title: Angiotensin converting enzyme inhibitor-related angioedema: onset, presentation, and management.
abstract: OBJECTIVE
  This study aimed to determine the duration of use, presentation, and management of angiotensin converting enzyme (ACE) inhibitor-related angioedema patients at an urban academic medical center.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Eighty-eight patients who presented with ACE inhibitor-related angioedema between January 1, 2012, and December 31, 2012, were identified. They presented anywhere from 1 day to 20 years after starting an ACE inhibitor. About half the patients (50.7%) presented after taking an ACE inhibitor for at least 1 year. Fifty-five patients were female (62.5%). Twenty-eight patients (31.8%) had an airway intervention with 27 intubated and 1 requiring cricothyroidotomy. Six patients were intubated after more than 1 flexible laryngoscopy. The percentage of patients with involvement of the face, lips, tongue, floor of mouth, soft palate/uvula, and larynx were 12.5%, 60.2%, 39.7%, 6.8%, 17.0%, and 29.5%, respectively. Sixty-eight percent of patients with laryngeal edema were intubated. The majority of patients were treated with a corticosteroid and H1 and H2 receptor antagonists.
  
  
  CONCLUSIONS
  Angioedema can occur at any time after starting ACE inhibitor use, with nearly half occurring after 1 year of use. Laryngeal involvement occurred in a minority of patients, but most of these patients were felt to require airway protection.
authors: Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Norman J
authors: NJ
authors: Chan
authors: Department of Otolaryngology-Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA asoliman@temple.edu.
authors: Ahmed M S
authors: AM
authors: Soliman
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D058109:Airway Management / Q000379:methods; D000799:Angioedema / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification; D018926:Anti-Allergic Agents / Q000008:administration & dosage*; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007819:Laryngeal Edema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010414:Pennsylvania; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D018926:Anti-Allergic Agents
keywords: ACE inhibitor; airway intervention; angioedema; intubation