Five-Membered Nitrogen Heterocycles Angiotensin-Converting Enzyme (ACE) Inhibitors Induced Angioedema: An Underdiagnosed Condition
Abstract
:1. Introduction
2. Clinical Presentation
3. Time of Onset of AE
4. Suggested Mechanisms
4.1. The Role of ACE in Renin Angiotensin Aldosterone Pathway and Degradation of Bradykinin
4.2. The Role of ACE inhibitors in AE
5. Risk Factors
6. Diagnosis
Mast-Cell-Mediated Versus Bradykinin-Mediated AE
7. Management
- ▯
- Fresh frozen plasma (FFP)
- ▯
- Icatibant
- ▯
- Ecallantide
- ▯
- C1 inhibitor concentrate
8. Prognosis
9. Future Perspectives: Related Drugs and AE
10. Addressing ACE Inhibitor-Induced Angioedema through Tailored Interventions
11. Cutting-Edge Horizons
12. Conclusions
Funding
Conflicts of Interest
References
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Angioedema Disorder | C4 | C1 INH Levels | C1 Inhibitor Function | C1q | Other |
---|---|---|---|---|---|
HAE with C1inhibitor deficiency Type I | Low | Low | Low (usually < 50%) | Normal | |
HAE with C1 inhibitor deficiency type II | Low | Normal or elevated | Low (usually < 50%) | Normal | |
HAE with normal C1 inhibitor | Normal | Normal | Normal | Normal | |
Acquired AE with C1 inhibitor Deficiency | Low | Normal or Low | Low (usually < 50%) | Normal or low | Anti C1 Inhibitor antibodies |
ACEI- AE | Normal | Normal | Normal | Normal | |
Mast cell mediated AE | Normal | Normal | Normal | Normal |
Mast Cell Mediated AE | Bradykinin Mediated AE (ACEIs-Induced AE) | |
---|---|---|
Wheals/history of recurrent wheals | + | - |
Recurrent Laryngeal AE | - | + |
Tongue AE | + | ++ |
Angioedema triggered by NSAIDs | + | - |
Rate of onset | minutes | hours |
Duration | <48 h | >48 h |
Response to antihistamines/ corticosteroids/ adrenaline | + | - |
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Papapostolou, N.; Gregoriou, S.; Katoulis, A.; Makris, M. Five-Membered Nitrogen Heterocycles Angiotensin-Converting Enzyme (ACE) Inhibitors Induced Angioedema: An Underdiagnosed Condition. Pharmaceuticals 2024, 17, 360. https://doi.org/10.3390/ph17030360
Papapostolou N, Gregoriou S, Katoulis A, Makris M. Five-Membered Nitrogen Heterocycles Angiotensin-Converting Enzyme (ACE) Inhibitors Induced Angioedema: An Underdiagnosed Condition. Pharmaceuticals. 2024; 17(3):360. https://doi.org/10.3390/ph17030360
Chicago/Turabian StylePapapostolou, Niki, Stamatios Gregoriou, Alexander Katoulis, and Michael Makris. 2024. "Five-Membered Nitrogen Heterocycles Angiotensin-Converting Enzyme (ACE) Inhibitors Induced Angioedema: An Underdiagnosed Condition" Pharmaceuticals 17, no. 3: 360. https://doi.org/10.3390/ph17030360
APA StylePapapostolou, N., Gregoriou, S., Katoulis, A., & Makris, M. (2024). Five-Membered Nitrogen Heterocycles Angiotensin-Converting Enzyme (ACE) Inhibitors Induced Angioedema: An Underdiagnosed Condition. Pharmaceuticals, 17(3), 360. https://doi.org/10.3390/ph17030360