Emergency department management of patients with ACE-inhibitor angioedema

J Emerg Med. 2013 Nov;45(5):775-80. doi: 10.1016/j.jemermed.2013.05.052. Epub 2013 Aug 26.


Background: Angiotensin-converting-enzyme inhibitors (ACEI) are one of the most prescribed medications worldwide. Angioedema is a well-recognized adverse effect of this class of medications, with a reported incidence of ACEI angioedema of up to 1.0%. Of importance to note, ACEI angioedema is a class effect and is not dose dependent. The primary goal of this literature search was to determine the appropriate Emergency Department management of patients with ACEI angioedema.

Methods: A MEDLINE literature search from January 1990 to August 2012 and limited to human studies written in English for articles with keywords of ACEI angioedema. Guideline statements and non-systematic reviews were excluded. Studies identified then underwent a structured review from which results could be evaluated.

Results: Five hundred sixty-two papers on ACEI angioedema were screened and 27 appropriate articles were rigorously reviewed in detail and recommendations given.

Conclusion: The literature search did not support any specific treatment protocol with a high level of evidence due to the limited--and limitations of the--available studies.

Keywords: ACE inhibitors; angioedema; angiotensin-converting-enzyme inhibitors.

Publication types

  • Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Angioedema / chemically induced*
  • Angioedema / diagnosis
  • Angioedema / therapy
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Emergency Service, Hospital*
  • Epinephrine / therapeutic use
  • Histamine Antagonists / therapeutic use
  • Humans
  • Intubation, Intratracheal
  • Laryngoscopy


  • Adrenal Cortex Hormones
  • Angiotensin-Converting Enzyme Inhibitors
  • Histamine Antagonists
  • Epinephrine