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[Angioedema caused by enalapril (Reniten)].

T Huwyler1, B Wüthrich, K Mühlethaler

  • 1Allergiestation der Dermatologischen Universitätsklinik Zürich.

Schweizerische Medizinische Wochenschrift
|September 16, 1989
PubMed
Summary

Enalapril-induced angioedema can present with delayed diagnosis and severe symptoms. Antinuclear antibodies were elevated in patients but normalized after discontinuing enalapril.

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Area of Science:

  • Cardiology
  • Immunology
  • Pharmacology

Background:

  • Angioedema is a rare but serious side effect of ACE inhibitors like enalapril.
  • The underlying mechanisms of enalapril-induced angioedema are not fully understood, with immunological involvement generally considered unlikely.

Observation:

  • Two cases of delayed angioedema diagnosis (over one year) in patients taking enalapril are presented.
  • One patient experienced life-threatening laryngeal and tongue swelling, progressing to asystole and apnea.
  • The second patient presented with recurrent tongue edema and dyspnea.

Findings:

  • Both patients exhibited elevated antinuclear antibody (ANA) titers.
  • ANA titers normalized in both patients after cessation of enalapril medication.

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  • These findings suggest a potential, albeit unusual, immunological component in some cases of enalapril-induced angioedema.

    • Implications:

    • This case series highlights the importance of considering ACE inhibitor-induced angioedema even with delayed presentation.
    • The reversible elevation of ANAs warrants further investigation into the pathomechanisms of this adverse drug reaction.
    • Clinicians should be aware of potential immunological associations and monitor patients accordingly.