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ACE inhibitor angio-oedema threatening the airway — SCE Acute Medicine MCQ

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HardAllergy and immunologyACE inhibitor angio-oedema threatening the airwaySCE Acute Medicine

A 59-year-old man taking ramipril presents with progressive tongue swelling and muffled voice but no urticaria or wheeze. Blood pressure is 148/86 mmHg and oxygen saturation is 96% on air. Symptoms began 2 hours ago and are worsening. What is the most appropriate next step in management?

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Correct answer: A — Urgent airway assessment and stop ACE inhibitor permanently

ACE inhibitor angio-oedema is bradykinin-mediated and can progress to airway obstruction without urticaria or bronchospasm. Airway assessment is the priority, and the ACE inhibitor should be stopped permanently. Antihistamines may be tried if diagnostic uncertainty exists but are often ineffective and should not delay airway planning.

Reference: BNF ACE inhibitors; NICE CKS angio-oedema