Bradykinin-Mediated Angioedema Associated with ACE Inhibitor, Managed with C1 Esterase Inhibitor

Year 2025, Volume: 7 Issue: 3, 51 - 53, 31.12.2025

Emel Çetinkaya , Oya Güven , Tugce Uskur

https://doi.org/10.55994/ejcc.1772152

https://izlik.org/JA53KP89XB

Abstract

Introduction: Bradykinin-mediated angioedema is a rare clinical condition that can present diagnostic challenges, particularly when it occurs independently of C1 esterase inhibitor activity. One of the most common triggers is angiotensin-converting enzyme (ACE) inhibitors, which can lead to edema by preventing the breakdown of bradykinin.
Case Presentation: A 70-year-old male patient, using an ACE inhibitor for hypertension, presented to the emergency department with tongue swelling after receiving cisplatin-docetaxel-5 fluorouracil treatment for laryngeal cancer. His symptoms did not improve with anti-allergic treatment, but showed rapid resolution following administration of C1 esterase inhibitor.
Discussion: This case presents a bradykinin-mediated angioedema episode associated with ACE inhibitor use, which responded to C1 esterase inhibitor treatment. Clinicians should consider C1 esterase inhibitor therapy in cases unresponsive to standard allergy treatments.

Keywords

Bradykinin , ACE inhibitor , Angioedema , C1 esterase inhibitor

C1 Esteraz İnhibitörü ile Tedavi Edilen ACE İnhibitörü ile İlişkili Bradikinin Aracılıklı Anjiyoödem

https://izlik.org/JA53KP89XB

Abstract

Giriş: Bradikinin aracılı anjiyoödem, özellikle C1 esteraz inhibitör aktivitesinden bağımsız olarak ortaya çıktığında tanısal zorluklara yol açabilen nadir bir klinik durumdur. En yaygın tetikleyicilerden biri, bradikininin parçalanmasını engelleyerek ödeme neden olabilen anjiyotensin dönüştürücü enzim (ACE) inhibitörleridir.
Olgu Sunumu: Hipertansiyon nedeniyle ACE inhibitörü kullanan 70 yaşında bir erkek hasta, larenks kanseri için sisplatin-dosetaksel-5 florourasil tedavisi aldıktan sonra dilinde şişme şikayetiyle acil servise başvurdu. Hastanın semptomları antialerjik tedavi ile iyileşmedi, ancak C1 esteraz inhibitörü uygulamasından sonra hızla düzeldi.
Tartışma: Bu olgu sunumunda, ACE inhibitörü kullanımına bağlı ve C1 esteraz inhibitörü tedavisine yanıt veren bradikinin aracılı anjiyoödem atağı sunulmaktadır. Klinisyenler, standart alerji tedavilerine yanıt vermeyen vakalarda C1 esteraz inhibitörü tedavisini düşünmelidir.

Keywords

Bradikinin , ACE inhibitörü , Anjiyoödem , C1 esteraz inhibitörü

References

• Reshef A, Buttgereit T, Betschel SD, Caballero T, Farkas H, Grumach AS, et al. Definition, acronyms, nomenclature, and classification of angioedema (DANCE): AAAAI, ACAAI, ACARE, and APAAACI DANCE consensus. J Allergy Clin Immunol 2024; 154(2): 398-411 e1.
• Zuberbier T, Abdul Latiff AH, Abuzakouk M, Aquilina S, Asero R, Baker D, et al. The international EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria. Allergy 2022; 77(3): 734-66.
• Maurer M, Magerl M. Differences and Similarities in the Mechanisms and Clinical Expression of Bradykinin-Mediated vs. Mast Cell-Mediated Angioedema. Clin Rev Allergy Immunol 2021; 61(1): 40-9.
• Lochbaum R, Hoffmann TK, Greve J, Hahn J. Concomitant medication in patients with bradykinin-mediated angioedema - there's more than ACE inhibitors. J Dtsch Dermatol Ges 2023; 21(11): 1283-9.
• Montinaro V, Cicardi M. ACE inhibitor-mediated angioedema. Int Immunopharmacol 2020; 78: 106081.
• Zhou M, Daubresse M, Stafford RS, Alexander GC. National trends in the ambulatory treatment of hypertension in the United States, 1997-2012. PLoS One 2015; 10(3): e0119292.
• Bavishi C, Ahmed M, Trivedi V, Khan AR, Gongora C, Bangalore S, et al. Meta-analysis of randomized trials on the efficacy and safety of angiotensin-converting enzyme inhibitors in patients≥ 65 years of age. The American journal of cardiology 2016;118(9):1427-1436.
• Montinaro V, Cicardi M. ACE inhibitor-mediated angioedema. International Immunopharmacology 2020; 78: 106081.
• Motwani SS, Sandh, SK, Kitchlu A. Cisplatin nephrotoxicity: novel insights into mechanisms and preventative strategies. In Seminars in Nephrology 2020; (42): 6, p. 151341. WB Saunders.
• Matsumoto A, Nagasawa Y, Yamamoto R, Shinzawa M, Yamazaki H, Shojima K, et al. Cigarette smoking and progression of kidney dysfunction: a longitudinal cohort study. Clinical and Experimental Nephrology 2024; 28(8):793-802.
• Özdemir Ö. Acil Serviste Herediter Anjioödem’e Yaklaşım. Sakarya Tıp Dergisi, 2020;10(1): 152-161.
• Toh S, Reichman ME, Houstoun M, Southworth MR, Ding X, Hernandez AF, et al. Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system. Archives of internal medicine 2012; 172(20): 1582-1589.
• Mahmoudpour SH, Baranova EV, Souverein PC, Asselbergs FW, de Boer A, Maitland‐van der Zee AH, et al. Determinants of angiotensin‐converting enzyme inhibitor (ACEI) intolerance and angioedema in the UK Clinical Practice Research Datalink. British journal of clinical pharmacology 2016;82(6): 1647-1659.
• Okello C. A case report of an adverse drug reaction with a combination of oxaliplatin and perindopril.
• Winters ME, Rosenbaum S, Vilke GM, Almazroua FY. Emergency department management of patients with ACE-inhibitor angioedema. The Journal of Emergency Medicine 2013; 45(5): 775-780.