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Fan M, Niu K, Wu X, Shi H. Risk of drug-induced angioedema: a pharmacovigilance study of FDA adverse event reporting system database. Front Pharmacol 2024; 15:1417596. [PMID: 39081961 PMCID: PMC11286412 DOI: 10.3389/fphar.2024.1417596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Objective The purpose of this study is to explore and analyze the FDA Adverse Event Reporting System (FAERS) database to identify drug adverse reaction signals associated with angioedema. The findings aim to provide valuable insights for clinical drug safety considerations. Methods The Open Vigil 2.1 data platform was utilized to collect adverse event reports related to angioedema from the first quarter of 2004 to the fourth quarter of 2023. The reporting odds ratio (ROR) and proportional reporting ratio (PRR) were employed as disproportionality measures to detect adverse reaction signals Sof drugs associated with angioedema. Results A total of 38,921 reports were retrieved, with the majority being reported by healthcare professionals. The analysis included predominantly adult patients (≥18 years of age), with slightly higher representation of females compared to males. Among the top 30 drugs associated with the occurrence of angioedema, 24 drugs showed positive signals in the risk analysis. Based on the individual drug reporting odds ratio (95% confidence interval) as a measure of risk signal strength, the top five drugs are as follows: lisinopril [ROR (95% CI): 46.43 (42.59-50.62)], enalapril [ROR (95% CI): 43.51 (39.88-47.46)], perindopril [ROR (95% CI): 31.17 (27.5-35.32)], alteplase [ROR (95% CI): 29.3 (26.95-31.85)], ramipril [ROR (95% CI): 20.93 (19.66-22.28)]. After categorizing the drugs, the strongest positive signal was observed in the antithrombotic agents [ROR (95% CI): 22.53 (21.16-23.99)], following that, cardiovascular drugs [ROR (95% CI): 9.17 (8.87-9.48)], antibiotics [ROR (95% CI): 6.42 (5.91-6.96)], immunosuppressors [ROR (95% CI): 5.95 (5.55-6.39)], anti-inflammatory analgesics [ROR (95% CI): 4.65 (4.45-4.86)], antiallergic drugs [ROR (95% CI): 4.47 (3.99-5)], antiasthmatics [ROR (95% CI): 2.49 (2.14-2.89)], blood sugar control drugs [ROR (95% CI): 1.65 (1.38-1.97)], and digestive system drugs [ROR (95% CI): 1.59 (1.45-1.74)] exhibited progressively decreasing ROR values. Conclusion Many medications are associated with a high risk of angioedema. These medications play a crucial and potentially preventable role in controlling the occurrence of angioedema. It is essential to consider the risk level of drug-induced angioedema in clinical practice to optimize medication therapy.
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Affiliation(s)
- Maoxia Fan
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Kaibin Niu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoqi Wu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Hongshuo Shi
- Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Poddar S, Chandra S, Podder I. Vildagliptin-Induced Tongue Angioedema: An Uncommon Occurrence. Indian Dermatol Online J 2024; 15:685-686. [PMID: 39050061 PMCID: PMC11265730 DOI: 10.4103/idoj.idoj_534_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/14/2023] [Accepted: 12/17/2023] [Indexed: 07/27/2024] Open
Affiliation(s)
- Shreya Poddar
- Department of Dermatology, Asansol District Hospital, Asansol, West Bengal, India
| | | | - Indrashis Podder
- Department of Dermatology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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3
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Yu J, Sim DW. A Case of Angioedema to Oral Doxycycline and Cross-Reactivity to Minocycline. Ann Pharmacother 2024:10600280241252542. [PMID: 38742420 DOI: 10.1177/10600280241252542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
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Sinnathamby ES, Urban BT, Clark RA, Roberts LT, De Witt AJ, Wenger DM, Mouhaffel A, Willett O, Ahmadzadeh S, Shekoohi S, Kaye AD, Varrassi G. Etiology of Drug-Induced Edema: A Review of Dihydropyridine, Thiazolidinedione, and Other Medications Causing Edema. Cureus 2024; 16:e53400. [PMID: 38435190 PMCID: PMC10908346 DOI: 10.7759/cureus.53400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Edema is an accumulation of fluid in the body's tissues that affects millions of Americans yearly. It can affect multiple body parts, for example, the brain or eyes, but often occurs in the periphery, including the feet and legs. Medications, such as dihydropyridine and thiazolidinediones (TZDs), can be the etiology of edema. Edema can develop in association with problems in the vasculature or lymphatic flow. In recent years, a better understanding of these drug-induced mechanisms has been appreciated. Specifically, dihydropyridines can increase hydrostatic pressure and cause selective pre-capillary vessel vasodilation. TZDs can cause edema through increased vascular permeability and increased hydrostatic pressure. Specifically, peroxisome proliferator-activated receptor gamma (PPARγ) stimulation increases vascular endothelial permeability, vascular endothelial growth factor (VEGF) secretion, renal sodium, and fluid retention. Other drugs that can cause edema include neuropathic pain agents, dopamine agonists, antipsychotics, nitrates, nonsteroidal anti-inflammatory (NSAIDS), steroids, angiotensin-converting enzyme (ACE) inhibitors, and insulin. There are various clinical presentations of edema. Since multiple mechanisms can induce edema, it is important to understand the basic mechanisms and pathophysiology of drug-induced edema. Edema can even become fatal. For example, angioedema can occur from ACE inhibitor therapy. In this regard, it is considered a medical emergency when there is laryngeal involvement. This review aims to thoroughly appreciate the multiple causes of drug-induced edema and the ways it can be treated or prevented.
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Affiliation(s)
- Evan S Sinnathamby
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Bretton T Urban
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Robert A Clark
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Logan T Roberts
- School of Medicine, Louisiana State University Health Sciences Center (LSUHSC) New Orleans, New Orleans, USA
| | - Audrey J De Witt
- School of Medicine, Louisiana State University (LSU) Health, Shreveport, USA
| | - Danielle M Wenger
- School of Medicine, The University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Aya Mouhaffel
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Olga Willett
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University (LSU) Health, Shreveport, USA
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Jasti VV, Anderson J, Abdujelil I. Angioedema without urticaria after recent initiation of celecoxib. BMJ Case Rep 2023; 16:e255446. [PMID: 37739445 PMCID: PMC10533717 DOI: 10.1136/bcr-2023-255446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Angioedema is potentially life-threating swelling of integument and mucosa that has multiple potential aetiologies with varying mechanisms. Drug-induced angioedema is often easily correlated with the offending agent and can be prevented with discontinuation of the medication. Many medications have now been implicated in drug-induced angioedema but the two most common are ACE inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs). This case highlights severe angioedema secondary to celecoxib and reviews varying aetiologies of angioedema and NSAID hypersensitivity reactions.
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Affiliation(s)
- Vivek Vardhan Jasti
- Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Jay Anderson
- Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Ifa Abdujelil
- Medical Education, Ohio University College of Osteopathic Medicine, Athens, Ohio, USA
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6
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Sharma NR, Sharma B, Lamichhane S, Pokhrel M, Shrestha P. A Rare Case Report of Sitagliptin-Induced Angioedema. Cureus 2022; 14:e30077. [PMID: 36381841 PMCID: PMC9640175 DOI: 10.7759/cureus.30077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Sitagliptin, a dipeptidyl peptidase-4 inhibitor, is used for the treatment of type 2 diabetes mellitus. Sitagliptin-induced angioedema has increased with the simultaneous use of angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. We present a rare case of a 50-year-old female diagnosed with sitagliptin-induced angioedema. On examination, she had both upper and lower lip swelling without any respiratory compromise. On further investigation, her C1 esterase inhibitor level was normal. After stopping sitagliptin, her symptoms resolved. Thus, cautious use of dipeptidyl peptidase-4 inhibitor is advised.
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Oral Surgery Procedures in a Patient Affected by Hereditary Angioedema Type I. Case Rep Dent 2022; 2022:6602411. [PMID: 35132366 PMCID: PMC8817880 DOI: 10.1155/2022/6602411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Hereditary Angioedema (HAE) is a rare disease characterized by a deficiency or a reduced function of the plasma protein C1 esterase inhibitor (C1-INH), which is involved in the downregulation of several inflammatory pathways. Patients affected by HAE suffer from episodic swellings of subcutaneous or submucosal tissues. Swellings can be caused by stress or dental and surgical procedures and can be life-threatening if the airways are involved. We have reported a clinical case of a patient affected by HAE type I who underwent oral surgery procedures under a short-term prophylaxis with C1-INH plasma-derived concentrate. The patient underwent a cyst removal, multiple tooth extractions, and an excisional biopsy with a prophylaxis with C1-INH plasma-derived concentrate and was hospitalized for 36 hours after the surgery to be monitored for possible HAE attacks. During the hospitalization, the patient did not show signs of swelling nor of HAE attacks. At 14 and 28 days after the surgery, the patient presented a good surgical healing. The prophylactic intravenous infusion of C1-INH concentrate was successful in preventing acute HAE attacks after oral surgery procedures.
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Kuzemczak M, Kavvouras C, Alkhalil M, Osten M. ACE inhibitor-related angioedema in a COVID-19 patient-a plausible contribution of the viral infection? Eur J Clin Pharmacol 2021; 77:933-934. [PMID: 33392667 PMCID: PMC7779079 DOI: 10.1007/s00228-020-03082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/28/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Michał Kuzemczak
- Peter Munk Cardiac Centre, Division of Cardiology, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada.
- Chair of Emergency Medicine, Department of Medical Rescue, Poznan University of Medical Sciences, Poznań, Poland.
- Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
| | - Charalampos Kavvouras
- Peter Munk Cardiac Centre, Division of Cardiology, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada
| | - Mohammad Alkhalil
- Peter Munk Cardiac Centre, Division of Cardiology, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada
| | - Mark Osten
- Peter Munk Cardiac Centre, Division of Cardiology, Toronto General Hospital, University Health Network, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada
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9
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Managing Chronic Urticaria and Recurrent Angioedema Differently with Advancing Age. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2186-2194. [PMID: 33819638 DOI: 10.1016/j.jaip.2021.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
Angioedema and urticaria affect people of all ages. Accurate diagnosis and optimum management is essential for healthy aging. Older people continue to experience mast cell-mediated urticaria and angioedema, with a higher prevalence of autoimmune and a lower prevalence of autoallergic disease. Bradykinin-mediated angioedemas are more common in the elderly because of their association with angiotensin-converting enzyme inhibitor (ACEI) treatment. Acquired C1-inhibitor deficiency, another bradykinin-mediated angioedema, occurs predominantly in older people, whereas hereditary angioedema due to C1-inhibitor deficiency continues to cause symptoms, even in old age. Drug-induced angioedemas disproportionately affect older people, the most frequent users of ACEIs, aspirin, and nonsteroidal anti-inflammatory drugs. Accurate diagnosis and targeted treatment prevent unnecessary morbidity and mortality. Second-generation antihistamines with omalizumab if required are effective and well tolerated in older people with mast cell-mediated urticaria. For bradykinin-mediated angioedemas, these drugs are ineffective. C1-inhibitor replacement or blockade of kallikrein or the bradykinin B2 receptor of the contact pathway is required to treat hereditary angioedema and may be considered in other bradykinin-mediated angioedemas, if supportive treatment is insufficient. For aspirin-related angioedema and urticaria, alternative medications or, exceptionally, desensitization may be required.
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10
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Kelly MA. Neurological complications of cardiovascular drugs. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:319-344. [PMID: 33632450 DOI: 10.1016/b978-0-12-819814-8.00020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiovascular drugs are used to treat arterial hypertension, hyperlipidemia, arrhythmias, heart failure, and coronary artery disease. They also include antiplatelet and anticoagulant drugs that are essential for prevention of cardiogenic embolism. Most neurologic complications of the cardiovascular drugs are minor or transient and are far outweighed by the anticipated benefits of treatment. Other neurologic complications are more serious and require early recognition and management. Overtreatment of arterial hypertension may cause lightheadedness or fatigue but often responds readily to dose adjustment or an alternative drug. Other drug complications may be more troublesome as in myalgia associated with statins or headache associated with vasodilators. The recognized bleeding risk of the antithrombotics requires careful calculation of risk/benefit ratios for individual patients. Many neurologic complications of cardiovascular drugs are well documented in clinical trials with known frequency and severity, but others are rare and recognized only in isolated case reports or small case series. This chapter draws on both sources to report the adverse effects on muscle, nerve, and brain associated with commonly used cardiovascular drugs.
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Affiliation(s)
- Michael A Kelly
- Department of Neurology, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, United States.
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Younas U, Shafiq O, Mansoor SN, Khalil MT. Solifenacin-induced acute urticaria and angioedema: a rare adverse effect. Postgrad Med J 2021; 98:420-421. [PMID: 33452148 DOI: 10.1136/postgradmedj-2020-138375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/16/2020] [Accepted: 01/01/2021] [Indexed: 12/27/2022]
Abstract
Antimuscarinics are first-line medication for management of overactive bladder with solifenacin being commonly prescribed. Angioedema is the swelling of mucosa and submucosal tissue. There are no published case reports of drug-induced angioedema involving solifenacin. We report a case of a 41-year-old man with spinal cord injury who presented with oedema of face, lips, tongue and associated pruritic urticaria after taking 5 mg of solifenacin. All other possible causes including food allergy, insect bite, hereditary angioedema, use of NSAIDs, ACE inhibitors and antibiotics were ruled out. The temporal association between solifenacin and angioedema and complete resolution of symptoms after discontinuing the drug suggest that solifenacin was the most probable cause of angioedema in our patient.
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Affiliation(s)
- Umer Younas
- Physical Medicine & Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Omar Shafiq
- Physical Medicine & Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Sahibzada Nasir Mansoor
- Physical Medicine & Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Muhammad Tawab Khalil
- Physical Medicine & Rehabilitation, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
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Srifuengfung M, Sukakul T, Liangcheep C, Viravan N. Paliperidone palmitate-induced facial angioedema: A case report. World J Clin Cases 2020; 8:4876-4882. [PMID: 33195656 PMCID: PMC7642554 DOI: 10.12998/wjcc.v8.i20.4876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Paliperidone palmitate is a once-monthly injectable, atypical antipsychotic. To our knowledge, there has been only one report of paliperidone palmitate-induced angioedema presenting with acute laryngeal edema with subsequent respiratory arrest. Here, we present a case report of paliperidone palmitate-induced angioedema with a relatively mild clinical presentation compared with the previously reported case, and the patient’s condition was not complicated by life-threatening anaphylaxis.
CASE SUMMARY A 79-year-old female, who had a major neurocognitive disorder due to Alzheimer’s disease with behavioral disturbances. Paliperidone palmitate was off-label used to control her aggression, irritability, and psychosis. After induction doses (150 mg and 100 mg intramuscularly, given 1 wk apart), she developed intermittent swelling of the face, eyelids, and lips on day 17 after the initial dose, and the edema was explicitly seen on day 20. The diagnosis was paliperidone palmitate-induced angioedema. The monthly injection dose was discontinued on day 33 after the initial dose. The angioedema was subsequently alleviated, and it had completely resolved by day 40 after the initial dose.
CONCLUSION Paliperidone palmitate-induced angioedema is a rare condition and can present with a mild, intermittent facial edema, which may be overlooked in clinical practice.
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Affiliation(s)
- Maytinee Srifuengfung
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Thanisorn Sukakul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chanika Liangcheep
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Natee Viravan
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Gürbüz HGA, Seçinti DD, Neze H. Clozapine-induced late-onset angioedema. Indian J Psychiatry 2020; 62:95-96. [PMID: 32001938 PMCID: PMC6964462 DOI: 10.4103/psychiatry.indianjpsychiatry_379_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/18/2018] [Accepted: 10/02/2019] [Indexed: 11/23/2022] Open
Abstract
Clozapine is an atypical antipsychotic which is generally used as a second line antipsychotic drug in clinical practice due to its side effects. It is known that Clozapine may induce hypersensitivity reaction, angioedema at the beginning of the treatment, late onset angioedema related to clozapine treatment is very rare in the literature. In this case report, we present a 19 years old man who was admitted to psychiatry with clozapine induced periorbital edema. He was receiving clozapine 200 mg per day for last two years when he applied to psychiatry. After reducing daily dose of clozapine to 150 mg, his periorbital edema regressed. It should be known that clozapine induced angioedema may develop not only at the beginning of the treatment but also during the treatment and may regress with dose reduction.
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Affiliation(s)
- Hatice Gözde Akkin Gürbüz
- Department of Child and Adolescent Psychiatry, Kartal Dr. Lütfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | - Dilara Demirpence Seçinti
- Department of Child and Adolescent Psychiatry, Şanliurfa Research and Training Hospital, Şanliurfa, Turkey
| | - Handan Neze
- Department of Child and Adolescent Psychiatry, Kartal Dr. Lütfi Kirdar Research and Training Hospital, Istanbul, Turkey
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Williams GD. Cross-reaction of angioedema with clozapine, olanzapine, and quetiapine: A case report. Ment Health Clin 2019; 9:315-317. [PMID: 31534873 PMCID: PMC6728117 DOI: 10.9740/mhc.2019.09.315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Angioedema is characterized by marked swelling of the subcutaneous or submucosal tissue and may affect various parts of the body, including the face, mouth, and extremities. Angioedema has specifically been associated with the use of several antipsychotic agents, including clozapine, olanzapine, iloperidone, haloperidol, quetiapine, paliperidone, ziprasidone, risperidone, and chlorpromazine. A 67-year-old African American male with a past medical history significant for hypertension, coronary artery disease requiring stent placement, mitral insufficiency, hyperlipidemia, tobacco use disorder, and schizophrenia presented with altered mental status and disorientation in the setting of clozapine nonadherence, which prompted acute hospitalization for clozapine reinitiation. During clozapine titration, the patient developed edema, erythema, and pruritus on his face and arms along with lip swelling characteristic of angioedema. Upon discontinuation of clozapine, the patient was trialed on several other antipsychotic medications to help manage acute psychosis and subsequently developed angioedema symptoms with trials of both olanzapine and quetiapine. Following these 3 distinct events of angioedema, the clinical decision was made to no longer trial atypical antipsychotics for the patient, and loxapine was cautiously initiated. The patient responded well to loxapine and continued to tolerate loxapine therapy for years. This case report identifies angioedema cross-reaction linked with 3 second-generation antipsychotics. Given the potentially life-threatening nature of angioedema, awareness of recurrent angioedema should be undertaken when trialing antipsychotics following an episode of angioedema correlated to antipsychotic use, particularly when trialing antipsychotics from the same generation and with similar chemical structures.
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Kim H, Baik SY, Yang SJ, Kim TM, Lee SH, Cho JH, Choi IY, Kim JH, Yoon KH, Kim HS. Clinical experiences and case review of angiotensin II receptor blocker-related angioedema in Korea. Basic Clin Pharmacol Toxicol 2018; 124:115-122. [PMID: 30003686 DOI: 10.1111/bcpt.13097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/10/2018] [Indexed: 12/01/2022]
Abstract
Although angiotensin-converting enzyme inhibitor-related angioedema is well known, angiotensin II receptor blocker (ARB)-related angioedema has not been extensively studied because of its lower incidence. Therefore, ARB-related angioedema is likely to be overlooked in the clinical setting. We analysed the medical records of adults who had been prescribed ARB and diagnosed with angioedema between 2009 and 2015. All adults over the age of 18 years who were initially administered ARB between 1 January 2009 and 31 December 2015 were selected as participants in this study. To confirm whether the angioedema was actually due to the administration of ARB, we conducted a chart review. A total of 35 584 patients were prescribed ARB for the first time when visiting the Seoul St. Mary's Hospital during the study period. Twenty-four patients diagnosed with angioedema for other reasons prior to their first prescription of ARB were excluded from this study. ARB-related angioedema was suspected in six of 35 560 patients (0.02%) who were initially prescribed ARB during the study period. The manifestation of ARB-related angioedema ranged from several days (1/6 case) to several years (3/6 cases). Some patients continued taking ARB with intermittent antihistamine or steroid therapy. In such cases, angioedema symptoms improved but did not completely resolve. Its diagnosis can be delayed and the symptoms may be recurrent as symptoms improve with antihistamine use. In some cases, the same person had different reactions depending on the type of ARB. Definitively diagnosing ARB-related angioedema is difficult, and physicians often overlook angioedema without suspecting that it is an adverse effect of ARB. Close attention of physicians and improved patient education can reduce the incidence of ARB-related angioedema.
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Affiliation(s)
- Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - Seo Yeon Baik
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Jung Yang
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tong Min Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Centre, Seoul National University College of Medicine, Seoul, Korea
| | - Kun-Ho Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun-Sung Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Do TP, Seetasith A, Belleli R, Schlienger RG, Corda S, Burudpakdee C, Streefkerk HJ, Behr S. A Database Cohort Study to Assess the Risk of Angioedema Among Patients with Heart Failure Initiating Angiotensin-Converting Enzyme Inhibitors in the USA. Am J Cardiovasc Drugs 2018; 18:205-211. [PMID: 29177815 DOI: 10.1007/s40256-017-0256-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Real-world evidence on the risk of angioedema associated with angiotensin-converting enzyme inhibitors (ACEIs) in patients with heart failure (HF) is scarce. OBJECTIVE This non-interventional study aimed to estimate the incidence of and risk factors for angioedema in patients with HF initiating an ACEI in real-world practice. METHODS This was a retrospective cohort study using claims data from the PharMetrics Plus database, supplemented with consumer health data, from 1 January 2007 to 31 March 2015. Patients with HF initiating an ACEI were followed up for a maximum of 1 year, until the first occurrence of angioedema or until cohort exit. Angioedema incidence rates were estimated and stratified by potential risk factors such as race, age, sex, and time from initiation of ACEI therapy. For each risk factor, the unadjusted and adjusted hazard ratio (HR) was calculated; exploratory analyses were carried out to account for all potential confounders. RESULTS We identified 21,639 patients with HF initiating an ACEI (mean age 58 years; 35.6% women; mean follow-up 205 days). The 1-year incidence of angioedema per 1000 patient-years was 3.3 [95% confidence interval (CI) 2.4-4.5]. The incidence was higher in Black [6.2 (95% CI 3.1-12.5)] than in non-black [2.9 (95% CI 2.1-4.1)] patients, higher in women [5.2 (95% CI 3.4-7.9)] than in men [2.3 (95% CI 1.5-3.6)], and greatest in the first 30 days of ACEI therapy. CONCLUSIONS The risk of angioedema in patients with HF initiating an ACEI observed in this study is in line with published estimates for the general patient population treated with ACEIs.
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Affiliation(s)
- Thy P Do
- Novartis Pharma AG, Postfach, 4002, Basel, Switzerland
| | | | | | | | - Stefano Corda
- Novartis Pharma AG, Postfach, 4002, Basel, Switzerland
| | | | | | - Sigrid Behr
- Novartis Pharma AG, Postfach, 4002, Basel, Switzerland
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17
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Kurnaz D, Semerci SY, Babayigit A, Cebeci B, Buyukkale G, Cetinkaya M. Angioedema Associated With Nebulized Recombinant Human DNase in a Preterm Infant: Case Report. J Pediatr Pharmacol Ther 2018; 23:219-222. [DOI: 10.5863/1551-6776-23.3.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pulmonary atelectasis leads to difficulties in weaning of the neonates from mechanical ventilation. The management of persistent atelectasis in neonates constitutes a common challenge for physicians. Several reports suggested Recombinant human DNase (rhDNase) as a beneficial therapy for neonates with persistent atelectasis by reducing mucous viscosity. No adverse effect associated with rhDNase treatment was reported in neonates. Herein, we report probable adverse reactions associated with rhDNase use in a preterm infant. Therefore, we suggest that clinicians must be aware of this reaction in neonates and should carefully follow up these infants for the development of adverse reactions. We think that more clinical experience and data are needed to define its tolerability and adverse effect profile in neonates.
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18
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Ranugha PSS, Betkerur J. Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives. Indian J Dermatol Venereol Leprol 2018; 84:137-147. [DOI: 10.4103/ijdvl.ijdvl_992_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Zalewska-Janowska A, Spiewak R, Kowalski ML. Cutaneous Manifestation of Drug Allergy and Hypersensitivity. Immunol Allergy Clin North Am 2017; 37:165-181. [PMID: 27886905 DOI: 10.1016/j.iac.2016.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Drug hypersensitivity reactions may manifest with either organ-specific or systemic symptoms, but cutaneous eruptions are the most common manifestations. Different medications may cause identical skin symptoms, whereas hypersensitivity to a single drug may manifest with various patterns of symptoms depending on the pathomechanism of hypersensitivity. Drug reactions should be also taken into account in the differential diagnosis of numerous skin rashes. Analysis of morphology of drug-induced lesions, about potential immunologic or nonimmunological mechanisms, is important for the final diagnosis. Thus, here the authors present a morphologic approach to the diagnosis of cutaneous drug-induced eruptions.
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Affiliation(s)
- Anna Zalewska-Janowska
- Department of Psychodermatology, Medical University of Lodz, 251 Pomorska Street, Lodz 92-213, Poland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Krakow 30-688, Poland
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, 251 Pomorska Street, Lodz 92-213, Poland.
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20
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Haga N, Nishie W, Morita Y, Mizuno O, Ohguchi Y, Shimizu H. A case of idiopathic angioedema exacerbated by angiotensin receptor blocker administration. Int J Dermatol 2017; 56:1504-1505. [DOI: 10.1111/ijd.13675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/11/2017] [Accepted: 05/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Naoya Haga
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Wataru Nishie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yusuke Morita
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Osamu Mizuno
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuka Ohguchi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hiroshi Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
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21
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Masiran R. Persistent oromandibular dystonia and angioedema secondary to haloperidol. BMJ Case Rep 2017; 2017:bcr-2017-220817. [PMID: 28978587 DOI: 10.1136/bcr-2017-220817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case in a young man who developed acute, persistent and painful tongue protrusion followed by swelling for more than 24 hours. He had relapse symptoms of schizophrenia and had recently received a single dose of parenteral haloperidol to manage his agitation. His record showed history of similar event and he has been taking atypical antipsychotic for maintenance. Mental state examination on admission revealed an agitated man with disorganised speech, restricted affect, auditory hallucination and persecutory delusion. His dystonia and oedema improved after 3 days. His mental status also recovered with the maintenance of low-potency antipsychotic and anticholinergic antiparkinsonian medications.
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Affiliation(s)
- Ruziana Masiran
- Department of Psychiatry, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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22
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Pasmatzi E, Monastirli A, Badavanis G, Tsambaos D. Angioedema without urticaria caused by oral acitretin. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2017; 26:67-68. [PMID: 28941265 DOI: 10.15570/actaapa.2017.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The efficacy of oral acitretin in the systemic treatment of severe and recalcitrant dermatoses has been established in a large number of clinical trials. Its mucocutaneous and ocular adverse reactions are common or relatively common, whereas systemic side effects are either uncommon or rare and include teratogenesis, hyperlipidemia, hepatotoxicity, intracranial hypertension, myopathy, and peripheral neuropathy. Angioedema is a term used to describe an acute, solitary or multiple, circumscribed, and non-pitting mucocutaneous swelling that affects the dermis and the subcutaneous tissue, lasts 24 to 72 hours, and may become potentially life-threatening when the pharynx and/or the larynx are involved. We report here the case of a 51-year old female psoriatic patient with angioedema (without urticaria) due to oral acitretin, confirmed by a positive oral provocation test. To the best of our knowledge, this is the second description of such an adverse reaction to acitretin.
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Affiliation(s)
| | - Alexandra Monastirli
- Department of Dermatology, University of Patras, Rio-Patras,Greece.,Center for Dermatologic Diseases, Limassol,Cyprus
| | - George Badavanis
- Department of Dermatology, University of Patras, Rio-Patras,Greece
| | - Dionysios Tsambaos
- Department of Dermatology, University of Patras, Rio-Patras,Greece.,Center for Dermatologic Diseases, Limassol,Cyprus
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23
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Randomized Trial of Icatibant for Angiotensin-Converting Enzyme Inhibitor–Induced Upper Airway Angioedema. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1402-1409.e3. [DOI: 10.1016/j.jaip.2017.03.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 01/14/2023]
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Dodiuk-Gad RP, Chung WH, Shear NH. Adverse Medication Reactions. CLINICAL AND BASIC IMMUNODERMATOLOGY 2017. [PMCID: PMC7123512 DOI: 10.1007/978-3-319-29785-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cutaneous adverse drug reactions (ADRs) are among the most frequent adverse reactions in patients receiving drug therapy. They have a broad spectrum of clinical manifestations, are caused by various drugs, and result from different pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Severe cutaneous ADRs comprise a group of diseases with major morbidity and mortality, reaching 30 % mortality rate in cases of Toxic Epidermal Necrolysis. This chapter covers the terminology, epidemiology, pathogenesis and classification of cutaneous ADR, describes the severe cutaneous ADRs and the clinical and laboratory approach to the patient with cutaneous ADR and presents the translation of laboratory-based discoveries on the genetic predisposition and pathogenesis of cutaneous ADRs to clinical management guidelines.
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25
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Subramanian A, Adhimoolam M, Gopalakrishnan S, Rajamohammed MA. Carbamazepine-induced angioedema. J Basic Clin Pharm 2016; 7:120-122. [PMID: 27999472 PMCID: PMC5153889 DOI: 10.4103/0976-0105.189436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Angioedema is a rare adverse reaction of carbamazepine, which causes localized tissue edema in submucosal and subcutaneous tissue mediated by histamine, serotonin, and kinins (bradykinin). We report a case of 34-year-old female who developed angioedema, 24 h after administration of carbamazepine for treating bipolar disorder. Patient's symptoms responded rapidly with antihistamine therapy and with the withdrawal of carbamazepine, the offending drug. Carbamazepine-induced angioedema is a life-threatening reaction which requires immediate treatment and monitoring in order to avoid morbidity and mortality.
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Affiliation(s)
- Ansha Subramanian
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | | | - Senthil Gopalakrishnan
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Meher Ali Rajamohammed
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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26
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Angioedema Due to ACE Inhibitors. CURRENT TREATMENT OPTIONS IN ALLERGY 2016. [DOI: 10.1007/s40521-016-0099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rawal G, Yadav S, Kumar R, Wani UR. Ofloxacin Induced Angioedema: A Rare Adverse Drug Reaction. J Clin Diagn Res 2016; 10:FD03-FD04. [PMID: 28050397 DOI: 10.7860/jcdr/2016/21316.8782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
The Adverse Drug Reaction (ADR) to a commonly prescribed anti-microbial can pose a major public health problem. The authors report a rare case of 24-year-old young lady who presented with angioedema of lips after ingestion of Ofloxacin, prescribed to her for treatment of loose motions. Fluoroquinolones are widely prescribed antibiotics for various disease conditions. The history, clinical examination and normal laboratory parameters led to the diagnosis of ofloxacin induced hypersensitivity reaction and the patient was successfully treated with corticosteroids and antihistamines. The hypersensitivity reactions to fluoroquinolones are rare with an incidence of 0.4% to 2%. The pharmacovigilance program and self-reporting of all the ADR's by the health care workers can help in ensuring the judicious use of the drug, drug safety and thus decrease the associated morbidity and mortality.
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Affiliation(s)
- Gautam Rawal
- Attending Consultant-Respiratory Intensive Care, Max Super Specialty Hospital , Saket, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Department of Medicine & TB, Chest Clinic Moti Nagar, North Delhi Municipal Corporation, New Delhi, India
| | - Raj Kumar
- Senior Consultant and Incharge-Respiratory Intensive Care, Max Super Specialty Hospital , Saket, New Delhi, India
| | - Umar Rasool Wani
- Clinical Associate, Critical Care, Max Super Specialty Hospital , Vaishali, Ghaziabad, Uttar Pradesh, India
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28
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Abstract
Acitretin is a synthetic oral retinoid that has been used for a number of dermatological diseases. Several side effects of acitretin have been reported such as teratogenicity, cheilitis, xerosis, dyslipidemia, and photosensitivity. Many drugs, mainly antibiotics and nonsteroidal anti-inflammatory drugs, can cause angioedema-urticaria. We present the case of angioedema-urticaria due to acitretin, confirmed by oral provocation test, in a 61-year-old man with psoriasis. To the best of our knowledge, only 1 case of angioedema due to oral acitretin has been reported in the literature so far. We report this case to draw attention that acitretin may cause angioedema-urticaria and to inform patients about this risk besides other side effects due to acitretin.
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29
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Belkhouribchia J, Backaert T, Neyrinck S. Isolated Intestinal Angioedema in the Emergency Department. J Emerg Med 2016; 50:660-2. [DOI: 10.1016/j.jemermed.2015.09.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
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30
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Marzano AV, Borghi A, Cugno M. Adverse drug reactions and organ damage: The skin. Eur J Intern Med 2016; 28:17-24. [PMID: 26674736 DOI: 10.1016/j.ejim.2015.11.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
Abstract
Cutaneous adverse drug reactions are frequent, affecting 2-3% of hospitalized patients and in one twentieth of them are potentially life-threatening. Almost any pharmacologic agent can induce skin reactions, and certain drug classes, such as non-steroidal anti-inflammatory drugs, antibiotics and antiepileptics, have drug eruption rates ranging from 1% to 5%. Cutaneous drug reactions recognize several different pathomechanisms: some skin manifestations are immune-mediated like allergic reactions while others are the result of non immunological causes such as cumulative toxicity, photosensitivity, interaction with other drugs or different metabolic pathways. Cutaneous adverse drug reactions can be classified into two groups: common non-severe and rare life-threatening adverse drug reactions. Non-severe reactions are often exanthematous or urticarial whereas life-threatening reactions typically present with skin detachment or necrosis of large areas of the body and mucous membrane involvement, as in the Stevens-Johnson syndrome or toxic epidermal necrolysis. Clinicians should carefully evaluate the signs and symptoms of all cutaneous adverse drug reactions thought to be due to drugs and immediately discontinue drugs that are not essential. Short cycles of systemic corticosteroids in combination with antihistamines may be necessary for widespread exanthematous rashes, while more aggressive corticosteroid regimens or intravenous immunoglobulins associated with supportive treatment should be used for patients with Stevens-Johnson syndrome or toxic epidermal necrolysis.
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Affiliation(s)
- Angelo V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandro Borghi
- Dipartimento di Scienze Mediche, Sezione di Dermatologia e Malattie Infettive, Università degli Studi di Ferrara, Ferrara, Italy
| | - Massimo Cugno
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
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31
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Kuriachan S, Amberkar MBV, Mohan MK, Shahul HA, Kishore MK. Acebrophylline-induced angioedema. Indian J Pharmacol 2016; 47:219-20. [PMID: 25878387 PMCID: PMC4386136 DOI: 10.4103/0253-7613.153435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 11/09/2022] Open
Abstract
A 53-year-old woman visited her physician complaining of acute breathlessness and productive cough. Her medications included budesonide and formoterol for asthma, fixed-dose combination aspirin 150 mg + clopidogrel 75 mg + atorvastatin 20 mg for ischemic heart disease. History revealed that she had allergic rhinitis and was hypersensitive to penicillins. The patient was prescribed acebrophylline (ABP). Six hours after ABP therapy she presented with generalized urticarial lesions, swelling of hands, feet, lips and face, suggestive of angioedema. ABP was stopped immediately, and the patient was treated symptomatically. This case was categorized as probable as per standard causality assessment scale.
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Affiliation(s)
- Sanitha Kuriachan
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Mohan Babu V Amberkar
- Department of Pharmacology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Manu K Mohan
- Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka, India
| | - Hameed Aboobackar Shahul
- Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka, India
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Angioedema Triggered by Medication Blocking the Renin/Angiotensin System: Retrospective Study Using the French National Pharmacovigilance Database. J Clin Immunol 2015; 36:95-102. [PMID: 26707788 DOI: 10.1007/s10875-015-0228-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 12/14/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Bradykinin-mediated angioedema (AE) is a rare side effect of some medications, including angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB). In France, side-effects to treatments are reported to the national pharmacovigilance database. METHODS The national MedDRA database was searched using the term "angioedema". Patients were included if they met the clinical criteria corresponding to bradykinin-mediated AE, if their C1-inhibitor levels were normal, and if they were treated with an ACEi or an ARB. RESULTS 7998 cases of AE were reported between 1994 and 2013. Among these, 112 met the criteria for bradykinin-mediated AE with normal C1-inhibitor levels. On the 112 drug-AE, patients were treated with an ARB in 21% of cases (24 patients), or an ACEi in 77% of cases (88 patients), in combination with another treatment in 17 cases (mTORi for 3 patients, iDPP-4 for 1 patient, hormonal treatment for 7 patients). ENT involvement was reported in 90% of cases (tongue: 48.2%, larynx: 23.2%). The median duration of treatment before the first attack was 720 days, and the mean duration of attacks was 36.6 h. Forty-one percent (19/46) of patients relapsed after discontinuing treatment. CONCLUSION Angioedema triggered by medication blocking the renin/angiotensin system is rare but potentially severe, with a high risk of recurrence despite cessation of the causative drug.
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Balakumar P, Kavitha M, Nanditha S. Cardiovascular drugs-induced oral toxicities: A murky area to be revisited and illuminated. Pharmacol Res 2015; 102:81-9. [DOI: 10.1016/j.phrs.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 08/22/2015] [Accepted: 09/08/2015] [Indexed: 12/20/2022]
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Fatal laryngeal angioedema: a case report and a workup of angioedema in a forensic setting. Forensic Sci Med Pathol 2015; 11:558-63. [PMID: 26242774 DOI: 10.1007/s12024-015-9701-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
Angioedema is an episodic swelling of the deep dermis, subcutis, and/or submucosal tissue due to an increase in local vascular permeability. Swelling may involve skin, respiratory, and gastrointestinal tracts. The most commonly involved areas are the periorbital region and the lips. Here we report a case of a fatal laryngeal obstruction due to angioedema likely caused by an angiotensin-converting-enzyme inhibitor. The decedent, a 58-year-old man, was witnessed developing sudden facial swelling and acute respiratory difficulties quickly followed by unresponsiveness. His past medical history suggested that this was his second episode of angioedema without urticaria. Postmortem examination revealed a complete laryngeal obstruction in the absence of infection, neoplasm, or autoimmune disease. Postmortem computed tomography of the head and neck showed a complete obstruction of the upper airway. Based on the current understanding of the pathophysiology of different types of angioedema, we will suggest a workup of angioedema without urticaria in the forensic setting and offer readers resources they can use in their practice.
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Horiuchi T. The ABC of angioedema: ace inhibitor, bradykinin, and C1-inhibitor are critical players. Intern Med 2015; 54:2535-6. [PMID: 26466685 DOI: 10.2169/internalmedicine.54.5130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Takahiko Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Japan
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36
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Hacard F, Nosbaum A, Bensaid B, Nicolas JF, Augey F, Goujon C, Bérard F. [Histaminergic angioedema and chronic urticaria]. Presse Med 2014; 44:37-42. [PMID: 25535159 DOI: 10.1016/j.lpm.2014.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022] Open
Abstract
Most angioedemas are histaminergic and correspond to deep urticarial swelling. Recurrent histaminergic angioedema led to the diagnosis of chronic urticaria, even when there are no superficial associated hives. Chronic urticaria is a benign disease, and autoimmune in 40 % of cases. The occurrence of angioedema in chronic urticaria is not a sign of severity. The occurrence of angioedema in chronic urticaria is associated with a longer duration of urticarial disease. NSAIDs and/or systemic corticotherapy are classic triggers of angioedema in chronic urticaria. In the absence of clinical endpoints, there is no need to make further assessment in chronic urticaria good responders to antihistamines.
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Affiliation(s)
- Florence Hacard
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Audrey Nosbaum
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Benoit Bensaid
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France
| | - Jean-François Nicolas
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Frédéric Augey
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Catherine Goujon
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France
| | - Frédéric Bérard
- Hospices civils de Lyon, centre hospitalier Lyon-Sud, service d'allergologie et d'immunologie clinique, 69495 Pierre-Bénite, France; Inserm U1111-CIRI/UMS3444/US8, 21, avenue Tony-Garnier, 69007 Lyon, France; Université Claude-Bernard Lyon I, UFR médecine Lyon-Sud Charles-Mérieux, 69921 Oullins cedex, France.
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Tharayil AM, Chanda AH, Shiekh HA, Elkhatib MS, Nayeemuddin M, Alshamandy AAA. Life threatening angioedema in a patient on ACE inhibitor (ACEI) confined to the upper airway. Qatar Med J 2014; 2014:92-7. [PMID: 25745598 PMCID: PMC4344982 DOI: 10.5339/qmj.2014.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/02/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction: ACE inhibitors accounts for 8% of all cases of angioneurotic edema and the overall incidence is 0.1 to 0.7% of patients on ACE inhibitors. It is a leading cause (20-40%) of emergency room visits in the US with angioedema. We report a case of angioedema caused by ACE inhibitors confined to the upper airway after four years on treatment with Lisinopril which persisted for three weeks and required endotracheal intubation and subsequent tracheostomy due to delayed resolution. This case is one of the rare cases presented as upper airway edema which persisted for a long time. Presentation: A 60-year-old Sudanese male patient with osteoarthritis in both knees underwent bilateral total knee replacement under single-shot epidural anesthesia. He had significant past medical history of type II diabetes, bipolar affective disorder and hypertension managed with Lisinopril for the past four years. Postoperatively after 10 hours the patient desaturated and developed airway obstruction requiring intubation. Laryngoscopy revealed an edematous tongue and upper airway and vocal cords were not visualized. In view of this clinical picture a provisional diagnosis of angioedema secondary to Lisinopril was made and it was discontinued. CT scan of the neck and soft tissues revealed severe airway edema with snugly fitting endotracheal tube with no peritubal air. A repeat CT neck on the tenth postoperative day showed no signs of resolution and an elective tracheostomy was performed on the eleventh postoperative day. C1 inhibitor protein and C4 levels were assayed to exclude hereditary angioedema and were found to be within normal range. Decannulation of tracheostomy was done after airway edema resolved on the twenty-fourth postoperative day as confirmed by CT scan. Subsequently he was transferred to the ward and discharged home. Conclusion: ACEI induced angioedema is a well-recognized condition. Early diagnosis based on a high index of suspicion, immediate withdrawal of the offending drug followed by supportive therapy is the cornerstone of management.
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Affiliation(s)
- Abdulgafoor Muslim Tharayil
- Department of Anesthesia, ICU, Pain & Palliative Care, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
| | - Arshad Hussain Chanda
- Department of Anesthesia, ICU, Pain & Palliative Care, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
| | - Hakim Ahmad Shiekh
- Department of Anesthesia, ICU, Pain & Palliative Care, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
| | - Mohamed Saad Elkhatib
- Department of Anesthesia, ICU, Pain & Palliative Care, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
| | - Mohammed Nayeemuddin
- Department of Anesthesia, ICU, Pain & Palliative Care, Al-Khor Hospital, Hamad Medical Corporation, Al-Khor, Qatar
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38
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Lipski SM, Casimir G, Vanlommel M, Jeanmaire M, Dolhen P. Angiotensin-converting enzyme inhibitors-induced angioedema treated by C1 esterase inhibitor concentrate (Berinert®): about one case and review of the therapeutic arsenal. Clin Case Rep 2014; 3:126-30. [PMID: 25767713 PMCID: PMC4352369 DOI: 10.1002/ccr3.171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/06/2014] [Accepted: 09/24/2014] [Indexed: 12/17/2022] Open
Abstract
C1 esterase inhibitor (Berinert®) is generally used to treat severe attack of hereditary angioedema. We describe here the case of a patient who presented with a severe angioedema induced by angiotensin-converting enzyme inhibitors (ACEIs) endangering her life. It could be successfully treated with that medicine.
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Affiliation(s)
- Samuel Michael Lipski
- Ear-Nose-Throat Department, Tivoli University Hospital, Free University of Brussels Brussels, Belgium
| | - Georges Casimir
- Pulmonology and Allergology Unit, University Children's Hospital Queen Fabiola, Free University of Brussels Brussels, Belgium
| | - Martine Vanlommel
- Ear-Nose-Throat Department, Tivoli University Hospital, Free University of Brussels Brussels, Belgium
| | - Mathieu Jeanmaire
- Emergency Department, Tivoli University Hospital, Free University of Brussels Brussels, Belgium
| | - Pierre Dolhen
- Ear-Nose-Throat Department, Tivoli University Hospital, Free University of Brussels Brussels, Belgium
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39
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Bell C, Chakravarty A, Gruber S, Heckbert SR, Levenson M, Martin D, Nelson JC, Pinheiro S, Psaty BM, Reich CG, Schneeweiss S, Shoaibi A, Toh S, Walker AM. Characteristics of study design and elements that may contribute to the success of electronic safety monitoring systems. Pharmacoepidemiol Drug Saf 2014; 23:1223-5. [DOI: 10.1002/pds.3712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 07/02/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Carlos Bell
- Office of Medical Policy, Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Aloka Chakravarty
- Office of Biostatistics, Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Susan Gruber
- Reagan-Udall Foundation for the FDA; Innovation in Medical Evidence Development and Surveillance; Washington DC USA
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, Department of Epidemiology; University of Washington; Seattle WA USA
- Group Health Research Institute; Group Health Cooperative; Seattle WA USA
| | - Mark Levenson
- Office of Biostatistics, Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - David Martin
- Office of Biostatistics and Epidemiology; FDA Center for Biologics Evaluation and Research; Rockville MD USA
| | - Jennifer C. Nelson
- Biostatistics Unit, Group Health Research Institute, Department of Biostatistics; University of Washington; Seattle WA USA
| | - Simone Pinheiro
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Services; University of Washington; Seattle WA USA
- Group Health Research Institute; Group Health Cooperative; Seattle WA USA
| | | | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women's Hospital and Harvard Medical School; Boston MA USA
| | - Azadeh Shoaibi
- Office of Medical Policy, Center for Drug Evaluation and Research; US Food and Drug Administration; Silver Spring MD USA
| | - Sengwee Toh
- Department of Population Medicine; Harvard Medical School and Harvard Pilgrim Health Care Institute; Boston MA USA
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Affiliation(s)
- Madhu Gupta
- Department of Anaesthesia, ESI PGIMSR and Associated Hospital, Basaidarapur, New Delhi, India
| | - Shalini Subramanian
- Department of Anaesthesia, ESI PGIMSR and Associated Hospital, Basaidarapur, New Delhi, India
| | - Anil Kumar
- Department of Anaesthesia, ESI PGIMSR and Associated Hospital, Basaidarapur, New Delhi, India
| | - Divya Sethi
- Department of Anaesthesia, ESI PGIMSR and Associated Hospital, Basaidarapur, New Delhi, India
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41
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Wadelius M, Marshall SE, Islander G, Nordang L, Karawajczyk M, Yue QY, Terreehorst I, Baranova EV, Hugosson S, Sköldefors K, Pirmohamed M, Maitland-van der Zee AH, Alfirevic A, Hallberg P, Palmer CNA. Phenotype standardization of angioedema in the head and neck region caused by agents acting on the angiotensin system. Clin Pharmacol Ther 2014; 96:477-81. [PMID: 24960520 PMCID: PMC4172548 DOI: 10.1038/clpt.2014.138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/18/2014] [Indexed: 11/10/2022]
Abstract
Angioedema is a potentially life-threatening adverse reaction to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. To study the genetic etiology of this rare adverse event, international consortia and multicenter recruitment of patients are needed. To reduce patient heterogeneity, we have standardized the phenotype. In brief, it comprises swelling in the head and neck region that first occurs during treatment. It should not coincide with urticaria or have another likely cause such as hereditary angioedema.
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Affiliation(s)
- M Wadelius
- Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - S E Marshall
- Medical Research Institute, College of Medicine, Dentistry and Nursing, University of Dundee, Ninewells Hospital, Dundee, UK
| | - G Islander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | - L Nordang
- Department of Surgical Sciences, Otorhinolaryngology, and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - M Karawajczyk
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Q-Y Yue
- Medical Products Agency, Uppsala, Sweden
| | - I Terreehorst
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - E V Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - S Hugosson
- Department of Otorhinolaryngology, Örebro University Hospital and Örebro University, Örebro, Sweden
| | - K Sköldefors
- Department of Otorhinolaryngology, Hudiksvall Hospital, Hudiksvall, Sweden
| | - M Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - A-H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - A Alfirevic
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - P Hallberg
- Department of Medical Sciences, Clinical Pharmacology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - C N A Palmer
- Medical Research Institute, College of Medicine, Dentistry and Nursing, University of Dundee, Ninewells Hospital, Dundee, UK
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42
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Lin SY, Tang SC, Tsai LK, Yeh SJ, Hsiao YJ, Chen YW, Chen KH, Yip BS, Shen LJ, Wu FLL, Jeng JS. Orolingual angioedema after alteplase therapy of acute ischaemic stroke: incidence and risk of prior angiotensin-converting enzyme inhibitor use. Eur J Neurol 2014; 21:1285-91. [DOI: 10.1111/ene.12472] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 04/22/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S.-Y. Lin
- Department of Pharmacy; National Taiwan University Hospital; Taipei
| | - S.-C. Tang
- Stroke Center and Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - L.-K. Tsai
- Stroke Center and Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - S.-J. Yeh
- Stroke Center and Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
| | - Y.-J. Hsiao
- Department of Neurology; National Taiwan University Hospital Yun-Lin Branch; Yunlin Taiwan
| | - Y.-W. Chen
- Department of Neurology; Landseed Hospital; Taoyuan Taiwan
| | - K.-H. Chen
- National Taiwan University Hospital Hsin-Chu Branch; Hsinchu Taiwan
| | - B.-S. Yip
- National Taiwan University Hospital Hsin-Chu Branch; Hsinchu Taiwan
| | - L.-J. Shen
- Department of Pharmacy; National Taiwan University Hospital; Taipei
- Graduate Institute of Clinical Pharmacy; College of Pharmacy; National Taiwan University; Taipei Taiwan
| | - F.-L. Lin Wu
- Department of Pharmacy; National Taiwan University Hospital; Taipei
- Graduate Institute of Clinical Pharmacy; College of Pharmacy; National Taiwan University; Taipei Taiwan
| | - J.-S. Jeng
- Stroke Center and Department of Neurology; National Taiwan University Hospital; Taipei Taiwan
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43
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Bertazzoni G, Spina MT, Scarpellini MG, Buccelletti F, De Simone M, Gregori M, Valeriano V, Pugliese FR, Ruggieri MP, Magnanti M, Susi B, Minetola L, Zulli L, D'Ambrogio F. Drug-induced angioedema: experience of Italian emergency departments. Intern Emerg Med 2014; 9:455-62. [PMID: 24214335 DOI: 10.1007/s11739-013-1007-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
Acute angioedema represents a cause of admission to the emergency department requiring rapid diagnosis and appropriate management to prevent airway obstruction. Several drugs, including angiotensin-converting enzyme inhibitors (ACE-I), nonsteroidal anti-inflammatory drugs (NSAIDs) and oral antidiabetics, have been reported to induce angioedema. The aim of this prospective observational study conducted in a setting of routine emergency care was to evaluate the incidence and extent of drug-induced non-histaminergic angioedema in this specific clinical setting, and to identify the class of drugs possibly associated with angioedema. Patients admitted to seven different emergency departments (EDs) in Rome with the diagnosis of angioedema and urticaria were enrolled during a 6-month period. Of the 120,000 patients admitted at the EDs, 447 (0.37 %) were coded as having angioedema and 655 (0.5 %) as having urticaria. After accurate clinical review, 62 cases were defined as drug-induced, non-histaminergic angioedema. NSAIDs were the most frequent drugs (taken by 22 out of 62 patients) associated with the angioedema attack. Of the remaining patients, 15 received antibiotic treatment and 10 antihypertensive treatment. In addition, we observed in our series some cases of angioedema associated with drugs (such as antiasthmatics, antidiarrheal and antiepileptics) of which there are few descriptions in the literature. The present data, which add much needed information to the existing limited literature on drug-induced angioedema in the clinical emergency department setting, will provide more appropriate diagnosis and management of this potentially life-threatening adverse event.
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Affiliation(s)
- G Bertazzoni
- Research Center on Evaluation and Promotion of Quality in Medicine "CEQUAM", La Sapienza University, Viale Regina Elena 291, 00161, Rome, Italy,
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44
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Trifluoperazine-Induced Angioedema. Case Rep Psychiatry 2014; 2014:140329. [PMID: 25197603 PMCID: PMC4150501 DOI: 10.1155/2014/140329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
Angioedema is a serious adverse drug reaction that can rarely be associated with trifluoperazine treatment. We present the case of a 44-year-old male with an established diagnosis of schizoaffective disorder, for which trifluoperazine therapy was considered. He presented to the emergency department with bilateral lower limb oedematous painful erythematous swelling that eased off completely when trifluoperazine was stopped. The possibility of allergic reaction, such as angioedema, should always be kept in mind by psychiatrists and mental health professionals when prescribing trifluoperazine antipsychotic.
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46
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Hide M, Saito H. Problems to be resolved in the management of urticaria. Allergol Int 2012; 61:515-6. [PMID: 23320283 DOI: 10.2332/allergolint.12-ed-0514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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