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Drug-induced angioedema without urticaria
1Department of Internal Medicine, IRCCS Milan Maggiore Hospital, University of Milan, Italy. Angelo.Agostoni@unimi.it
Drug Safety
|August 2, 2001
Summary
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.
- 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.