Department of Endocrinology and Metabology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Diabetol Metab Syndr. 2010 Jan 20;2:4. doi: 10.1186/1758-5996-2-4.
Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for patients with diabetes as a nephroprotector drug or to treat hypertension. Generally they are safe for clinical practice, but the relationship between these drugs and angioedema is known. The exact mechanism for ACE inhibitors-induced angioedema is not clear and it is still a matter of discussion.
We reported a case of a 23-year-old black female with an 11 year history of type 1 diabetes, regularly monitored in the department of diabetes, in use of 0,98 UI/kg/day of human insulin, which presented an allergic reaction 24 h after ramipril use. The drug had been prescribed to treat diabetic nephropathy. There was no previous history of drug induced or alimentary allergy. The patient was instructed to discontinue the use of ramipril and oral antihistaminic drug and topical corticosteroid were prescribed. Skin biopsies were performed and confirmed the clinical hypothesis of pharmacodermy. The evaluation of ACE polymorphism identified DD genotype. Six months after the withdrawal of ramipril the patient was prescribed the angiotensin-II receptor blocker (ARB) losartan as nephroprotector. She remained well without adverse reactions.
ACE inhibitors-induced angioedema is uncommon and the clinical presentation is variable with lips, tongue, oropharinge, and larynge as the most common locations. The presence of angioedema during treatment requires the immediate cessation of treatment due to the risk of possible severe complications. The case reported presented moderate symptoms, with the development of early onset edema in uncommon regions. ACE DD genotype had been associated with angioedema-ACE inhibitors induced. In patients who have experienced ACE inhibitor-related angioedema, ARB should be used cautiously used. However in the case of our patient, the prescription of losartan as nefroprotector did not result in any recurrent adverse effect.
血管紧张素转换酶（ACE）抑制剂被广泛用于治疗糖尿病肾病或高血压等疾病。一般来说，它们在临床实践中是安全的，但已知这些药物与血管性水肿之间存在关联。ACE 抑制剂引起的血管性水肿的确切机制尚不清楚，仍存在争议。
我们报告了一例 23 岁的黑人女性，患有 11 年的 1 型糖尿病，在糖尿病科定期监测，使用 0.98 UI/kg/天的人胰岛素，在使用雷米普利 24 小时后出现过敏反应。该药物曾用于治疗糖尿病肾病。患者此前无药物或食物过敏史。患者被指示停止使用雷米普利，并开具了口服抗组胺药和外用皮质类固醇。进行了皮肤活检，证实了药疹的临床假设。ACE 多态性评估确定为 DD 基因型。雷米普利停药 6 个月后，患者开始使用血管紧张素Ⅱ受体阻滞剂（ARB）氯沙坦作为肾保护剂。她一直状况良好，无不良反应。
ACE 抑制剂引起的血管性水肿并不常见，临床表现多样，最常见的部位是嘴唇、舌头、口咽和喉部。治疗期间出现血管性水肿时，由于可能发生严重并发症的风险，应立即停止治疗。本例患者表现为中度症状，在不常见的部位出现早期水肿。ACE DD 基因型与 ACE 抑制剂引起的血管性水肿有关。在曾经历 ACE 抑制剂相关血管性水肿的患者中，应谨慎使用 ARB。然而，在我们的患者中，处方氯沙坦作为肾保护剂并未导致任何复发性不良反应。
