Philippe Camus, M.D.

Dijon, France

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XXVIII.a

Angioedema (may cause UAO, asphyxia and death)

Risk is increased in smokers and in patients with renal failure or in solid organ transplant recipients. Can be unilateral (PMID 14595286). Severe cases can fatal due to asphyxia. Ecallantide and icatibant are significant additions to the management of angioedema-UAO cases with compromised airway patency (PMID 24096073, 25328718, 25635988, 25944565. Significant upper airway angioedema is a potentially life-threatening condition capable of causing asphyxia. Management include maintenance or airway patency. In recalcitrant cases, in addition to icatibant (PMID 22936825, 22944544, 25646708), C1-inhibitor concentrate (22944544) or fresh-frozen plasma (FFP) (PMID 15191027, 24096073) are indicated (PMID 18206518). A report indicates that patients on this class of medications may develop unusually severe oral allergy syndrome with mouth or throat swelling (PMID: 25727650). ACEI-associated angioedema may also involve the genitalia or intestines, causing cramping, diarrhea or an acute abdomen with or without systemic hypotension (PMID 11773949)

Publications

Briggs B, Cline D, Husain I

Disposition of emergency department patients presenting with angiotensin-converting enzyme inhibitor-induced angioedema.

International journal of emergency medicine 2025 Jan 10;18;11 — 2025 Jan 10 — 11

Landry L, Witten T, Anwar AI, Jackson CN, Talbot NC, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD

Angiotensin-Converting Enzyme Inhibitors and Other Medications Associated With Angioedema.

Cureus 2023 Nov;15;e49306 — 2023 Nov — e49306

Day C, Van der Walt J, Crombie K, Hendrikse C, Peter J

Acute angioedema in Cape Town emergency centres and a suggested algorithm to simplify and improve management.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2023 Aug 03;113;51-57 — 2023 Aug 03 — 51-57

Weisman DS, Arnouk N, Asghar MB, Qureshi MR, Kumar A, Desale S, Camire L, Pineda S

ACE inhibitor angioedema: characterization and treatment versus non-ACE angioedema in acute hospitalized patients.

Journal of community hospital internal medicine perspectives 2020;10;16-18 — 2020 — 16-18

Burd M, McPheeters C, Scherrer LA

Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors.

Advanced emergency nursing journal 2019 Jul/Sep;41;204-214 — 2019 Jul/Sep — 204-214

Ducote C, Kesterke MJ, Bhattacharjee R, Read-Fuller A, Reddy LV

Macroglossia secondary to lisinopril-induced acute angioedema.

Proceedings (Baylor University. Medical Center) 2019 Jan;32;70-72 — 2019 Jan — 70-72

Alharbi FA, Alharthi AA, Alsaadi FN

Perindopril-induced angioedema of the lips and tongue: a case report.

Journal of medical case reports 2018 Dec 05;12;359 — 2018 Dec 05 — 359

Sczepanski M, Bozyk P

Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents.

Critical care research and practice 2018;2018;9360918 — 2018 — 9360918

Depetri F, Tedeschi A, Cugno M

Angioedema and emergency medicine: From pathophysiology to diagnosis and treatment.

European journal of internal medicine 2019 01;59;8-13 — 2019 01 — 8-13

Jackeviciute J, Pilvinis V, Pilviniene R

Fatal outcome of late-onset angiotensin-converting enzyme inhibitor induced angioedema: A case report.

Medicine 2018 Aug;97;e11695 — 2018 Aug — e11695

Kostis WJ, Shetty M, Chowdhury YS, Kostis JB

ACE Inhibitor-Induced Angioedema: a Review.

Current hypertension reports 2018 06 08;20;55 — 2018 06 08 — 55

Gandhi J, Jones R, Teubner D, Gabb G

Multicentre audit of ACE-inhibitor associated angioedema (MAAAA).

Australian family physician 2015 Aug;44;579-83 — 2015 Aug — 579-83

Bukhari E, Safdar OY, Shalaby M, AlSharif SM, Alsufiany K, Kari JA

Potentially lethal ACE-inhibitor-induced angioedema in a child.

Clinical case reports 2015 Jun;3;427-30 — 2015 Jun — 427-30

Javaud N, Floccard B, Gontier F, Lapostolle F, Boccon-Gibod I, Martin L, Amarger S, Boumedienne A, Boubaya M, Asfar P, Coppere B, Ollivier Y, Bouillet L, Adnet F, Fain O

Bradykinin-mediated angioedema: factors associated with admission to an intensive care unit, a multicenter study.

European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2016 Jun;23;219-23 — 2016 Jun — 219-23

Berhe DF, Juhlin K, Star K, Beyene KG, Dheda M, Haaijer-Ruskamp FM, Taxis K, Mol PG

Adverse drug reaction reports for cardiometabolic drugs from sub-Saharan Africa: a study in VigiBase.

Tropical medicine & international health : TM & IH 2015 Jun;20;797-806 — 2015 Jun — 797-806

Ba? M, Greve J, Stelter K, Havel M, Strassen U, Rotter N, Veit J, Schossow B, Hapfelmeier A, Kehl V, Kojda G, Hoffmann TK

A randomized trial of icatibant in ACE-inhibitor-induced angioedema.

The New England journal of medicine 2015 Jan 29;372;418-25 — 2015 Jan 29 — 418-25

Felder S, Curtis RM, Ball I, Borici-Mazi R

Prognostic factors in outcome of angioedema in the emergency department.

Allergy and asthma proceedings 2014 Sep-Oct;35;362-70 — 2014 Sep-Oct — 362-70

Chan NJ, Soliman AM

Angiotensin converting enzyme inhibitor-related angioedema: onset, presentation, and management.

The Annals of otology, rhinology, and laryngology 2015 Feb;124;89-96 — 2015 Feb — 89-96

Loftus PA, Tan M, Patel G, Lin J, Helman S, Badhey A, Du E, Smith RV, Fried MP, Ow TJ

Risk factors associated with severe and recurrent angioedema: an epidemic linked to ACE-inhibitors.

The Laryngoscope 2014 Nov;124;2502-7 — 2014 Nov — 2502-7

Baram M, Kommuri A, Sellers SA, Cohn JR

ACE inhibitor-induced angioedema.

The journal of allergy and clinical immunology. In practice 2013 Sep-Oct;1;442-5 — 2013 Sep-Oct — 442-5

Brook CD, Devaiah AK, Davis EM

Angioedema of the upper aerodigestive tract: risk factors associated with airway intervention and management algorithm.

International forum of allergy & rhinology 2014 Mar;4;239-45 — 2014 Mar — 239-45

Rasmussen ER, Mey K, Bygum A

Angiotensin-converting enzyme inhibitor-induced angioedema--a dangerous new epidemic.

Acta dermato-venereologica 2014 May;94;260-4 — 2014 May — 260-4

Bertazzoni G, Spina MT, Scarpellini MG, Buccelletti F, De Simone M, Gregori M, Valeriano V, Pugliese FR, Ruggieri MP, Magnanti M, Susi B, Minetola L, Zulli L, D'Ambrogio F

Drug-induced angioedema: experience of Italian emergency departments.

Internal and emergency medicine 2014 Jun;9;455-62 — 2014 Jun — 455-62

Lewis LM

Angioedema: etiology, pathophysiology, current and emerging therapies.

The Journal of emergency medicine 2013 Nov;45;789-96 — 2013 Nov — 789-96

Winters ME, Rosenbaum S, Vilke GM, Almazroua FY

Emergency department management of patients with ACE-inhibitor angioedema.

The Journal of emergency medicine 2013 Nov;45;775-80 — 2013 Nov — 775-80

Leung E, Hanna MY, Tehami N, Francombe J

Isolated unilateral tongue oedema: the adverse effect of Angiotensin converting enzyme inhibitors.

Current drug safety 2012 Nov 01;7;382-3 — 2012 Nov 01 — 382-3

Montoro de Francisco A, García-Luque A, Fernández M, Puerro M

Side effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists: are we facing a new syndrome.

The American journal of cardiology 2012 Nov 15;110;1552-3 — 2012 Nov 15 — 1552-3

Javaud N, Karami A, Stirnemann J, Pilot F, Branellec A, Boubaya M, Chassaignon C, Adnet F, Fain O

Bradykinin-mediated angioedema: factors prompting ED visits.

The American journal of emergency medicine 2013 Jan;31;124-9 — 2013 Jan — 124-9

Holm JP, Ovesen T

Increasing rate of angiotensin-converting enzyme inhibitor-related upper airway angio-oedema.

Danish medical journal 2012 Jun;59;A4449 — 2012 Jun — A4449

Stojiljkovic L

Renin-angiotensin system inhibitors and angioedema: anesthetic implications.

Current opinion in anaesthesiology 2012 Jun;25;356-62 — 2012 Jun — 356-62

Andrew N, Gabb G, Del Fante M

ACEI associated angioedema - a case study and review.

Australian family physician 2011 Dec;40;985-8 — 2011 Dec — 985-8

Gallitelli M, Alzetta M

Icatibant: a novel approach to the treatment of angioedema related to the use of angiotensin-converting enzyme inhibitors.

The American journal of emergency medicine 2012 Oct;30;1664.e1-2 — 2012 Oct — 1664.e1-2

Caballero T, Baeza ML, Cabañas R, Campos A, Cimbollek S, Gómez-Traseira C, González-Quevedo T, Guilarte M, Jurado-Palomo J, Larco JI, López-Serrano MC, López-Trascasa M, Marcos C, Muñoz-Caro JM, Pedrosa M, Prior N, Rubio M, Sala-Cunill A,

Consensus statement on the diagnosis, management, and treatment of angioedema mediated by bradykinin. Part II. Treatment, follow-up, and special situations.

Journal of investigational allergology & clinical immunology 2011;21;422-41; quiz 442-3 — 2011 — 422-41; quiz 442-3

Beltrami L, Zanichelli A, Zingale L, Vacchini R, Carugo S, Cicardi M

Long-term follow-up of 111 patients with angiotensin-converting enzyme inhibitor-related angioedema.

Journal of hypertension 2011 Nov;29;2273-7 — 2011 Nov — 2273-7

Bramante RM, Rand M

Images in clinical medicine. Angioedema.

The New England journal of medicine 2011 Jul 14;365;e4 — 2011 Jul 14 — e4

Beavers CJ, Dunn SP, Macaulay TE

The role of angiotensin receptor blockers in patients with angiotensin-converting enzyme inhibitor-induced angioedema.

The Annals of pharmacotherapy 2011 Apr;45;520-4 — 2011 Apr — 520-4

Kloth N, Lane AS

ACE inhibitor-induced angioedema: a case report and review of current management.

Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2011 Mar;13;33-7 — 2011 Mar — 33-7

Sánchez-Borges M, González-Aveledo LA

Angiotensin-converting enzyme inhibitors and angioedema.

Allergy, asthma & immunology research 2010 Jul;2;195-8 — 2010 Jul — 195-8

Duerr M, Glander P, Diekmann F, Dragun D, Neumayer HH, Budde K

Increased incidence of angioedema with ACE inhibitors in combination with mTOR inhibitors in kidney transplant recipients.

Clinical journal of the American Society of Nephrology : CJASN 2010 Apr;5;703-8 — 2010 Apr — 703-8

Taki M, Watanabe H, Hasegawa T, Bamba H, Shimada T, Hisa Y

Angioedema: 6 years experience with fourteen cases.

Auris, nasus, larynx 2010 Apr;37;199-204 — 2010 Apr — 199-204

Hoover T, Lippmann M, Grouzmann E, Marceau F, Herscu P

Angiotensin converting enzyme inhibitor induced angio-oedema: a review of the pathophysiology and risk factors.

Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 2010 Jan;40;50-61 — 2010 Jan — 50-61

Banerji A, Clark S, Blanda M, LoVecchio F, Snyder B, Camargo CA

Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2008 Apr;100;327-32 — 2008 Apr — 327-32

Miller DR, Oliveria SA, Berlowitz DR, Fincke BG, Stang P, Lillienfeld DE

Angioedema incidence in US veterans initiating angiotensin-converting enzyme inhibitors.

Hypertension (Dallas, Tex. : 1979) 2008 Jun;51;1624-30 — 2008 Jun — 1624-30

Weber MA, Messerli FH

Angiotensin-converting enzyme inhibitors and angioedema: estimating the risk.

Hypertension (Dallas, Tex. : 1979) 2008 Jun;51;1465-7 — 2008 Jun — 1465-7

Symvoulakis EK, Kyrmizakis DE, Drivas EI, Bizakis J, Velegrakis GA, Lionis C

Angiotensin-converting enzyme inhibitor (ACE-I)- and angiotensin receptor blocker (ARB)-related angioedema: a neglected issue in daily practice in Greece.

The European journal of general practice 2007;13;239-41 — 2007 — 239-41

Cupido C, Rayner B

Life-threatening angio-oedema and death associated with the ACE inhibitor enalapril.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2007 Apr;97;244-5 — 2007 Apr — 244-5

Sarkar P, Nicholson G, Hall G

Brief review: angiotensin converting enzyme inhibitors and angioedema: anesthetic implications.

Canadian journal of anaesthesia = Journal canadien d'anesthesie 2006 Oct;53;994-1003 — 2006 Oct — 994-1003

Bas M, Hoffmann TK, Kojda G

Evaluation and management of angioedema of the head and neck.

Current opinion in otolaryngology & head and neck surgery 2006 Jun;14;170-5 — 2006 Jun — 170-5

Hurst M, Empson M

Oral angioedema secondary to ACE inhibitors, a frequently overlooked association: case report and review.

The New Zealand medical journal 2006 Apr 21;119;U1930 — 2006 Apr 21 — U1930

Shiber JR

Images in clinical medicine. Angioedema of the arytenoids.

The New England journal of medicine 2005 Oct 27;353;e15 — 2005 Oct 27 — e15

Sondhi D, Lippmann M, Murali G

Airway compromise due to angiotensin-converting enzyme inhibitor-induced angioedema: clinical experience at a large community teaching hospital.

Chest 2004 Aug;126;400-4 — 2004 Aug — 400-4

Ducroix JP, Outurquin S, Benabes-Jezraoui B, Gras V, Chaby G, Strunski V, Salle V, Smail A, Lok C, Andrejak M

[Angioedema and angiotensin converting enzyme inhibitors: a report of 19 cases].

La Revue de medecine interne 2004 Jul;25;501-6 — 2004 Jul — 501-6

Warrier MR, Copilevitz CA, Dykewicz MS, Slavin RG

Fresh frozen plasma in the treatment of resistant angiotensin-converting enzyme inhibitor angioedema.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 2004 May;92;573-5 — 2004 May — 573-5

Elinav E, Rabinowitz Y, Lorberbaum M, Nisanewitz V

Episodic macroglossia as the sole manifestation of angiotensin-converting enzyme inhibitor-induced angioedema.

The Annals of otology, rhinology, and laryngology 2004 Mar;113;223-4 — 2004 Mar — 223-4

Amen F, Thirlwall A, Lale A, Corbridge R

Acute airway obstruction secondary to ACE inhibitors: a growing concern.

The Journal of laryngology and otology 2004 Jan;118;70 — 2004 Jan — 70

Hill MD, Lye T, Moss H, Barber PA, Demchuk AM, Newcommon NJ, Green TL, Kenney C, Cole-Haskayne A, Buchan AM

Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke.

Neurology 2003 May 13;60;1525-7 — 2003 May 13 — 1525-7

Dean DE, Schultz DL, Powers RH

Asphyxia due to angiotensin converting enzyme (ACE) inhibitor mediated angioedema of the tongue during the treatment of hypertensive heart disease.

Journal of forensic sciences 2001 Sep;46;1239-43 — 2001 Sep — 1239-43

Chiu AG, Newkirk KA, Davidson BJ, Burningham AR, Krowiak EJ, Deeb ZE

Angiotensin-converting enzyme inhibitor-induced angioedema: a multicenter review and an algorithm for airway management.

The Annals of otology, rhinology, and laryngology 2001 Sep;110;834-40 — 2001 Sep — 834-40

Warner KK, Visconti JA, Tschampel MM

Angiotensin II receptor blockers in patients with ACE inhibitor-induced angioedema.

The Annals of pharmacotherapy 2000 Apr;34;526-8 — 2000 Apr — 526-8

Assadi FK, Wang HE, Lawless S, McKay CP, Hopp L, Fattori D

Angiotensin converting enzyme inhibitor-induced angioedema: a report of two cases.

Pediatric nephrology (Berlin, Germany) 1999 Nov;13;917-9 — 1999 Nov — 917-9

Gibbs CR, Lip GY, Beevers DG

Angioedema due to ACE inhibitors: increased risk in patients of African origin.

British journal of clinical pharmacology 1999 Dec;48;861-5 — 1999 Dec — 861-5

Mchaourab A, Sarantopoulos C, Stowe DF

Airway obstruction due to late-onset angioneurotic edema from angiotensin-converting enzyme inhibition.

Canadian journal of anaesthesia = Journal canadien d'anesthesie 1999 Oct;46;975-8 — 1999 Oct — 975-8

Abbosh J, Anderson JA, Levine AB, Kupin WL

Angiotensin converting enzyme inhibitor-induced angioedema more prevalent in transplant patients.

Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 1999 May;82;473-6 — 1999 May — 473-6

Agah R, Bandi V, Guntupalli KK

Angioedema: the role of ACE inhibitors and factors associated with poor clinical outcome.

Intensive care medicine 1997 Jul;23;793-6 — 1997 Jul — 793-6

Brown NJ, Snowden M, Griffin MR

Recurrent angiotensin-converting enzyme inhibitor--associated angioedema.

JAMA 1997 Jul 16;278;232-3 — 1997 Jul 16 — 232-3

Gabb GM, Ryan P, Wing LM, Hutchinson KA

Epidemiological study of angioedema and ACE inhibitors.

Australian and New Zealand journal of medicine 1996 Dec;26;777-82 — 1996 Dec — 777-82

Brown NJ, Ray WA, Snowden M, Griffin MR

Black Americans have an increased rate of angiotensin converting enzyme inhibitor-associated angioedema.

Clinical pharmacology and therapeutics 1996 Jul;60;8-13 — 1996 Jul — 8-13

Thompson T, Frable MA

Drug-induced, life-threatening angioedema revisited.

The Laryngoscope 1993 Jan;103;10-2 — 1993 Jan — 10-2

Oike Y, Ogata Y, Higashi D, Matsumura T, Numata Y

Fatal angioedema associated with enalapril.

Internal medicine (Tokyo, Japan) 1993 Apr;32;308-10 — 1993 Apr — 308-10

Pigman EC, Scott JL

Angioedema in the emergency department: the impact of angiotensin-converting enzyme inhibitors.

The American journal of emergency medicine 1993 Jul;11;350-4 — 1993 Jul — 350-4

Waldfahrer F, Leuwer A, Krause J, Iro H

[Severe oropharyngeal angioedema caused by ACE inhibitor. A case report].

HNO 1995 Jan;43;35-8 — 1995 Jan — 35-8

Warner NJ, Rush JE

Safety profiles of the angiotensin-converting enzyme inhibitors.

Drugs 1988;35 Suppl 5;89-97 — 1988 — 89-97

Cooper WD, Sheldon D, Brown D, Kimber GR, Isitt VL, Currie WJ

Post-marketing surveillance of enalapril: experience in 11,710 hypertensive patients in general practice.

The Journal of the Royal College of General Practitioners 1987 Aug;37;346-9 — 1987 Aug — 346-9

Huwyler T, Wüthrich B, Mühlethaler K, Kuhn H, Jungbluth H, Späth P, Hochreutener H

[Angioedema caused by enalapril (Reniten)].

Schweizerische medizinische Wochenschrift 1989 Sep 16;119;1253-6 — 1989 Sep 16 — 1253-6

Zech J, Tasman A, Maier H

[Angioneurotic edema of the tongue, induced by administration of ACE inhibitors].

HNO 1990 Apr;38;143-4 — 1990 Apr — 143-4

Seidman MD, Lewandowski CA, Sarpa JR, Potesta E, Schweitzer VG

Angioedema related to angiotensin-converting enzyme inhibitors.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 1990 Jun;102;727-31 — 1990 Jun — 727-31

Roberts JR, Wuerz RC

Clinical characteristics of angiotensin-converting enzyme inhibitor-induced angioedema.

Annals of emergency medicine 1991 May;20;555-8 — 1991 May — 555-8

Hedner T, Samuelsson O, Lunde H, Lindholm L, Andrén L, Wiholm BE

Angio-oedema in relation to treatment with angiotensin converting enzyme inhibitors.

BMJ (Clinical research ed.) 1992 Apr 11;304;941-6 — 1992 Apr 11 — 941-6

Kharasch ED

Angiotensin-converting enzyme inhibitor-induced angioedema associated with endotracheal intubation.

Anesthesia and analgesia 1992 Apr;74;602-4 — 1992 Apr — 602-4