RESUMEN
Angioedema is a rare but potentially life-threatening adverse effect of angiotensin-converting enzyme inhibitors (ACEI) which usually occurs within the first weeks of therapy. We report three patients in whom ACEI-induced angioedema began with a late onset of 12-33 months, and who had an irregular, unpredictable course under ACEI therapy. In two patients, other drugs or trauma appeared to trigger some of the episodes. After withdrawal of the ACEI, the trigger drugs were well tolerated in provocation tests and upon re-exposure. To avoid putting some patients unnecessarily at risk for long periods, one should consider this irregular pattern of ACEI-induced angioedema and regularly monitor patients for this adverse effect.
Asunto(s)
Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Cilazapril/efectos adversos , Enalapril/efectos adversos , Anciano , Anestesia Local/efectos adversos , Angioedema/diagnóstico , Pruebas de Provocación Bronquial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Pruebas Cutáneas , Factores de TiempoAsunto(s)
Anafilaxia/inducido químicamente , Erupciones por Medicamentos/etiología , Hirudinas/análogos & derivados , Inmunoglobulina G/inmunología , Urticaria/inducido químicamente , Enfermedad Aguda , Adulto , Quimasas , Hirudinas/administración & dosificación , Hirudinas/efectos adversos , Hirudinas/inmunología , Humanos , Inmunización , Inyecciones Intravenosas , Inyecciones Subcutáneas , Pruebas Intradérmicas , Masculino , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/inmunología , Serina Endopeptidasas/sangre , Pruebas Cutáneas , TriptasasRESUMEN
A 43-year-old woman suffered from recurrent localized swellings and an eczematous dermatitis starting 1 day after an injection of lidocaine. Intradermal patch and lymphocyte transformation tests revealed sensitization to lidocaine and cross-reactivity to the other aminoacylamide local anesthetics bupivacaine, mepivacaine and prilocaine, but not to articane. Contact allergy to the ester local anesthetics benzocaine, procaine and tetracaine, the quinoline or aminoacylamide cinchocaine, and the preservatives methylparaben and metabisulfite, was excluded. A subcutaneous challenge with articaine was well tolerated.