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[ACE-inhibition and bradykinin-mediated angioedema]
D Ndjekembo Shango1, O Simonet1, F Vallot1
1Service d'Anesthésie et Soins Intensifs, Centre Hospitalier de Wallonie-Picarde (CHwapi), Tournai, Belgique.
Revue Medicale De Liege
|March 12, 2020
Summary
Angiotensin converting enzyme inhibitors (ACE-i) can cause bradykinin-induced angioedema, often misdiagnosed as histamine-induced. Prompt recognition of ACE-i angioedema is crucial for appropriate patient management.
Area of Science:
- Pharmacology
- Immunology
- Emergency Medicine
Background:
- Angiotensin converting enzyme inhibitors (ACE-i) are a frequent cause of bradykinin-mediated angioedema.
- Bradykinin-induced angioedema is often misdiagnosed as histamine-induced angioedema, leading to delayed and inappropriate management.
- This confusion can result in adverse patient outcomes.
Observation:
- A case report details a patient experiencing bradykinin-mediated angioedema shortly after starting perindopril.
- The patient developed laryngeal edema requiring emergency orotracheal intubation.
- Enzyme assays revealed decreased activity of aminopeptidase P (APP) and Angiotensin-Converting Enzyme (ACE) in kinin catabolism.
Findings:
- The patient's angioedema was confirmed as bradykinin-mediated.
- Delayed diagnosis prevented the administration of specific treatments like C1 inhibitor concentrate or icatibant.
- Reduced activity in APP and ACE suggests a potential mechanism for impaired bradykinin breakdown.
Implications:
- Any angioedema developing during ACE-i therapy should be presumed to be bradykinin-mediated.
- Early and accurate diagnosis of ACE-i-induced angioedema is critical for timely intervention.
- This case highlights the importance of considering ACE-i as a potential cause of angioedema, even with atypical presentations.
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