Beta-Blockers, Angiotensin-Converting Enzyme Inhibitors, and Anaphylaxis

This article examines the evolving understanding of β-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs) in the context of anaphylaxis. While once considered relative or absolute contraindications, current evidence shows minimal absolute risk of severe reactions and supports continuation in most patients, particularly when cardiovascular disease is present. For venom and allergen immunotherapies, large studies and guidelines endorse individualized risk-benefit assessment and shared decision-making. Caution remains for patients with unpredictable anaphylaxis, and glucagon may aid adrenaline-resistant cases in BB users. Discontinuation is rarely necessary, with cardiovascular protection usually outweighing theoretic allergic risk.