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Beta-Blockers, Angiotensin-Converting Enzyme Inhibitors, and Anaphylaxis.
1Division of Allergy & Immunology, Department of Medicine, Queen's University; Allergy Research Unit, Kingston Health Sciences Centre - Kingston General Hospital Site; Department of Biomedical and Molecular Sciences, Queen's University.
Immunology and Allergy Clinics of North America
|April 3, 2026
Summary
Beta-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs) are rarely contraindicated in anaphylaxis. Current evidence supports continuing these cardiovascular medications, as benefits typically outweigh theoretical allergy risks.
Area of Science:
- Cardiology
- Allergy and Immunology
- Pharmacology
Background:
- Historically, beta-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs) were often viewed as contraindications for anaphylaxis management.
- Concerns existed regarding potential for exacerbated or refractory anaphylactic reactions in patients using these medications.
Purpose of the Study:
- To review the current understanding and evidence regarding the use of BBs and ACEIs in patients experiencing anaphylaxis.
- To evaluate the risks versus benefits of continuing these medications during anaphylactic events, particularly in patients with cardiovascular disease.
Main Methods:
- Literature review of studies and guidelines concerning BBs, ACEIs, and anaphylaxis.
- Analysis of evidence on patient outcomes and reaction severity in relation to BB and ACEI use.
Main Results:
- Current evidence indicates a minimal absolute risk of severe reactions associated with BBs and ACEIs during anaphylaxis.
- Continuation of BBs and ACEIs is generally supported, especially in patients with underlying cardiovascular conditions.
- Individualized risk-benefit assessment is recommended for venom and allergen immunotherapy.
Conclusions:
- Discontinuation of BBs and ACEIs is rarely necessary for anaphylaxis management.
- The cardiovascular protective benefits of these medications usually outweigh theoretical risks of allergic reactions.
- Glucagon may be considered for adrenaline-resistant anaphylaxis in BB users.
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