title: Use of C1 Inhibitor for Angiotensin-Converting Enzyme (ACE) Inhibitor-Induced Angioedema Decreases Mechanical Ventilation Time.
abstract: BACKGROUND
  Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is a rare, albeit serious emergency that can result in airway compromise and potentially death if not treated promptly. Currently, there are no agents approved by the Food and Drug Administration to target ACE inhibitor angioedema and to prevent intubation. C1 inhibitors are approved for hereditary angioedema but may show promise in alleviating inflammation associated with ACE inhibitor angioedema.
  
  
  METHODS
  A 41-year-old man presented to the emergency department with swelling of his lips a few days after starting lisinopril for hypertension. Despite receiving diphenhydramine, ranitidine, and methylprednisolone, the swelling progressed to the patient's tongue. A C1 inhibitor was ordered in an effort to prevent intubation. Before the arrival of the medication, the patient was intubated emergently for airway protection. After receipt of the C1 inhibitor, the swelling dramatically improved, and the patient was successfully extubated after less than 18 hours from presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates a potential role for C1 inhibitors in the emergency setting for treating drug-induced angioedema, which may prevent or minimize mechanical ventilation time.
authors.affiliation: Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Urnoski
authors.affiliation: Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.
authors.forename: Angelo
authors.initials: A
authors.lastname: Grillo
authors.affiliation: Department of Pharmacy, Christiana Care Health System, Newark, Delaware.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rosini
mesh_terms: D000328:Adult; D000799:Angioedema / Q000139:chemically induced* / Q000188:drug therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D003174:Complement C1 Inactivator Proteins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012121:Respiration, Artificial
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D003174:Complement C1 Inactivator Proteins
keywords: ACE inhibitor; C1 inhibitor; angioedema