Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers
Background: Bradykinin angioedemas are a potentially serious side effect of angiotensin-converting enzyme inhibitors (ACEI) and more controversially of angiotensin II receptor blockers (ARB). Their challenging diagnosis is based on the absence of any recurrence after more than 6 months of drug disco...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-08-01
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| Series: | World Allergy Organization Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1939455123000698 |
| _version_ | 1827821349850054656 |
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| author | Marie Douillard, MD Zineb Deheb, MD Agathe Bozon, MD Nadia Raison-Peyron, MD Olivier Dereure, MD, PhD Lionel Moulis, MD Angèle Soria, MD, PhD Aurélie Du-Thanh, MD, PhD |
| author_facet | Marie Douillard, MD Zineb Deheb, MD Agathe Bozon, MD Nadia Raison-Peyron, MD Olivier Dereure, MD, PhD Lionel Moulis, MD Angèle Soria, MD, PhD Aurélie Du-Thanh, MD, PhD |
| author_sort | Marie Douillard, MD |
| collection | DOAJ |
| description | Background: Bradykinin angioedemas are a potentially serious side effect of angiotensin-converting enzyme inhibitors (ACEI) and more controversially of angiotensin II receptor blockers (ARB). Their challenging diagnosis is based on the absence of any recurrence after more than 6 months of drug discontinuation; otherwise mast-cell driven angioedemas as a differential diagnosis must be considered. Objective: The aim of this study was to determine the prevalence of recurrent angioedema in patients referred for ACEI/ARB-induced bradykinin angioedema, after more than 6 months of drug discontinuation. Methods: We included ACEI/ARB-treated patients referred for angioedema(s) without hives and unresponsive to antihistamines, after they discontinued ACEI/ARB for at least 6 months. Any C1-inhibitor deficiency was excluded. The primary endpoint was the prevalence of patients with recurrent angioedema after more than 6 months of drug discontinuation and/or developing hives during follow-up. The secondary endpoint was the identification of epidemiological factors associated with any final diagnosis. Results: Thirty-eight of 93 patients (41%) with a suspicion of ACEI/ARB-induced bradykinin angioedema still had recurrent angioedema (n = 27) or developed hives (n = 2) or both (n = 9) after 6 months of drug discontinuation. Good response to icatibant and facial but not oral localization were predictive for the final diagnosis of ACEI/ARB-induced bradykinin angioedema and mast-cell driven angioedema, respectively. Conclusion: In patients referred for acquired angioedema without wheals occurring during ACEI/ARB therapy, 59% finally had a diagnosis of ACEI/ARB-induced bradykinin angioedema whereas 41% were rather diagnosed with mast-cell driven angioedema. The overdiagnosis of ACEI/ARB-induced bradykinin angioedema may deteriorate the management of severe cardiovascular conditions. |
| first_indexed | 2024-03-12T01:43:09Z |
| format | Article |
| id | doaj.art-22ec798aadd14a1dadc011c9e6ce36bf |
| institution | Directory Open Access Journal |
| issn | 1939-4551 |
| language | English |
| last_indexed | 2024-03-12T01:43:09Z |
| publishDate | 2023-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | World Allergy Organization Journal |
| spelling | doaj.art-22ec798aadd14a1dadc011c9e6ce36bf2023-09-10T04:24:01ZengElsevierWorld Allergy Organization Journal1939-45512023-08-01168100809Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockersMarie Douillard, MD0Zineb Deheb, MD1Agathe Bozon, MD2Nadia Raison-Peyron, MD3Olivier Dereure, MD, PhD4Lionel Moulis, MD5Angèle Soria, MD, PhD6Aurélie Du-Thanh, MD, PhD7Department of Dermatology, St Eloi Hospital, 34000, Montpellier, FranceMédecine Sorbonne Université, Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, FranceDepartment of Dermatology, St Eloi Hospital, 34000, Montpellier, FranceDepartment of Dermatology, St Eloi Hospital, 34000, Montpellier, FranceDepartment of Dermatology, St Eloi Hospital, 34000, Montpellier, FranceClinical and Epidemiological Research Unit, CHU, Montpellier, 34000, FranceMédecine Sorbonne Université, Service de Dermatologie et Allergologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Cimi-Paris, INSERM 1135, Paris, FranceDepartment of Dermatology, St Eloi Hospital, 34000, Montpellier, France; Corresponding author.Background: Bradykinin angioedemas are a potentially serious side effect of angiotensin-converting enzyme inhibitors (ACEI) and more controversially of angiotensin II receptor blockers (ARB). Their challenging diagnosis is based on the absence of any recurrence after more than 6 months of drug discontinuation; otherwise mast-cell driven angioedemas as a differential diagnosis must be considered. Objective: The aim of this study was to determine the prevalence of recurrent angioedema in patients referred for ACEI/ARB-induced bradykinin angioedema, after more than 6 months of drug discontinuation. Methods: We included ACEI/ARB-treated patients referred for angioedema(s) without hives and unresponsive to antihistamines, after they discontinued ACEI/ARB for at least 6 months. Any C1-inhibitor deficiency was excluded. The primary endpoint was the prevalence of patients with recurrent angioedema after more than 6 months of drug discontinuation and/or developing hives during follow-up. The secondary endpoint was the identification of epidemiological factors associated with any final diagnosis. Results: Thirty-eight of 93 patients (41%) with a suspicion of ACEI/ARB-induced bradykinin angioedema still had recurrent angioedema (n = 27) or developed hives (n = 2) or both (n = 9) after 6 months of drug discontinuation. Good response to icatibant and facial but not oral localization were predictive for the final diagnosis of ACEI/ARB-induced bradykinin angioedema and mast-cell driven angioedema, respectively. Conclusion: In patients referred for acquired angioedema without wheals occurring during ACEI/ARB therapy, 59% finally had a diagnosis of ACEI/ARB-induced bradykinin angioedema whereas 41% were rather diagnosed with mast-cell driven angioedema. The overdiagnosis of ACEI/ARB-induced bradykinin angioedema may deteriorate the management of severe cardiovascular conditions.http://www.sciencedirect.com/science/article/pii/S1939455123000698AngioedemaBradykininMast-cellAngiotensin converting enzyme inhibitorsUrticaria |
| spellingShingle | Marie Douillard, MD Zineb Deheb, MD Agathe Bozon, MD Nadia Raison-Peyron, MD Olivier Dereure, MD, PhD Lionel Moulis, MD Angèle Soria, MD, PhD Aurélie Du-Thanh, MD, PhD Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers World Allergy Organization Journal Angioedema Bradykinin Mast-cell Angiotensin converting enzyme inhibitors Urticaria |
| title | Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers |
| title_full | Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers |
| title_fullStr | Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers |
| title_full_unstemmed | Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers |
| title_short | Over diagnosis of bradykinin angioedema in patients treated with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers |
| title_sort | over diagnosis of bradykinin angioedema in patients treated with angiotensin converting enzyme inhibitors or angiotensin ii receptor blockers |
| topic | Angioedema Bradykinin Mast-cell Angiotensin converting enzyme inhibitors Urticaria |
| url | http://www.sciencedirect.com/science/article/pii/S1939455123000698 |
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