[Angioneurotic edema of the head and neck in association with ACE inhibitors]

ACE-inhibitors are said to cause angioneurotic edema. In spite of the fact that patients with acute angioedema of the head and neck region are usually admitted to an ENT department, there is only limited information available in the otorhinolaryngological literature on the frequency, risk of recurrent episodes and clinical significance of ACE inhibitor related angioedema.

The medical histories of all patients admitted to our hospital due to acute angioneurotic edema during the period from 1 January 1988 to 31 December 2001 were reviewed. These were supplemented with the results of a standardized questionnaire filed out by the affected patients and of a non-affected control-group.

During the observation period. 121 patients were treated for acute angioneurotic edema of the head and neck region. In 34 patients (=28.1%), edema was related to permanent treatment with ACE inhibitors. The overall frequency of angioedema and the percentage of ACE inhibitor related angioedema showed a continuous increase during the study period. There was a latency from the beginning of ACE inhibitor treatment until the first manifestation of angioedema of up to 13 years. In comparison with the group of edema patients without ACE inhibitor treatment, we found a threefold risk of recurrent edema in the ACE group. Women were affected by recurrent episodes more often than men. Until now, any individual assessment of the probable risk of developing an angioneurotic edema during ACE inhibitor treatment appears to be impossible.