アンジオテンシンII受容体拮抗薬内服中に発症した血管性浮腫の2例

抄録

Angiotensin-converting enzyme (ACE) inhibitor-induced angioedema is commonly known as drug-induced angioedema, and can causes upper airway obstruction. On the other hand, angiotensin II receptor blockers (ARBs) are considered as being useful to avoid angioedema, as they exert their antihypertensive effect without increasing the serum bradykinin levels. However, with the increasingly wide use of ARBs, a steadily increasing number of cases of angioedema associated with ARB use have been reported. Herein, we report two cases of ARB-induced angioedema. A 69-year-old man and a 50-year-old woman who were taking ARBs for the control of hypertension were referred to our hospital for throat edema. As the ARB prescribed was suspected as the cause of the angioedema in both cases, the drug was withdrawn in both, and treatment was initiated with corticosteroids, tranexamic acid, and antihistamines. In both cases, the throat edema improved promptly within a few days, and no recurrence of the symptom has been noted for several years after discontinuation of the ARBs. Herein, we discuss potential therapeutic agents for angioedema, and also the clinical features of ARB-induced angioedema based on a review of 8 cases of ARB-induced angioedema reported in the literature. Angioedema induced by ACE inhibitors and ARBs has been classified as bradykinin-type angioedema as well as hereditary angioedema. The efficacy and safety of a C1-inactivator preparation and a selective bradykinin B2 receptor antagonist for ARB-induced angioedema are expected to be further verified.