Diagnosis
H&P:
Typical presentation: Patient was started on Lisinopril. A few hours after taking the first dose, he shows up to the ER with facial, lip, tongue edema, tightness in his throat that has been gradually progressing over the last few hours. He has some mild stridor but no rash and no pruritus.
DDx
Treatment
Icatibant (a bradykinin receptor type 2 blocker) is recommended in patients with laryngeal angioedema compromising airway function.
Background
“Less than 1% of patients started on an ACE inhibitor develop angioedema, but some studies have reported that up to 10% of these patients require intubation.” ABFM
ACE-inhibitor induced angioedema is due to increased bradykinin and NOT histamine. As such, antihistamines, anticholinergics, corticosteroids, and epinephrine are not effective.
Reference / Further Reading
Bezalel S, Mahlab-Guri K, Asher I, et al: Angiotensin-converting enzyme inhibitor-induced angioedema. Am J Med 2015;128(2):120-125.