gms | German Medical Science

80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

Angioneurotic edema of head and neck in patients with ACE-inhibitors

Meeting Abstract

  • corresponding author Christian Güldner - Department of ORL – Head and Neck Surgery, University Gießen – Marburg, Marburg, Germany
  • Karen Lampe - Department of ORL – Head and Neck Surgery, University Magdeburg, Magdeburg, Germany
  • Christian Motsch - Department of ORL, Heinrich–Braun–Klinikum Zwickau, Zwickau, Germany
  • Ulrich Vorwerk - Department of ORL – Head and Neck Surgery, University Magdeburg, Magdeburg, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno002

DOI: 10.3205/09hno002, URN: urn:nbn:de:0183-09hno0020

Published: July 22, 2009

© 2009 Güldner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: ACE-Inhibitors are used in therapy of at least 40 million hypertonic patients worldwide. Well known side effects are angioneurotic edema which can be located in skin and mucous membrane [4]. Pathogenesis is not clear, but Bradykinin seems to play a key role [1], [2]. Aim of study was to analysis data of university of Magdeburg for predictive factors and relevance in ENT-departments.

Materials/results: Data of 75746 treated patients in time of 2002 to 2007 in department of ORL-head and neck surgery of university of Magdeburg were scanned for diagnosis associated with edema or hypertonia (ICD10: T78.3; J39.2; Y57.9; R60.0; R22.0; D84.1; K14.8; J38.4). 486 patients could be found with one of this diagnosis. 52 (female: 28, male: 23) showed an ACE-inhibitor associated angioneurotic edema. Mean age was 70 ± 10.3 years (female: 67 years; male: 73 years). 51 patients needed to stay in hospital (3 ± 1 day). Reason for edema were ACE-inhibitors (enalapril: 17; ramipril: 11; lisinopril/ captopril: both 7; benazepril: 3; perindopril/ quinapril/ urapidil: each 1) and AT(1)-inhibitors (irbesartan/ candesartan/ valsartan/ losartan: each 1). Location was tongue (34), floor of mouth (17), larynx (15), pharynx (9) and facial skin (6). All patients were tested negative for lack of C1-esterase-inhibitor. Consecutive allergies or co-medication (3 ± 2 additional medicaments) could be excluded as causal for edema. 49 of 52 treated patients showed complete remission after conservative therapy (prednisolon: 290 ± 210 mg; dimetinden (e.g. fenistil®): 6 ± 5 mg; ranitidine (e.g. ranitic®): 80 ± 80 mg). Three persons (enalapril: 2, captopril: 1) got an intubation in emergency room because of dyspnea caused by edema of the larynx. One could be extubated after three days. The two other got a tracheotomy during hospital stay. One of them died three weeks after release of hospital with a bulbar paralysis. The other got his tracheotomy closed after one year. We saw him regular, and he never had any kind of dyspnea.

Conclusion: As well ACE-inhibitors as AT(1)-inhibitors caused edema are increasing in frequency and relevance for ENT-doctors. You can see it in comparison with other publicized data. Leuwer et al. had 9 persons in 5 years (1993–1997) [3], Wahbe et al. treated 34 patients within 14 years (1988–2001) [4] and we had 52 patients in 6 years (2002–2007). That AT(1)-inhibitors can cause angioedema is still reported [5]. Why they do it is still not clear. But it shows that in pathogenesis of non-allergic angioedema are pathways beyond bradykinin. At present there are no predictive factors (like age, gender, allergies or co-genesis of medicaments) which could help us to know which person not to treat with ACE-inhibitors. In agreement of other publications, tongue is the major region of edema [4]. Three of 52 persons (6 %) who needed a temporary tracheotomy is a notable number of serious complications. Nevertheless, the other 94% showed a complete remission under conservative therapy. Whether new medicaments (e.g. icatibant = Firacyr®) can reduce rate of intubation, length of stay in hospital or dosis of co-medication has to be shown.


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