Perioral angioedema associated with angiotensin-converting enzyme inhibitor.
BACKGROUND
Angioedema is a non-pruritic swelling usually limited to the skin and mucous membranes of the face and perioral soft tissues. It can be life threatening but usually is not, and can be managed with conservative medical treatment unless the airway is endangered. Recent reports suggest that angiotensin-converting enzyme (ACE) inhibitors can predispose and/or precipitate angioedema, with a predilection toward patients of African American ancestry.


METHODS
This case report involved a 65-year-old African American female who was being treated surgically for localized chronic periodontitis. The procedure was performed without incident, and the patient was alert and stable when released. The next day, the patient called and reported that her lips were swollen. She stated that this had happened a number of times over the past several years, sometimes related to eating shellfish and other times without any known precipitating factor. All previous episodes of perioral swelling occurred after ACE inhibitor therapy had been initiated.


RESULTS
The patient was in no distress, with no other site involvement. She was prescribed oral hydroxyzine and her appearance returned to normal after 5 days. Although the patient had experienced previous episodes of angioedema, none had been in response to any dental procedure. She was referred to the Allergy and Immunology Clinic for skin testing, the results of which were negative to shellfish with good controls. Other potentiating etiologies were also ruled out by the allergist.


CONCLUSIONS
Angioedema is a recognized possible side effect of ACE inhibitor therapy. The exact mechanism by which ACE inhibitors induce angioedema is not known, although the risk of occurrence is much greater in African Americans. Practitioners should be alert to this potentially fatal condition in patients who take ACE inhibitors or the newer angiotensin II receptor blockers (ARBs).
Peacock
Mark E
ME
U.S. Army, Landstuhl, Germany. mark.peacock@lnd.amedd.army.mil
Park
Dong S
DS
Swiec
Gary D
GD
Erley
Kenneth J
KJ
D001741:Black or African American; D000368:Aged; D000799:Angioedema / Q000139:chemically induced* / Q000188:drug therapy; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D019557:Dermatitis, Perioral / Q000139:chemically induced / Q000188:drug therapy; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use*; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use*; D008047:Lip Diseases / Q000139:chemically induced* / Q000188:drug therapy; D010518:Periodontitis / Q000601:surgery; D011183:Postoperative Complications
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D006634:Histamine H1 Antagonists; D006919:Hydroxyzine