A patient on lisinopril develops nonpruritic lip edema after a meal; no urticaria. What is the best next step?

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Study for the NBME Form 13 Test with our comprehensive quiz collection, featuring flashcards and multiple-choice questions to ensure your readiness. Enhance your knowledge with detailed explanations for each question.

Multiple Choice

A patient on lisinopril develops nonpruritic lip edema after a meal; no urticaria. What is the best next step?

Explanation:
ACE inhibitor–induced angioedema causes nonpruritic swelling of the lips or face without urticaria, driven by excess bradykinin rather than histamine. Because this is not a histamine-mediated allergic reaction, epinephrine and steroids are unlikely to rapidly reverse it. The best next step is to discontinue the ACE inhibitor to remove the trigger and allow the edema to resolve, with careful airway monitoring for possible progression. If needed later, an alternative antihypertensive with a lower risk of angioedema can be used.

ACE inhibitor–induced angioedema causes nonpruritic swelling of the lips or face without urticaria, driven by excess bradykinin rather than histamine. Because this is not a histamine-mediated allergic reaction, epinephrine and steroids are unlikely to rapidly reverse it. The best next step is to discontinue the ACE inhibitor to remove the trigger and allow the edema to resolve, with careful airway monitoring for possible progression. If needed later, an alternative antihypertensive with a lower risk of angioedema can be used.

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