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Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema

INTRODUCTION: 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 ACEI acquired angioedema (ACEI AAE). OBJE...

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Autores principales: Kovaltchouk, Uliana, Zhang, Boyang, Jain, Vipul, Kalicinsky, Chrystyna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885369/
https://www.ncbi.nlm.nih.gov/pubmed/33588931
http://dx.doi.org/10.1186/s13223-021-00521-w
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author Kovaltchouk, Uliana
Zhang, Boyang
Jain, Vipul
Kalicinsky, Chrystyna
author_facet Kovaltchouk, Uliana
Zhang, Boyang
Jain, Vipul
Kalicinsky, Chrystyna
author_sort Kovaltchouk, Uliana
collection PubMed
description INTRODUCTION: 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 ACEI acquired angioedema (ACEI AAE). OBJECTIVE: To evaluate the efficacy of C1-INH in management of ACEI AAE at our local centers. RESULTS: Nine patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010–2020. The majority of the patients (n = 8/9) required endotracheal intubation prior to the initiation of C1-INH. Overall, approximately 56% of patients (n = 5/9) had resolution of angioedema ranging between 12 and 17 h, with a median time of 13.5 h, and no recurrence after the administration of C1-INH concentrate. One patient had transient symptom resolution in 14 h, however, recurrence of angioedema required re-intubation. The remainder of patients (n = 4/9), had resolution of angioedema between 22 and 72 h, with a median time of 33.75 h. CONCLUSION: Our findings demonstrate continued ambivalence of the efficacy and role of C1-INH concentrate in the treatment of ACEI AAE, secondary to multiple uncontrolled confounding factors. Further research into characterizing a subgroup of intubated patients in our study that responded to C1-INH concentrate needs to be completed.
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spelling pubmed-78853692021-02-17 Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema Kovaltchouk, Uliana Zhang, Boyang Jain, Vipul Kalicinsky, Chrystyna Allergy Asthma Clin Immunol Letter to the Editor INTRODUCTION: 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 ACEI acquired angioedema (ACEI AAE). OBJECTIVE: To evaluate the efficacy of C1-INH in management of ACEI AAE at our local centers. RESULTS: Nine patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010–2020. The majority of the patients (n = 8/9) required endotracheal intubation prior to the initiation of C1-INH. Overall, approximately 56% of patients (n = 5/9) had resolution of angioedema ranging between 12 and 17 h, with a median time of 13.5 h, and no recurrence after the administration of C1-INH concentrate. One patient had transient symptom resolution in 14 h, however, recurrence of angioedema required re-intubation. The remainder of patients (n = 4/9), had resolution of angioedema between 22 and 72 h, with a median time of 33.75 h. CONCLUSION: Our findings demonstrate continued ambivalence of the efficacy and role of C1-INH concentrate in the treatment of ACEI AAE, secondary to multiple uncontrolled confounding factors. Further research into characterizing a subgroup of intubated patients in our study that responded to C1-INH concentrate needs to be completed. BioMed Central 2021-02-15 /pmc/articles/PMC7885369/ /pubmed/33588931 http://dx.doi.org/10.1186/s13223-021-00521-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Letter to the Editor
Kovaltchouk, Uliana
Zhang, Boyang
Jain, Vipul
Kalicinsky, Chrystyna
Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title_full Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title_fullStr Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title_full_unstemmed Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title_short Effectiveness of C1-INH therapy in angiotensin converting enzyme inhibitor induced angioedema
title_sort effectiveness of c1-inh therapy in angiotensin converting enzyme inhibitor induced angioedema
topic Letter to the Editor
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885369/
https://www.ncbi.nlm.nih.gov/pubmed/33588931
http://dx.doi.org/10.1186/s13223-021-00521-w
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