Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
Abstract Introduction Angiotensin Converting Enzyme Inhibitors (ACEI) are a common cause of Emergency Room presentation for angioedema. Although no treatment guidelines exist, C1 esterase inhibitor concentrate (C1-INH) is used on an off label basis for management of ACEI acquired angioedema (ACEI AA...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-02-01
|
| Series: | Allergy, Asthma & Clinical Immunology |
| Online Access: | https://doi.org/10.1186/s13223-021-00521-w |
| _version_ | 1818923503394488320 |
|---|---|
| author | Uliana Kovaltchouk Boyang Zhang Vipul Jain Chrystyna Kalicinsky |
| author_facet | Uliana Kovaltchouk Boyang Zhang Vipul Jain Chrystyna Kalicinsky |
| author_sort | Uliana Kovaltchouk |
| collection | DOAJ |
| description | Abstract Introduction Angiotensin Converting Enzyme Inhibitors (ACEI) are a common cause of Emergency Room presentation for angioedema. Although no treatment guidelines exist, C1 esterase inhibitor concentrate (C1-INH) is used on an off label basis for management of ACEI acquired angioedema (ACEI AAE). Objective To evaluate the efficacy of C1-INH in management of ACEI AAE at our local centers. Results Nine patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010–2020. The majority of the patients (n = 8/9) required endotracheal intubation prior to the initiation of C1-INH. Overall, approximately 56% of patients (n = 5/9) had resolution of angioedema ranging between 12 and 17 h, with a median time of 13.5 h, and no recurrence after the administration of C1-INH concentrate. One patient had transient symptom resolution in 14 h, however, recurrence of angioedema required re-intubation. The remainder of patients (n = 4/9), had resolution of angioedema between 22 and 72 h, with a median time of 33.75 h. Conclusion Our findings demonstrate continued ambivalence of the efficacy and role of C1-INH concentrate in the treatment of ACEI AAE, secondary to multiple uncontrolled confounding factors. Further research into characterizing a subgroup of intubated patients in our study that responded to C1-INH concentrate needs to be completed. |
| first_indexed | 2024-12-20T02:10:28Z |
| format | Article |
| id | doaj.art-f7755c07441b4e3599b6f3704d797a16 |
| institution | Directory Open Access Journal |
| issn | 1710-1492 |
| language | English |
| last_indexed | 2024-12-20T02:10:28Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Allergy, Asthma & Clinical Immunology |
| spelling | doaj.art-f7755c07441b4e3599b6f3704d797a162022-12-21T19:57:05ZengBMCAllergy, Asthma & Clinical Immunology1710-14922021-02-011711410.1186/s13223-021-00521-wEffectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedemaUliana Kovaltchouk0Boyang Zhang1Vipul Jain2Chrystyna Kalicinsky3Internal medicine, University of ManitobaMax Rady College of Medicine, University of ManitobaClinal Immunology and Allergy, McMaster UniversityAllergy and Immunology, University of ManitobaAbstract Introduction Angiotensin Converting Enzyme Inhibitors (ACEI) are a common cause of Emergency Room presentation for angioedema. Although no treatment guidelines exist, C1 esterase inhibitor concentrate (C1-INH) is used on an off label basis for management of ACEI acquired angioedema (ACEI AAE). Objective To evaluate the efficacy of C1-INH in management of ACEI AAE at our local centers. Results Nine patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010–2020. The majority of the patients (n = 8/9) required endotracheal intubation prior to the initiation of C1-INH. Overall, approximately 56% of patients (n = 5/9) had resolution of angioedema ranging between 12 and 17 h, with a median time of 13.5 h, and no recurrence after the administration of C1-INH concentrate. One patient had transient symptom resolution in 14 h, however, recurrence of angioedema required re-intubation. The remainder of patients (n = 4/9), had resolution of angioedema between 22 and 72 h, with a median time of 33.75 h. Conclusion Our findings demonstrate continued ambivalence of the efficacy and role of C1-INH concentrate in the treatment of ACEI AAE, secondary to multiple uncontrolled confounding factors. Further research into characterizing a subgroup of intubated patients in our study that responded to C1-INH concentrate needs to be completed.https://doi.org/10.1186/s13223-021-00521-w |
| spellingShingle | Uliana Kovaltchouk Boyang Zhang Vipul Jain Chrystyna Kalicinsky Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema Allergy, Asthma & Clinical Immunology |
| title | Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema |
| title_full | Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema |
| title_fullStr | Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema |
| title_full_unstemmed | Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema |
| title_short | Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema |
| title_sort | effectiveness of c1 inh therapy in angiotensin converting enzyme inhibitor induced angioedema |
| url | https://doi.org/10.1186/s13223-021-00521-w |
| work_keys_str_mv | AT ulianakovaltchouk effectivenessofc1inhtherapyinangiotensinconvertingenzymeinhibitorinducedangioedema AT boyangzhang effectivenessofc1inhtherapyinangiotensinconvertingenzymeinhibitorinducedangioedema AT vipuljain effectivenessofc1inhtherapyinangiotensinconvertingenzymeinhibitorinducedangioedema AT chrystynakalicinsky effectivenessofc1inhtherapyinangiotensinconvertingenzymeinhibitorinducedangioedema |