Abstract
We describe the case of a 75-year-old woman who presented with massive tongue and lip swelling secondary to angiotensin-converting enzyme inhibitor-induced angioedema. An awake fibre-optic intubation was performed because of impending airway obstruction. As there was no improvement in symptoms after 72 hours, the selective bradykinin B2 receptor antagonist icatibant (Firazyr) was administered and the patient's trachea was successfully extubated 36 hours later. To our knowledge this is the first documented case of icatibant being used for the treatment of angiotensin-converting enzyme inhibitor-induced angioedema in the United Kingdom and represents a novel therapeutic option in its management.
Highlights
Angiotensin-converting enzyme inhibitor- (ACEi-) induced angioedema is one form of bradykinin-mediated angioedema
We describe what we believe to be the first reported case in the UK of ACEiinduced angioedema treated successfully with icatibant
Interest in icatibant for the treatment of Angiotensin-converting enzyme inhibitors (ACEi)-induced angioedema is growing with a recent case series showing significant symptom reduction within a mean time of 50.6 minutes [4]
Summary
Angiotensin-converting enzyme inhibitor- (ACEi-) induced angioedema is one form of bradykinin-mediated angioedema. It occurs in less than 1% of patients receiving treatment with ACEi. The effect is not dose-related and is a class effect. The effect is not dose-related and is a class effect It may occur at any time after beginning treatment with the drug, with 60% of patients developing symptoms within the first week [1]. Several case reports have documented that it can be used safely and successfully for the treatment of ACEi-induced angioedema. We describe what we believe to be the first reported case in the UK of ACEiinduced angioedema treated successfully with icatibant
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