Are Angiotensin Converting Enzyme Inhibitors the Main Elicitors of Tongue Angioedema?

Rationale:  ACE-I has been considered main elicitor in angioedema of the tongue (AET) but its real implication is undetermined.

Methods:   A retrospective-descriptive study including patients diagnosed with AET at the Emergency Department (ED)  Jan-2013 to Dec-2014 at the third level Hospital was conducted. 

Results: 300.300 Patients were attended at the ED. 513 were identified with angioedema. (Incidence 0.17%) 70 had AET. (13%) Mean age: 60 DS +/-20,07. Median 64, with no gender differences. 32 (51,52%) had recurrent episodes. In 44 patients (62,85 %) the  AET was isolated, 17 (24,28%)   was accompanied by facial angioedema (eye lid, lips or cheeks), 10 (14,28%) had pharyngolaryngeal involvement. 16 patients (22,85%) had breathing or swallowing difficulties and one required  intubation. ACE-I were responsible for the AET in 24 patients (34,28%), other drugs were suspected in 12 (17,14%), foods 7 (10,%),  unknown in 26 (37,14%) and others 1(1,42%). AET was isolated in 54,2% of the ACE-I-induced AE, compared to the 63,2% on the rest of the patients. 47 cases were later studied at the Allergy Department. They were classified as histaminergic 21 (45,65%), no histaminergic 24 (52,17%). There were 2 cases of inflammatory edema. On the first group foods were involved in 3 (15%) and 18 (85%) were considered idiopathic.  In the second group the most common cause identified was ACE-I 21(87,5%), followed by hereditary AE 2(8,33%) and idiopathic AE 1 (4.16%) .

Conclusions: ACE-I was the cause of a third of the AET, being responsible for 87,5% of the non-histaminergic episodes. Most of the histaminergic AET were idiopathic.