title: Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema.
abstract: OBJECTIVE
  To investigate, for the first time, the frequency of recurrences of angiotensin-converting enzyme inhibitor (ACE-I)-related angioedema after the discontinuation of ACE-I.
  
  
  METHODS
  This retrospective study was conducted in an outpatient tertiary-level centre for a total period of 173 months (about 14 years). Consecutive patients with recurrent angioedema symptoms, initiated during treatment with an ACE-I, who had been followed for at least 12 months after discontinuation of the drug were eligible. The primary study variable was the incidence of recurrences of angioedema after ACE-I discontinuation. Angioedema location, type of ACE-I and indication for this treatment and the drugs prescribed after the discontinuation of ACE-I were also evaluated.
  
  
  RESULTS
  In total, 111 patients were followed; 54 of them (49%) were on enalapril. After discontinuation from ACE-I, 51 patients (46%) had further recurrences of angioedema; in 18 relapsers (16% of the total), the frequency of angioedema recurrences remained unchanged when compared with that reported during ACE-I treatment. The large majority of relapsers (88%) had the first recurrence of angioedema within the first month since ACE-I discontinuation. The switch to a different antihypertensive therapy did not seem associated with a reduction in the frequency of angioedema attacks.
  
  
  CONCLUSIONS
  Even with all the limitations on any observational analysis, this long-term study suggests for the first time that patients with angioedema started while on ACE-I treatment seem to have a condition predisposing to angioedema that is elicited by the treatment with these drugs. Further studies in this field appear advocated due to the potential severity of angioedema attacks.
authors.affiliation: Fondazione Salvatore Maugeri, Istituto Scientifico di Milano, IRCCS, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Beltrami
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanichelli
authors.forename: Lorenza
authors.initials: L
authors.lastname: Zingale
authors.forename: Romualdo
authors.initials: R
authors.lastname: Vacchini
authors.forename: Stefano
authors.initials: S
authors.lastname: Carugo
authors.forename: Marco
authors.initials: M
authors.lastname: Cicardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D002309:Cardiology / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors