title: Icatibant in angiotensin-converting enzyme (ACE) inhibitor-associated angioedema.
abstract: BACKGROUND
  Angioedema occurs in up to 2% of those taking angiotensin-converting enzyme (ACE) inhibitors. Upper airway angioedema may potentially require endotracheal intubation or cricothyrotomy, and is usually unresponsive to adrenaline. The bradykinin receptor antagonist icatibant is proven to be effective in the treatment of acute attacks of hereditary angioedema, and has also been reported effective in the treatment of angioedema associated with ACE inhibitors.
  
  
  OBJECTIVE
  To describe the use of icatibant for ACE inhibitor-associated airway angioedema.
  
  
  METHODS
  We treated 13 consecutive emergency department (ED) patients, who had not improved with adrenaline and/or corticosteroids, with icatibant 30 mg subcutaneously for ACE inhibitor-associated upper respiratory tract angioedema according to an agreed protocol.
  
  
  RESULTS
  Four patients were intubated in the ED either before or after receiving icatibant; three of these were extubated within 24 h of treatment. Eight patients received early icatibant and did not require intubation. The time from onset of airway angioedema to ED presentation ranged from 1 h to 3 days (median 4 h); from ED presentation to receiving icatibant, from 30 minutes to 3 days (median 3 h); and to onset of symptom improvement after icatibant, 15 minutes to 7 h (median 2 h). One patient received a second dose of icatibant.
  
  
  CONCLUSIONS
  All patients improved after receiving icatibant, consistent with its bradykinin receptor blocking mechanism. Icatibant rapidly reversed symptoms, and appeared to avert the need for intubation or expedite extubation. Timely use of icatibant in ACE inhibitor-associated angioedema may avert the need for invasive airway procedures and intensive care unit admission.
authors.affiliation: Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: J S
authors.initials: JS
authors.lastname: Fok
authors.affiliation: Department of Clinical Immunology and Allergy, Campbelltown Hospital, Sydney, New South Wales, Australia.|University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: C H
authors.initials: CH
authors.lastname: Katelaris
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Queensland, Australia.|Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: A F
authors.initials: AF
authors.lastname: Brown
authors.affiliation: Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: W B
authors.initials: WB
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced / Q000188:drug therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065094:Bradykinin B2 Receptor Antagonists / Q000627:therapeutic use*; D000066491:Clinical Decision-Making / Q000379:methods; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007830:Larynx / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000473:pathology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D065094:Bradykinin B2 Receptor Antagonists; C065679:icatibant; D001920:Bradykinin
keywords: airway angioedema; angiotensin-converting enzyme inhibitor; emergency department; icatibant; intubation