Life-threatening anaphylaxis to venom immunotherapy in a patient taking an angiotensin-converting enzyme inhibitor

• Published in: Journal of allergy and clinical immunology 2003-11, Vol.112 (5), p.1008-1009
• Main Authors: Ober, Andrew I., MacLean, James A., Hannaway, Paul J.
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Adult; Allergies; Anaphylaxis - etiology; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Biological and medical sciences; Drug dosages; Drug Synergism; Drug toxicity and drugs side effects treatment; Enzymes; Female; Humans; Immune system; Immunotherapy - adverse effects; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Pharmacology. Drug treatments; Venom; Venoms - therapeutic use
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/S0091-6749(03)01940-7

"9 The recently published Practice Parameters on Allergen Immunotherapy do not address the ACE inhibitor issue and cite only β-adrenergic blocking agents as a risk factor or relative contradiction for immunotherapy.10 Systemic anaphylaxis can trigger catecholamine release and activate the rennin-angiotension-aldosterone system. Because ACE inhibitors inhibit the metabolism of angiotension, leading to a buildup of bradykinen and substance P, one can postulate that ACE inhibitor therapy might predispose some individuals to anaphylaxis. Because the use of these important ACE inhibitors is constantly expanding throughout medicine, case reports should be gathered and studies undertaken to determine whether there is an association between ACE inhibitors and anaphylactic events triggered by inhaled, oral, or injected allergens, especially venom.