ACE Inhibitor-Induced Angioedema

Angioedema

Ambulatory Care,Dermatologic

Written by the doctors and editors at UpToDate
What is angioedema? — Angioedema is a condition that causes puffiness in the tissue under the skin. People with angioedema might have swelling of the face, eyelids, ears, mouth, tongue, hands, feet, or genitals.
Some people who get angioedema also get hives. Hives are red, raised patches of skin that are very itchy (picture 2).
Sometimes, people have symptoms of angioedema when they are having a dangerous allergic reaction. Call for an ambulance (in the US and Canada, dial 9-1-1) if you suddenly have puffiness or hives plus any of the following:
Trouble breathing
Tightness in your throat
Trouble swallowing your saliva
Nausea and vomiting
Cramps or stomach pain
Passing out
Why did I get angioedema? — A common cause of angioedema is allergies. If you just got angioedema for the first time, it might be because you have a new allergy to something. Allergies to the following things can cause angioedema:
Medicines (described below)
Insect stings
Foods, such as eggs, nuts, fish, or shellfish
Something you have touched, such as a plant, animal saliva, or latex
Exercise
The medicines that can cause angioedema include:
Antibiotics (usually with hives, trouble breathing, and other symptoms of an allergic reaction)
Medicines used to treat high blood pressure or heart disease called angiotensin-converting enzyme inhibitors (or "ACE inhibitors") – Examples include enalapril, captopril, and lisinopril. People who get angioedema because of these medicines usually don't have hives or itching.
Over-the-counter medicines for pain and fever, such as aspirin, ibuprofen (sample brand names: Motrin, Advil), and naproxen (sample brand name: Aleve)
Angioedema can also be caused by rare diseases that sometimes run in families. An example is hereditary angioedema. In this disease, people get repeated attacks of angioedema, belly pain, or swelling in the throat. These attacks last 2 to 5 days and then get better. However, the disease is serious because swelling in the throat can cut off the air supply. If you have angioedema and other people in your family do too, you should see a doctor. There is testing and treatment for hereditary angioedema.
Sometimes, doctors don't know the cause of angioedema.
Is there a test for angioedema? — There are tests for angioedema caused by allergies and for the rare diseases that can run in families. But there are no tests for most of the other causes of angioedema. Still, your doctor or nurse can often tell if you have angioedema by learning about your symptoms and asking questions.
How is angioedema treated? — The treatment depends on how serious your symptoms are. If you get angioedema because of a dangerous allergic reaction, you will need to be treated in a hospital right away. At the hospital, the staff will give you treatments to stop the allergic reaction and help your symptoms.
If your symptoms are mild, you might not need treatment. But you should try to figure out if anything triggered your symptoms. If so, you will need to avoid that trigger.
Your doctor might recommend that you take medicines called antihistamines. These are the same medicines people take for seasonal allergies.
Your doctor might also prescribe medicines called steroids. Steroids can help with itching and reduce swelling. But you should not take steroids for any longer than you need them, because they can cause serious side effects. These are not the same as the steroids some athletes take illegally.
If you got angioedema because of a medicine you took, your doctor will switch you to a different medicine.
Can angioedema be prevented? — You can lower your chances of getting angioedema by avoiding foods, medicines, or insects that make you have an allergic reaction. If you get angioedema a lot, your doctor might recommend that you take antihistamines every day.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17000 Version 9.0
Release: 28.2.2 - C28.105
© 2020 UpToDate, Inc. and/or its affiliates. All rights reserved.

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