Angiotensin-converting enzyme inhibitors as a cause of isolated angioedema in a Slovenian population

Abstract

Introduction: Angioedema (AE) is a localized swelling of the subcutaneous tissue and mucosa. We aimed to identify how often AE is associated with angiotensin-converting enzyme inhibitor (ACEI-AE) therapy and whether the severity of AE episodes in these patients differs from the severity in idiopathic AE (IAE). Methods: We included patients with AE that were referred to a tertiary allergy clinic from 2005 to 2014. We obtained data on AE location, severity, number, and treatment of episodes from patient medical files. Patients treated with ACEI were contacted to obtain follow-up data on the effect of ACEI discontinuation. Results: A total of 603 patients with AE were referred (59.9% women) to our clinic. A total of 36.9% had AE associated with urticaria or anaphylaxis. Among 381 patients with isolated AE, 10.5% of the patients were diagnosed with identified causes. The proportion of ACEI-AE was 27.1% to 37.9% (95% CI); others were classified as IAE. ACEI-AE cases had more severe episodes compared to IAE cases, which were more likely to be treated by a family doctor or even hospitalized. Conclusion: ACEI was shown to be the most frequent removable cause of isolated AE. About two-thirds of AE cases taking ACEI were resolved after removal of the drug.