• Angioedema is induced by elevated levels of bradykinin.

• Bradykinin is noramlly degraded by angiotensin-1 converting enzyme and several other enzymes (including aminipeptidase–P)

• A deficiency in aminopeptidase-P likely leads to ACE induced angioedema.

• Treatment typically starts with discontinuing ACE inhibitors, administering H1 and H2 antagonists, and corticosteroids (all Class indeterminate). 

• Another consideration may be FFP 10-15 ml/kg IV or the off label use of icatibant (both Class II recommendations).

• Icatibant inhibits the bradykin B2 receptor. It is a sythetic decapeptide structurally similar to bradykin.

• Icatibant has been effective in case reports and case series in ACE induced angioedema. There is a prospective, double blind randomized placebo controlled trial underway.

 

References

Wilerson G. Angioedema in the Emergency Department: An evidence-based review. Emergency Medicine Practice, Nov 2012.