Résumé
Background: angioedema is a potentially serious side effect of ACE inhibitor/sartan therapy. Management is based on discontinuation of the drug. The over-diagnosis of drug-induced angioedema may lead to the useless discontinuation of an otherwise valuable treatment for cardiology and nephrology management.Objective: the aim of this study was to determine the percentage of mast-cell angioedemas (including idiopathic non-histaminergic angioedema and refractory to antihistamines chronic spontaneous urticaria) in patients consulting for angioedema while undertaking ACE inhibitors/sartans and possible associated factors. Methods: patients referred for isolated, unresponsive to antihistamines (non-histaminergic) angioedema occurring during ACEI/sartan therapy were included. Diagnoses of hereditary/acquired C1-inhibitor deficiency were ruled out. Suspect therapy was systematicallydiscontinued. The primary endpoint was the percentage of patients with a final diagnosis of mast-cell angioedema defined by the recurrence of angioedema after 6 months of discontinuation and/or subsequent development of hives, i.e. idiopathic non-histaminergic angioedema or chronic spontaneous urticaria. Results: a total of 38 patients over 93 (40.86%) were diagnosed with idiopathic non histaminergic angioedema (n=27) or spontaneous chronic urticaria (n=11). No epidemiological or clinical factor was predictive for any final diagnosis, but good response to icatibant wasassociated with ACE/sartan-induced angioedema (p=0.036).Conclusions: nearly 41% of patients referred for suspected ACEI/sartan-induced angioedema were ultimately diagnosed with mast-cell angioedemas, theoretically allowing resumption of the suspected therapy.