Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press146010.36691/RJA1460Original studiesОригинальные исследованияResearch ArticleAngioedema induced by angiotensin-converting enzyme inhibitors: an analysis of hospitalizations during the COVID-19 pandemicАнгиоотёки, индуцированные ингибиторами ангиотензинпревращающего фермента: анализ госпитализаций в период пандемии СOVID-19https://orcid.org/0000-0002-8702-64869309-5550SabalenkaTatiiana М.СоболенкоТатьяна Михайловна
Belarus

MD, Cand. Sci. (Med.), Associate Professor

к.м.н., доцент

t.sobolen@tut.byhttps://orcid.org/0000-0002-6696-07048993-3484ZakharavaVolha V.ЗахароваОльга Вячеславовна
Belarus

MD

zakharovkan@mail.ruhttps://orcid.org/0000-0002-3471-69774022-5469PrakoshynaNatallia R.ПрокошинаНаталья Робертовна
Belarus

MD, Cand. Sci. (Med.)

к.м.н.

drnatalipr@gmail.comEducational Establishment Vitebsk State Order of Peoples’ Friendship Medical UniversityВитебский государственный ордена Дружбы народов медицинский университетVitebsk Regional Clinical HospitalВитебская областная клиническая больница15092021061020211835152005202108092021Copyright ©; 2021, Pharmarus Print MediaCopyright ©; 2021, Фармарус Принт Медиа2021Pharmarus Print MediaФармарус Принт Медиаhttps://rusalljournal.ru/raj/article/view/1460

BACKGROUND: The pathogenesis of angioedema induced by angiotensin-converting enzyme inhibitors is based on the accumulation of bradykinin as a result of angiotensin-converting enzyme blockade. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 receptor, which may inhibit its production and thereby lead to an increase in bradykinin levels. Thus, SARS-CoV-2 infection may be a likely trigger for the development of angioedema.

AIMS: This study aimed to analyze cases of hospitalizations of patients with angioedema associated with the use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers during the coronavirus disease 2019 (COVID-19) pandemic.

MATERIALS AND METHODS: This study retrospectively analyzed medical records of patients admitted to the Vitebsk Regional Clinical Hospital between May 2020 and December 2020 with isolated (without urticaria) angioedema while receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. In all patients, smears from the naso- and oropharynx for COVID-19 were analyzed by polymerase chain reaction.

RESULTS: Fifteen inpatients (9 men and 6 women) aged 44–72 years were admitted because of emergent events, of which 53.6% had isolated angioedema. In two cases, a concomitant diagnosis of mild COVID-19 infection was established with predominant symptoms of angioedema, including edema localized in the face, tongue, sublingual area, and soft palate. All patients had favorable disease outcomes.

CONCLUSIONS: Patients with аngiotensin-converting enzyme inhibitor-induced angioedema may require hospitalization to monitor upper respiratory tract patency. There were cases of a combination of аngiotensin-converting enzyme inhibitor-induced angioedema and mild COVID-19. Issues requiring additional research include the effect of SARS-CoV-2 infection on the levels of bradykinin and its metabolites, the triggering role of COVID-19 in the development of angioedema in patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, recommendations for the management of patients with аngiotensin-converting enzyme inhibitor-induced angioedema, and a positive result for COVID-19.

ОБОСНОВАНИЕ. В основе патогенеза ангиоотёков, индуцированных приёмом ингибиторов ангиотензинпревращающего фермента, лежит накопление брадикинина в результате блокады ангиотензинпревращающего фермента. Вирус SARS-CoV-2, связываясь с рецептором ангиотензинпревращающего фермента 2, возможно, подавляет его продукцию, что в свою очередь ведёт к повышению уровня брадикинина. Таким образом, инфицирование SARS-CoV-2 может являться вероятным триггером развития ангиоотёка.

ЦЕЛЬ ― анализ случаев госпитализаций пациентов с ангиоотёками, ассоциированными с приёмом ингибиторов ангиотензинпревращающего фермента и блокаторов ангиотензиновых рецепторов в период пандемии COVID-19.

МАТЕРИАЛ И МЕТОДЫ. Проведён ретроспективный анализ медицинских карт стационарных пациентов, госпитализированных в Витебскую областную клиническую больницу в мае-декабре 2020 года с изолированными (без крапивницы) ангиоотёками на фоне приёма ингибиторов ангиотензинпревращающего фермента или блокаторов ангиотензиновых рецепторов. Всем пациентам были взяты мазки из носо- и ротоглотки на COVID-19 методом полимеразной цепной реакции.

РЕЗУЛЬТАТЫ. По экстренным показаниям госпитализировано 15 пациентов (9 мужчин и 6 женщин) в возрасте 44–72 лет, что составило 53,6% всех пациентов с изолированными ангиоотёками. В двух случаях установлен сопутствующий диагноз инфекции COVID-19 лёгкого течения с преобладанием в клинической картине симптомов ангиоотёка с локализацией в области лица, языка, подъязычной области, мягкого нёба. Все пациенты имели благоприятный исход заболевания.

ЗАКЛЮЧЕНИЕ. Пациенты с ангиоотёками, индуцированными ингибиторами ангиотензинпревращающего фермента, могут нуждаться в госпитализации с целью мониторинга проходимости верхних дыхательных путей. Выявлены случаи сочетания ангиоотёка на фоне приёма ингибиторов ангиотензинпревращающего фермента и инфекции COVID-19 лёгкого течения. Вопросы, требующие дополнительных исследований: влияние инфицирования SARS-CoV-2 на уровни брадикинина и его метаболитов; триггерная роль инфекции COVID-19 в развитии ангиоотёков у пациентов, получающих ингибиторы ангиотензинпревращающего фермента/блокаторы ангиотензиновых рецепторов; рекомендации по ведению пациентов с ангиоотёками, индуцированными ингибиторами ангиотензинпревращающего фермента, и положительным результатом на COVID-19.

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