DefinitionThis section has been translated automatically.
Occurrence of angioedema after taking ACE inhibitors or angiotensin II receptor blockers (AT2RB). The latency period between drug intake and initial manifestation of the edema is highly variable (on average 2-3 years; about 2/3 of angioedema occurs within the first 3 months). In some cases, angioedema only develops in connection with a relevant infection or in combination with other drugs (e.g. diuretics, antidiabetics or even antibiotics). Due to the large number of medications taken, it is not always possible to clearly assign the ACE inhibitor etiologically and/or chronologically. Angioedema has also been reported in connection with dipeptidyl peptidase IV inhibitors (saxagliptin) and neprilysin inhibitors (sacubitrile).
Occurrence/EpidemiologyThis section has been translated automatically.
incidence 400-700/100,000 (0.4-0.7%); purely arithmetically, around 20,000-35,000 cases/year would be expected in Germany. In about 20% of these patients, the angioedema is severe, making an inpatient stay necessary.
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EtiopathogenesisThis section has been translated automatically.
LocalizationThis section has been translated automatically.
Clinical featuresThis section has been translated automatically.
- Edema occurs several months after the start of therapy, but also after years of problem-free use (on average 2-3 years). The bradykinin level is elevated during a seizure. The cough induced by ACE inhibitors is not a precursor of angioedema.
- The clinic of RAE angioedema is treacherous because it often starts as harmless mucosal edema, but after hours it develops into severe edema. The larynx and pharynx area is often affected. Swelling subsides after 24-72 hours, but can last up to 5 days. Infestation of hands, feet and the gastrointestinal tract is also possible.
DiagnosisThis section has been translated automatically.
Differential diagnosisThis section has been translated automatically.
TherapyThis section has been translated automatically.
- Stop the ACE inhibitor!
- The angioneurotic edema usually subsides within 1-5 days after discontinuation of the ACE inhibitor or the AT-II receptor blocker.
- In case of a vital threatening laryngeal edema, immediate securing of the respiratory tract (initiation of immediate intensive care measures - sedation, analgesia, if necessary intubation, tracheotomy; stabilization of circulation; see below shock, anaphylactic).
- Immediate administration ofC1 inactivator concentrate: 20IE/kg KG Berinert P.
- Alternatively: Icatibant (Firazyr), a synthetically produced decapeptide (protein fragment) is the most effective antagonist of the bradykinin B2 receptor to date. To date, Icatibant has only been approved by the EMA for the symptomatic treatment of acute attacks of hereditary angioedema in adults with C1 esterase inhibitor deficiency. Off-label use is currently only available for applications outside this indication. In a smaller study (n=12), the use of Icatibant (30mg s.c.) leads to a prompt improvement of angioedema.
Note(s)This section has been translated automatically.
Note: Antiallergic therapy is not effective in this form of angioedema.
Angioedema is also induced by renin inhibitors.
In ACEI-induced angioedema, switching to an AT1 receptor blocker is not a solution to the problem, as these can also cause angioedema (although less frequently than ACEI).
LiteratureThis section has been translated automatically.
- Bas M et al (2010) Emergency situation acute angioedema. DMW 135:1027-1031
- Bouillet L et al (2003) Angioedema and oral contraception. Dermatology 206: 106-109
- Dick W et al (1985) Current Diagnostic Options for Hereditary Angioedema (HAE) and Acquired Angioedema (AAE) Immune Infection 13: 113-118
- Greaves M et al (1991) Angioedema: manifestations and management. J Am Acad Dermatol 25: 155-161
- Sachs B et al (2018) Drug-associated angioedema. Dermatologist 69: 298-305
- Zuraw BL, Christiansen SC (2009) Pathogenesis and laboratory diagnosis of hereditary angioedema. Allergy Asthma Proc 30:487-492
Incoming links (3)Angioedema acquired; Angioedema acquired ace inhibitor-induced; Angioedema histamine-mediated;
Outgoing links (8)Ace inhibitors; Anaphylactic shock; Angioedema hereditary; Angioedema (overview); Bradykinin; Icatibant; Off-label use; Renin inhibitor;
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.