title: Angioedema induced by cardiovascular drugs: new players join old friends.
abstract: During the last years, two new cardiovascular drug classes, namely inhibitors of DPP IV or neprilysin, have been developed. In both cases, there is clinical evidence for their potential to induce angioedema as known already from blockers of the renin-angiotensin-aldosterone system (RAAS). The majority of angioedema induced by DPP IV inhibitors occurs during concomitant treatment with ACEi and is therefore likely mediated by overactivation of bradykinin type 2 receptors (B2). In striking contrast, the molecular pathways causing angioedema induced by neprilysin inhibitors, that is, sacubitril, are unclear, although a contribution of bradykinin appears likely. Nevertheless, there is no clinical evidence suggesting that inhibition of B2 might relieve the symptoms and/or prevent invasive treatment including coniotomy or tracheotomy in angioedema caused by these drugs. Therefore, the risk of angioedema should always be considered, especially in ambulatory care situations where patients have no rapid access to intensive care.
authors.affiliation: Otorhinolaryngology Department, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bas
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Greve
authors.affiliation: Otorhinolaryngology Department, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Strassen
authors.affiliation: Institute of Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Khosravani
authors.affiliation: Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany.
authors.forename: T K
authors.initials: TK
authors.lastname: Hoffmann
authors.affiliation: Institute of Pharmacology and Clinical Pharmacology, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kojda
mesh_terms: D000799:Angioedema / Q000209:etiology* / Q000378:metabolism; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D001920:Bradykinin / Q000378:metabolism; D002317:Cardiovascular Agents / Q000009:adverse effects*; D006801:Humans; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D001920:Bradykinin
keywords: ACE inhibitor; angioedema; bradykinin type 2 receptor; icatibant; sacubitril