Lisinopril induced allergic reactions
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Lisinopril-Induced Allergic Reactions: Clinical Manifestations and Mechanisms
Cutaneous and Mucosal Allergic Reactions to Lisinopril
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, has been associated with a range of allergic reactions affecting the skin and mucous membranes. Reported cases include lupus erythematosus-like drug reactions, characterized by erythematous, scaling, and pruritic rashes, often appearing in sun-exposed areas within days of starting the medication. Histological findings in such cases show features like vacuolar degeneration, apoptotic keratinocytes, and a lymphocytic infiltrate with a significant presence of eosinophils, supporting an allergic mechanism rather than classic lupus erythematosus .
Additionally, lisinopril has been linked to oral bullous eruptions, presenting as blisters and ulcerations in the mouth. These lesions can mimic autoimmune conditions like pemphigus, but lack the typical immunopathological markers, and resolve upon discontinuation of lisinopril, further indicating an allergic etiology .
Angioedema and Exacerbation of Food Allergies
A well-known but potentially severe allergic reaction to lisinopril is angioedema, which can involve swelling of the lips, tongue, and throat. This reaction may occur at any time during therapy and is often bradykinin-mediated. However, in patients with pollen-food allergy syndrome (PFAS), lisinopril can exacerbate IgE-mediated reactions, leading to rapid-onset angioedema and oral symptoms after consuming certain foods. These cases respond to standard allergy treatments and resolve after switching from lisinopril to alternative antihypertensive agents, such as angiotensin receptor blockers .
Frequency and Risk Among Cardiovascular Drugs
Adverse drug reaction data indicate that ACE inhibitors, including lisinopril (especially in combination with hydrochlorothiazide), are among the cardiovascular drugs most frequently associated with allergic reactions. While cough is the most common side effect, allergic manifestations, including angioedema and skin reactions, are significant concerns. Angiotensin II receptor blockers are noted to have a better safety profile regarding allergic reactions .
Diagnostic Considerations and Cross-Reactivity
Patch testing is a useful tool in diagnosing allergic reactions to ACE inhibitors and assessing cross-reactivity among different agents. While captopril, another ACE inhibitor, is more commonly associated with immune-mediated skin reactions, patch testing has shown that cross-reactivity between captopril and lisinopril is rare, suggesting that patients allergic to one ACE inhibitor may tolerate others, including lisinopril .
Conclusion
Lisinopril can induce a variety of allergic reactions, ranging from skin rashes and oral lesions to severe angioedema, particularly in individuals with underlying allergies. These reactions are typically reversible upon discontinuation of the drug. Diagnostic tools like patch testing can help identify the culprit drug and guide safe alternative therapy. Awareness of these potential reactions is important for clinicians managing patients on lisinopril, especially those with a history of allergies or atopic conditions 12345.
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