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BALTIMORE -- Antihypertensive treatment with ACE inhibitors may prime oral allergy syndrome patients for severe reactions, a case-report suggested.
One patient on lisinopril (Prinivil, Zestril) for a decade went into anaphylaxis after eating an apple, Denisa Ferastraoaru, MD, of Montefiore Medical Center in New York City, and colleagues found.
A second patient on the same drug for a year developed tongue angioedema three times after eating jackfruit and cashews, the researchers reported in a poster presentation here at the American College of Allergy, Asthma, and Immunology meeting.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"Oral allergy syndrome usually manifests as mild symptoms, and rarely presents with severe manifestations such as angioedema," the group noted.
Angioedema and anaphylaxis have been reported with ACE inhibitors on their own.
"However, these cases suggest that concomitant use of ACE inhibitors in patients with oral allergy syndrome might represent a priming effect, thereby increasing the severity of oral allergy syndrome symptoms," Ferastraoaru and colleagues explained.
In both cases, patients had seasonal allergies and were found to have immunoglobulin E (IgE) sensitization to birch.
The patient who had one episode of tongue and lip angioedema and oral itching followed by a second episode a week later requiring epinephrine and hospital admission also tested positive for IgE sensitization to apple, which he had been eating before both episodes.
Neither case had elevated serum total IgE, serum eosinophils, complement, or C1-esterase inhibitor levels.
Both patients were switched to an angiotensin receptor blocker (ARB) in place of their ACE inhibitor, advised to avoid raw fruit, and had no further oral allergy symptoms.
"This can happen, and keep in mind it might happen more frequently in patients that are allergic to pollen, because that's what it means oral allergy syndrome," Ferastraoaru told 51˶.
Switching all hypertensive patients with the combination of food and pollen allergies off of ACE inhibitors may not be warranted, she cautioned, whereas referring such patients to an allergist might be wise.
Disclosures
Ferastraoaru reported having no conflicts of interest to disclose.
Primary Source
American College of Allergy, Asthma & Immunology
Source Reference: Ferastraoaru D, et al "The association between severe manifestations of oral allergy syndrome and concurrent angiotensin-converting enzyme inhibitor therapy" ACAAI 2013; Abstract P2.