Hom Katherine A, Hirsch Russel, Elluru Ravindhra G
Division of Pediatric Otolaryngology, Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
Int J Pediatr Otorhinolaryngol. 2012 Jan;76(1):14-9. doi: 10.1016/j.ijporl.2011.07.016. Epub 2011 Aug 31.
Angioedema is a well-described complication arising from the use of antihypertensive agents in the adult population. However, its occurrence and potential for upper airway compromise in pediatrics has only been sporadically reported in the literature. Our objective is to report and review the occurrence of antihypertensive-induced angioedema in the pediatric population and the potential for airway compromise.
Charts of 42 patients admitted to Cincinnati Children's Hospital Medical Center with the discharge diagnosis of angioedema (ICD-9 code 995.1) from January 2000 to January 2010 were reviewed. Of the 42 charts, 3 cases had angioedema induced by antihypertensive drugs and all 3 resulted in upper airway obstruction. Summary and findings of the data collected from the medical chart review included demographics, chief complaint(s), past medical history, hospital course, antihypertensive drugs used, diagnostic test(s), medical treatment, and time from onset of symptoms to resolution. In addition, a PubMed literature search using the terms angioedema and antihypertensive drugs was performed to review its occurrence in pediatrics. The previous literature case reports were compared to our cases to further characterize and emphasize the clinical features of this occurrence in children and adolescents.
Despite the well-known occurrence of antihypertensive drug-induced angioedema causing airway obstruction in adults, only 4 case reports have been previously published in children. At our institution, we describe 3 children who developed acute angioedema with upper airway obstruction after the chronic use of antihypertensive medications [2 drugs in the ACE inhibitor class (enalapril and lisinopril), and 1 drug in the calcium channel blocker class (CCB; amlodipine)]. In all 3 cases, the symptoms resolved within 1 week after the antihypertensive agent was discontinued.
Upper airway obstruction can occur at any age when taking antihypertensive drugs. Particular caution should be applied to ACE inhibitors and CCBs in this regard. With the increasing use of antihypertensive agents in the pediatric population, clinicians should be alert to the possibility of angioedema with upper airway obstruction as a potential lethal adverse effect.
血管性水肿是成人使用抗高血压药物引发的一种已被充分描述的并发症。然而，其在儿科患者中的发生情况以及导致上呼吸道梗阻的可能性在文献中仅有零星报道。我们的目的是报告并回顾儿科患者中抗高血压药物所致血管性水肿的发生情况以及气道梗阻的可能性。
回顾了2000年1月至2010年1月间入住辛辛那提儿童医院医疗中心、出院诊断为血管性水肿（国际疾病分类第九版编码995.1）的42例患者的病历。在这42份病历中，有3例血管性水肿由抗高血压药物引起，且均导致上呼吸道梗阻。从病历回顾中收集的数据的总结与发现包括人口统计学信息、主要症状、既往病史、住院过程、使用的抗高血压药物、诊断检查、药物治疗以及从症状出现到缓解的时间。此外，利用血管性水肿和抗高血压药物等关键词在PubMed上进行文献检索，以回顾其在儿科中的发生情况。将既往文献中的病例报告与我们的病例进行比较，以进一步描述并强调儿童和青少年中这种情况的临床特征。
尽管抗高血压药物所致血管性水肿在成人中导致气道梗阻已广为人知，但此前儿童中仅发表过4例病例报告。在我们的机构，我们描述了3名儿童，他们在长期使用抗高血压药物后（2种血管紧张素转换酶抑制剂类药物[依那普利和赖诺普利]，以及1种钙通道阻滞剂类药物[氨氯地平]）出现了伴有上呼吸道梗阻的急性血管性水肿。在所有3例病例中，停用抗高血压药物后1周内症状均得到缓解。
服用抗高血压药物时，任何年龄段都可能发生上呼吸道梗阻。在这方面，应特别注意血管紧张素转换酶抑制剂和钙通道阻滞剂。随着儿科人群中抗高血压药物使用的增加，临床医生应警惕血管性水肿伴上呼吸道梗阻这一致命潜在不良反应的可能性。
