RSS Feeds
Adverse Effects of ACE Inhibitors
- Zafar H. Israili, MD; and
- W. Dallas Hall, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
Dr. Edwards is correct that our statement may be misleading. The case reports he and Drs. Chu and Chow describe, as well as those in our review and recent ones [1-3], confirm that angioneurotic edema can occur even after prolonged therapy with ACE inhibitors. Because most cases occur within a week [4], we used the word “usually”.
In some instances, the symptoms of angioedema may be very mild and subside without the patient's awareness. The symptoms may incorrectly be attributed to other causes such as food allergy, insect sting, or other drug reactions. Continued use of ACE inhibitors in such patients may result in the recurrence of severe angioneurotic edema.
Because of the unpredictable occurrence and severity of angioedema and the risk for serious life-threatening consequences, ACE inhibitors should not be given to patients who have had even a mild or easily reversed episode [5] or are prone to spontaneous angioedema.
Drs. Adams and Hazard point out a letter [6] not cited by us [1] describing the use of cromolyn inhalation therapy for persistent cough induced by ACE inhibitor therapy. The authors report that cromolyn resulted in the cessation of cough in three of six patients and reduction in cough severity in another two. No mention was made of dose or duration of cromolyn therapy in this uncontrolled study.
Cromolyn shares some common adverse effects (cough, wheezing, bronchospasm, angioedema, joint swelling, and urticaria) with ACE inhibitors. Thus, the use of cromolyn is not encouraged, especially in patients with compromised pulmonary function.
The use of ACE inhibitors is certainly desirable for many patients with congestive heart failure or diabetic nephropathy, and it may become necessary to continue or reinstate these drugs in patients who can tolerate the adverse effect of cough. A recent report has also shown that, in some patients, cough abates despite continued use of ACE inhibitors [7].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
