Abstract
Background
Approximately 2% of angioedema (AE) patients have a hereditary or an acquired deficiency
of the complement 1 (C1) esterase inhibitor (C1 INH) gene. Some case reports indicate
an association between angiotensin-converting enzyme inhibitor (ACEI) use and exacerbation
of hereditary AE (HAE).
Objective
The aim of this retrospective study is to investigate the association between HAE
and ACEI use in a larger patient population.
Methods
A retrospective chart review of patients who presented with AE and patients with diagnostic
serum assays for functional C1 INH, C1 INH antigenic protein, C1q, C1q immune complex
(C1q IC), and complement 4 (C4) regardless of medical complaint. Descriptive statistics
were used to analyze the data.
Results
A total of 1594 patients had complement levels measured (136 C1 INH, 55 C1q, 10 C1q
IC, and 1500 C4), of which 156 (9.7%) patients presented with AE. Angiotensin-converting
enzyme inhibitor use was documented in 747 (47%) patients. Low C1 INH was detected
in one patient with recurrent AE who was not taking ACEI. Another patient who presented
with recurrent AE was found to have systemic lupus erythematosus with abnormal C4,
C1q, and C1q IC, but normal C1 INH. A low C4 level was present in 94 patients, 4 of
which had AE.
Conclusions
The risk of exacerbating HAE by ACEI might be present, but we did not find any association
in this retrospective study. Further studies are needed to determine the existence
of this association.
Keywords
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References
- Hereditary angiodema: a current state-of-the-art review, VII: Canadian Hungarian 2007 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema.Ann Allergy Asthma Immunol. 2008; 100: S30-S40
- 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema.Allergy Asthma Clin Immunol. 2010; 6: 24
- Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department.Ann Allergy Asthma Immunol. 2008; 100: 327-332
- Cytokine-associated angioedema syndromes including episodic angioedema with eosinophilia (Gleich's Syndrome).Immunol Allergy Clin North Am. 2006; 26: 769-781
- Nonallergic angioedema: role of bradykinin.Allergy. 2007; 62: 842-856
- An evaluation of risk factors for adverse drug events associated with angiotensin-converting enzyme inhibitors.J Eval Clin Pract. 2004; 10: 499-509
- Diagnosis and treatment of hereditary angioedema with normal C1 inhibitor.Allergy Asthma Clin Immunol. 2010; 6: 15
- Hereditary angioedema: new findings concerning symptoms, affected organs, and course.Am J Med. 2006; 119: 267-274
- Hypertension mega-trials with cardiovascular end points: effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.Am Heart J. 2004; 148: 747-754
- Angiotensin-converting enzyme inhibitors.Circulation. 1998; 97: 1411-1420
- Disease expression in women with hereditary angioedema.Am J Obstet Gynecol. 2008; 199: 484.e1-484.e4
- Angioedema due to ACE inhibitors: increased risk in patients of African origin.Br J Clin Pharmacol. 1999; 48: 861-865
- The stoichiometric measurement of the serum inhibition of the first component of complement by the inhibition of immune hemolysis.J Immunol. 1968; 100: 1154-1164
- Quantitation of Clr-Cls-Cl inactivator complexes by electroimmunoassay.Acta Pathol Microbiol Scand C. 1979; 87C: 79-81
- The value of rocket immunoelectrophoresis for C4 activation in the evaluation of patients with angioedema or C1-inhibitor deficiency.J Allergy Clin Immunol. 1986; 78: 1115-1120
- Acquired angioedema.Allergy Asthma Clin Immunol. 2010; 6: 14
- An adverse reaction to angiotensin-converting enzyme inhibitors in a patient with neglected C1 esterase inhibitor deficiency.J Allergy Clin Immunol. 1997; 99: 425-426
- Unmasking of acquired autoimmune C1-inhibitor deficiency by an angiotensin-converting enzyme inhibitor.Ann Allergy Asthma Immunol. 2001; 86: 461-464
- Hereditary angioedema presenting in late middle age after angiotensin-converting enzyme inhibitor treatment.Ann Allergy Asthma Immunol. 2007; 98: 397-401
- Hereditary angioedema first apparent in the ninth decade during treatment with ACE inhibitor.Ann Allergy Asthma Immunol. 2001; 87: 138-139
- Contraindications to the use of ace inhibitors in patients with C1 esterase inhibitor deficiency.Am J Med. 1991; 90: 278
- Hereditary angioedema: a broad review for clinicians.Arch Intern Med. 2001; 161: 2417-2429
- Hereditary and acquired angioedema: problems and progress: Proceedings of the Third C1 Esterase Inhibitor Deficiency Workshop and beyond.J Allergy Clin Immunol. 2004; 114: S51-131
- Clinical practice. Hereditary angioedema.N Engl J Med. 2008; 359: 1027-1036
- Activation of the coagulation cascade in C1-inhibitor deficiencies.Blood. 1997; 89: 3213-3218
- Mechanism of angioedema in first complement component inhibitor deficiency.Immunol Allergy Clin North Am. 2006; 26: 633-651
- The pathophysiology of hereditary angioedema.Clin Immunol. 2005; 114: 3-9
- Pathogenesis and laboratory diagnosis of hereditary angioedema.Allergy Asthma Proc. 2009; 30: 487-489
- The bradykinin-forming cascade and its role in hereditary angioedema.Ann Allergy Asthma Immunol. 2010; 104: 193-204
- Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema.J Emerg Med. 2013; 44: 764-772
- Fresh-frozen plasma as a treatment for life-threatening ACE-inhibitor angioedema.J Allergy Clin Immunol. 2002; 109: 370-371
- Effective treatment of hereditary angioedema with fresh frozen plasma in an emergency department.J Emerg Med. 2007; 33: 137-139
- Local bradykinin generation in hereditary angioedema.J Allergy Clin Immunol. 1999; 104: 1321-1322
- Hereditary angiodema: a current state-of-the-art review, IV: short- and long-term treatment of hereditary angioedema: out with the old and in with the new?.Ann Allergy Asthma Immunol. 2008; 100: S13-S18
- Acquired deficiency of the inhibitor of the first complement component: presentation, diagnosis, course, and conventional management.Immunol Allergy Clin North Am. 2006; 26: 669-690
- Clinical, biochemical, and genetic characterization of type III hereditary angioedema in 13 Northwest Spanish families.Ann Allergy Asthma Immunol. 2012; 109 (e2): 195-200
Article info
Publication history
Published online: July 29, 2013
Accepted:
May 1,
2013
Received in revised form:
December 20,
2012
Received:
September 12,
2012
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
