Angiotensin converting enzyme (ACE) inhibitors have been associated with the onset of angioedema in a small subset of treated patients. The angioedema commonly involves the face and oropharyngeal tissues and may result in life-threatening airway compromise. The mechanism by which ACE inhibitors precipitate angioedema has not been well-defined, and retrospective analysis of reported cases has failed to identify a group of patients at high risk. We report four cases of ACE inhibitor—related angioedema that required immediate medical intervention. All four cases occurred in patients with a prior history of idiopathic angioedema, an otherwise uncommon clinical entity. These observations suggest that patients with a history of idiopathic angioedema are at increased risk for the development of ACE inhibitor—related angioedema and should be treated cautiously with this class of drugs.
Orfan N, Patterson R, Dykewicz MS. Severe Angioedema Related to ACE Inhibitors in Patients With a History of Idiopathic Angioedema. JAMA. 1990;264(10):1287-1289. doi:10.1001/jama.1990.03450100077030