title: Hypotensive shock and angio-oedema from angiotensin II receptor blocker: a class effect in spite of tripled tryptase values.
abstract: In adverse reactions with shock, tripled tryptase values can support a diagnosis of anaphylaxis. A 51-year old physically fit woman experienced angio-oedema and hypotensive shock after irbesartan ingestion requiring noradrenaline infusion. Serum tryptase rose to three times the normal value. Total immunoglobulin E and skin prick tests were normal, however. As nonallergic increases in tryptase have been observed, e.g. during angio-oedema from angiotensin-converting enzyme inhibitors, and bradykinin itself can degranulate mast cells acutely, we interpret the reaction as a class effect. To our knowledge, our report is one of the first on shock and angio-oedema from irbesartan.
authors.affiliation: Department of Anaesthesiology, Nordland Hospital, Bodø; and University of Tromsø, Tromsø, Norway. erikwn@fagmed.uit.no
authors.forename: E W
authors.initials: EW
authors.lastname: Nielsen
mesh_terms: D000799:Angioedema / Q000139:chemically induced* / Q000188:drug therapy / Q000201:enzymology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001713:Biphenyl Compounds / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy / Q000201:enzymology; D000077405:Irbesartan; D008407:Mast Cells / Q000187:drug effects; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D012697:Serine Endopeptidases / Q000097:blood*; D012769:Shock / Q000139:chemically induced* / Q000188:drug therapy / Q000201:enzymology; D012882:Skin Tests; D013777:Tetrazoles / Q000009:adverse effects*; D053802:Tryptases
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D015415:Biomarkers; D001713:Biphenyl Compounds; D013777:Tetrazoles; D012697:Serine Endopeptidases; D053802:Tryptases; D000077405:Irbesartan; D009638:Norepinephrine