Anaphylactoid Reactions | Angiotensin Converting Enzyme (ACE) Inhibitor

 

Pathogenesis: Kininogen may be activated by exposure to negatively-charged surfaces of an artificial blood processing filter, resulting in formation of bradykinin. ACE inhibitors inhibit kininase II, which delays bradykinin metabolism and results in increased plasma levels.

 

Situations:

(1) transfusion of blood through leukocyte reduction filter

(2) hemodialysis

(3) apheresis

(4) plasma exchange

(5) Staphylococcal protein A affinity absorption

 

Clinical findings:

(1) hypotension

(2) bradycardia

(3) flushing

(4) dyspnea

 

Prevention: ACE inhibitors should be stopped 24-48 hours prior to exposure.