Angioedema is induced by elevated levels of bradykinin.
Bradykinin is noramlly degraded by angiotensin-1 converting enzyme and several other enzymes (including aminipeptidase–P)
A deficiency in aminopeptidase-P likely leads to ACE induced angioedema.
Treatment typically starts with discontinuing ACE inhibitors, administering H1 and H2 antagonists, and corticosteroids (all Class indeterminate).
Another consideration may be FFP 10-15 ml/kg IV or the off label use of icatibant (both Class II recommendations).
Icatibant inhibits the bradykin B2 receptor. It is a sythetic decapeptide structurally similar to bradykin.
Icatibant has been effective in case reports and case series in ACE induced angioedema. There is a prospective, double blind randomized placebo controlled trial underway.
References
Wilerson G. Angioedema in the Emergency Department: An evidence-based review. Emergency Medicine Practice, Nov 2012.
