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Drug-induced angioedema without urticaria.

A Agostoni¹, M Cicardi

¹Department of Internal Medicine, IRCCS Milan Maggiore Hospital, University of Milan, Italy. Angelo.Agostoni@unimi.it

|August 2, 2001

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Angioedema without hives can be a serious side effect of medications like ACE inhibitors. Promptly discontinuing the suspected drug is crucial for managing this condition.

Area of Science:

Pharmacology
Immunology
Clinical Medicine

Background:

Angioedema without urticaria involves deep tissue swelling and can be allergic or non-allergic.
Antihistamines are effective for allergic angioedema, but not for cases linked to C1-INH deficiency or drug reactions.
Angiotensin-converting enzyme (ACE) inhibitors are a significant cause of drug-induced angioedema, potentially leading to fatal laryngeal edema.

Purpose of the Study:

To review the causes and management of angioedema, particularly drug-induced forms.
To highlight the underestimation of ACE inhibitor-induced angioedema.
To discuss alternative drug classes and other potential triggers for angioedema.

Main Methods:

Literature review of angioedema, focusing on drug-induced cases.

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Analysis of the mechanisms and clinical presentations of angioedema.

Discussion of diagnostic and management strategies.

Main Results:

ACE inhibitors are a common cause of non-allergic angioedema, often overlooked.
Angiotensin II receptor antagonists and fibrinolytic agents are also implicated.
Other drugs including estrogens, antihypertensives, psychotropics, and NSAIDs can trigger angioedema.

Conclusions:

Discontinuation of the offending drug is the primary management for drug-induced angioedema.
Patients with C1-INH deficiency should avoid ACE inhibitors and estrogens.
Further research is needed to establish optimal treatments for severe angioedema and airway obstruction.