ABSTRACT
Angioedema is a rare but potentially life-threatening adverse effect of angiotensin-converting enzyme inhibitors (ACEI) which usually occurs within the first weeks of therapy. We report three patients in whom ACEI-induced angioedema began with a late onset of 12-33 months, and who had an irregular, unpredictable course under ACEI therapy. In two patients, other drugs or trauma appeared to trigger some of the episodes. After withdrawal of the ACEI, the trigger drugs were well tolerated in provocation tests and upon re-exposure. To avoid putting some patients unnecessarily at risk for long periods, one should consider this irregular pattern of ACEI-induced angioedema and regularly monitor patients for this adverse effect.
Subject(s)
Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Cilazapril/adverse effects , Enalapril/adverse effects , Aged , Anesthesia, Local/adverse effects , Angioedema/diagnosis , Bronchial Provocation Tests , Female , Humans , Male , Middle Aged , Risk Factors , Skin Tests , Time FactorsSubject(s)
Anaphylaxis/chemically induced , Drug Eruptions/etiology , Hirudins/analogs & derivatives , Immunoglobulin G/immunology , Urticaria/chemically induced , Acute Disease , Adult , Chymases , Hirudins/administration & dosage , Hirudins/adverse effects , Hirudins/immunology , Humans , Immunization , Injections, Intravenous , Injections, Subcutaneous , Intradermal Tests , Male , Recombinant Proteins/administration & dosage , Recombinant Proteins/adverse effects , Recombinant Proteins/immunology , Serine Endopeptidases/blood , Skin Tests , TryptasesABSTRACT
A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articane. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, the quinoline or aminoacylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated.