Department of Allergy and Immunology, Wilford Hall Ambulatory Surgical Center, San Antonio, Tex.
San Antonio Asthma and Allergy Clinic, San Antonio, Tex.
J Allergy Clin Immunol Pract. 2017 Sep-Oct;5(5):1207-1211. doi: 10.1016/j.jaip.2017.04.033. Epub 2017 May 25.
The objective of this article is to review the available studies regarding angiotensin converting enzyme (ACE) inhibitors and beta-blockers and their effect on patients at risk for anaphylaxis. A literature search was conducted in PUBMED to identify peer-reviewed articles using the following keywords: anaphylaxis, ACE inhibitor, beta-blocker, food allergy, radiocontrast media, venom allergy, skin testing, and immunotherapy. Some studies show an increased risk of anaphylaxis in patients who are taking ACE inhibitors and beta-blockers, whereas others studies do not show an increased risk. For venom immunotherapy, there are more data supporting the concomitant use of beta-blockers and ACE inhibitors in the build-up and maintenance phases. Most of the medical literature is limited to case reports and retrospective data. Prospective controlled trials are needed on this important topic. For those patients at risk of anaphylaxis who lack cardiovascular disease, it is recommended to avoid beta-blockers and possibly ACE inhibitors. However, for those patients with cardiovascular disease, beta-blockers and ACE inhibitors have been shown to increase life expectancy. Consideration should be given for the concomitant use of these medications while patients are receiving venom immunotherapy.
本文旨在回顾有关血管紧张素转换酶（ACE）抑制剂和β受体阻滞剂及其对过敏反应风险患者的影响的现有研究。在 PUBMED 中进行了文献检索，使用以下关键字识别同行评审文章：过敏反应、ACE 抑制剂、β受体阻滞剂、食物过敏、放射造影剂、毒液过敏、皮肤测试和免疫疗法。一些研究表明，服用 ACE 抑制剂和β受体阻滞剂的患者过敏反应的风险增加，而其他研究则没有显示出风险增加。对于毒液免疫疗法，有更多数据支持在建立和维持阶段同时使用β受体阻滞剂和 ACE 抑制剂。大多数医学文献仅限于病例报告和回顾性数据。需要对此重要主题进行前瞻性对照试验。对于那些缺乏心血管疾病但有过敏反应风险的患者，建议避免使用β受体阻滞剂和可能的 ACE 抑制剂。但是，对于患有心血管疾病的患者，β受体阻滞剂和 ACE 抑制剂已被证明可延长预期寿命。在接受毒液免疫疗法的同时，应考虑同时使用这些药物。
