Angiotensin Converting Enzyme Inhibitors (ACEI) are a common cause of Emergency Room presentation for angioedema. Although no treatment guidelines exist, C1 esterase inhibitor concentrate (C1-INH) is used on an off label basis for management of ACE I acquired angioedema (ACEI AAE). We are evaluating the efficacy of C1-INH in management of ACEI AAE.
This is a retrospective chart review of treatment with C1-INH therapy for ACEI AAE. The primary end point is defined as time to symptom resolution from start of C1-INH. Exclusion criteria is angioedema from any other cause.
8 patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010-2015. Less than 20 hours from time of C1-INH infusion to resolution of angioedema was defined as a positive response to treatment1. 6/8 patients required endotracheal intubation prior to initiation of C1-INH. 4/8 patients had resolution of angioedema between 12-13.5 hours (median 12.75) and no recurrence. One patient had transient symptom resolution in 14 hours, however, recurrence of angioedema required reintubation.
Our findings demonstrate a therapeutic response with C1-INH in 50 % of patients with severe ACEI AAE.
1 Bas, Murat, et al. "Icatibant in ACE-Inhibitor–Induced Angioedema." New England Journal of Medicine N Engl J Med 372.19 (2015): 1866-868.