[Angioneurotic edema induced by angiotensin converting enzyme inhibitors]

Angioneurotic oedema is one of rare side effects of angiotensin converting enzyme inhibitors, its incidence is around 0.1-0.2%. Angio-oedema most commonly develops in the first 4 weeks of the treatment, but it can be observed later, after several months or even years. The association between the oedema and the drug intake can be difficult to recognize if the oedema is of delayed type and because the attacks can disappear spontaneously without discontinuation of the drug. The angioneurotic oedema is tend to be worsening during the treatment, and finally the obstruction of the upper respiratory tract can be fatal. The affected sites are the face, lips, tongue, upper respiratory tract, and the oedema can also develop in the gastrointestinal tract with abdominal pain and diarrhea, which can be misdiagnosed. The pathomechanism is thought to be rather biochemical than immunological. The pathogenetic factors are under investigation nowadays, but the increased level of bradykinin seems to be the most important factor. Authors treated 248 patients with angioneurotic oedema in the Department of Dermatology (Semmelweis Hospital, Miskolc) between January of 1997 and December of 2000, 44 patients took angiotensin converting enzyme inhibitors, and 16 patients were suspected as suffering from angio-oedema induced by this drug. All of the patients remained symptom-free after the adequate treatment and discontinuation of the suspected drug. Authors describe the clinical picture of the angio-oedema, the risk factors, and the contraindications of the angiotensin converting enzyme inhibitor treatment.