Clinical experience with angiotensin-converting enzyme inhibitor-induced angioedema.
OBJECTIVE
To understand the presentation and clinical course of angiotensin-converting enzyme (ACE) inhibitor-induced angioedema and to determine management factors associated with progression to airway compromise.


METHODS
Retrospective chart review of patients taking ACE inhibitors who presented to the emergency department with angioedema between December 1999 and July 2004 (n = 228). Clinical presentation, treatment, and clinical course were analyzed.


RESULTS
The oral cavity was the most common location of upper-airway angioedema. Twenty-two (10%) patients required intubation, and all were intubated within 12 hours of presentation. Of the patients who required intubation, those who were started on an H(1)-blocker were extubated earlier than those not on an H(1)-blocker (P = 0.05).


CONCLUSIONS
The locations of swelling and drooling on admission are predictive of the need for intubation. Other aspects of presentation, treatment, and disposition can help in management decisions for this potentially fatal condition.


CONCLUSIONS
This is the largest series to date of ACE inhibitor-related angioedema that challenges theories on the etiology and treatment of this condition.
Grant
Nazaneen N
NN
Department of Otolaryngology Head and Neck Surgery, Washington Hospital Center and Georgetown University Hospital, Washington, DC 20010, USA. nazaneengrant@yahoo.com
Deeb
Ziad E
ZE
Chia
Stanley H
SH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced* / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007442:Intubation, Intratracheal; D007818:Laryngeal Diseases / Q000139:chemically induced / Q000628:therapy; D008047:Lip Diseases / Q000139:chemically induced / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000139:chemically induced / Q000628:therapy; D009060:Mouth Floor / Q000187:drug effects; D010160:Palate, Soft / Q000187:drug effects; D010608:Pharyngeal Diseases / Q000139:chemically induced / Q000628:therapy; D012189:Retrospective Studies; D012798:Sialorrhea / Q000139:chemically induced / Q000628:therapy; D014060:Tongue Diseases / Q000139:chemically induced / Q000628:therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D006634:Histamine H1 Antagonists; D006635:Histamine H2 Antagonists