Allergic reaction related to ramipril use: a case report

Area of Science:

• Nephrology
• Pharmacology
• Genetics

Background:

• Angiotensin-converting enzyme (ACE) inhibitors are common treatments for diabetic nephropathy and hypertension.
• While generally safe, ACE inhibitors are known to cause angioedema, though the exact mechanism remains unclear.
• Angioedema presents a potential risk, necessitating careful patient monitoring during ACE inhibitor therapy.

Purpose of the Study:

• To report a case of angioedema induced by an ACE inhibitor in a patient with type 1 diabetes.
• To investigate the potential role of ACE gene polymorphism in the development of ACE inhibitor-induced angioedema.
• To assess the safety of angiotensin-II receptor blockers (ARBs) as an alternative in patients with a history of ACE inhibitor-induced angioedema.

Main Methods:

• A case report of a 23-year-old female with type 1 diabetes experiencing an allergic reaction (angioedema) 24 hours after initiating ramipril.
• Clinical diagnosis of pharmacodermy confirmed by skin biopsy.
• Genetic analysis revealing the DD genotype for the ACE polymorphism.
• Subsequent treatment with an ARB (losartan) after discontinuation of ramipril.

Main Results:

• The patient presented with moderate angioedema in uncommon regions shortly after ramipril initiation.
• Skin biopsy confirmed pharmacodermy.
• The ACE polymorphism identified was DD genotype.
• The patient tolerated losartan without adverse effects when prescribed as a nephroprotector.

Conclusions:

• ACE inhibitor-induced angioedema is uncommon, with variable clinical presentations and potential for severe complications.
• The DD genotype of the ACE gene may be associated with an increased risk of ACE inhibitor-induced angioedema.
• While ARBs should be used cautiously in patients with a history of ACE inhibitor-induced angioedema, they can be a viable alternative, as demonstrated by the successful use of losartan in this case.