Treatment
ÎA fourth reaction type to aspirin and NSAIDs is urticaria or angioedema caused by all drugs that inhibit COX-1. It occurs in patients without a prior history of chronic urticaria. (C)
ÎRarely, patients exhibit combined ("blended") respiratory and cutaneous reaction to aspirin or NSAIDs and hence cannot be classified into one of the four reaction types described above. (C)
ACE Inhibitors
ÎACE inhibitors are associated with 2 major adverse effects—cough and angioedema. (C)
ÎACE inhibitor-related cough often begins within the first few weeks of treatment and occurs in up to 20% of patients, particularly women, blacks, and Asians. (C)
ÎThe mechanism of ACE inhibitor-related cough is unclear. The cough resolves with discontinuation of the drug therapy in days to weeks. (D)
ÎPatients with ACE inhibitor-related cough are able to tolerate angiotensin receptor blockers (ARBs). (A)
ÎACE inhibitor-induced angioedema occurs in approximately 0.1% to 0.7% of patients and is most common in blacks. (C)
ÎACE inhibitor-induced angioedema frequently involves the face and oropharynx and can be life-threatening or fatal. (C)
ÎThe mechanism of ACE inhibitor-induced angioedema may be related to interference with bradykinin degradation. It may take months or years after initiation of therapy for a reaction to appear, and it often occurs sporadically despite persistent treatment. (C)
ÎTreat ACE inhibitor-induced angioedema by discontinuing the drug therapy. Subsequently, have the patient avoid all ACE inhibitors. (D)
ÎMost patients who experience angioedema during ACE inhibitor treatment are able to tolerate ARBs. (C)
ÎPatients with a history of angioedema or C1 esterase inhibitor deficiency are at increased risk of more frequent and severe episodes of angioedema with the administration of ACE inhibitors. Therefore do not administer these drugs to such patients. (C)
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