname: Dykewicz
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Slavin
mesh_terms: D000328:Adult; D000799:Angioedema / Q000209:etiology / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D010949:Plasma; D017257:Ramipril / Q000009:adverse effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril