Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema

R Gentry Wilkerson; Michael E Winters

doi:10.1016/j.emc.2021.09.004

Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema

Emerg Med Clin North Am. 2022 Feb;40(1):79-98. doi: 10.1016/j.emc.2021.09.004. Epub 2021 Oct 29.

Authors

R Gentry Wilkerson¹, Michael E Winters²

Affiliations

¹ Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: gwilkerson@som.umaryland.edu.
² Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: https://twitter.com/critcareguys.

PMID: 34782093
DOI: 10.1016/j.emc.2021.09.004

Abstract

Angioedema is a well-recognized and potentially lethal complication of angiotensin-converting enzyme inhibitor (ACEi) therapy. In ACEi-induced angioedema, bradykinin accumulates due to a decrease in its metabolism by ACE, the enzyme that is primarily responsible for this function. The action of bradykinin at bradykinin type 2 receptors leads to increased vascular permeability and the accumulation of fluid in the subcutaneous and submucosal space. Patients with ACEi-induced angioedema are at risk for airway compromise because of the tendency for the face, lips, tongue, and airway structures to be affected. The emergency physician should focus on airway evaluation and management when treating patients with ACEi-induced angioedema.

Keywords: ACE inhibitor–induced angioedema; Bradykinin; C1-inhibitor; Difficult airway; Quincke disease.

Publication types

Review

MeSH terms

Angioedema / etiology*
Angioedema / physiopathology
Angiotensin-Converting Enzyme Inhibitors / adverse effects*
Angiotensin-Converting Enzyme Inhibitors / pharmacology
Humans

Substances

Angiotensin-Converting Enzyme Inhibitors