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CASE REPORT
Life-threatening ACE inhibitor-induced angio-oedema successfully treated with icatibant: a bradykinin receptor antagonist
  1. Sarah Ostenfeld1,
  2. Anette Bygum2,
  3. Eva Rye Rasmussen3
  1. 1Department of Anaesthesiology and Intensive Care, Roskilde University Hospital, Roskilde, Denmark
  2. 2Dermatology and Allergy Center, University Hospital of Odense, Odense, Denmark
  3. 3Department of Otorhinolaryngology Head and Neck Surgery, Koege Hospital, Koege, Denmark
  1. Correspondence to Dr Anette Bygum, anette.bygum{at}rsyd.dk

Summary

We present a case of a 75-year-old woman treated with an ACE inhibitor, who presented with angio-oedema of the tongue and had difficulty speaking. No symptoms of anaphylaxis or urticaria were present. The patient was treated intravenously with antihistamine and glucocorticoid in combination with adrenaline inhalations. After 6 h in the hospital the swelling progressed, and the patient was admitted to the intensive care unit and treated with one injection of icatibant—a bradykinin receptor antagonist. The patient reported subjective relief after 20–30 min and the swelling resolved within 2 h. Although the angio-oedema was potentially life threatening, the patient avoided intubation and mechanical ventilation. ACE inhibitor-induced angio-oedema is most likely caused by an accumulation of bradykinin and substance P. Consequently, a bradykinin receptor antagonist is the rational treatment of choice instead of antiallergic medications, which have no proven efficacy in this condition.

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