Does Race Predispose to Angiotensin-Associated Angioneurotic Edema?

TO THE EDITOR:

Since the report by Wilkin and colleagues [1] of angioneurotic edema in two patients receiving captopril, many other cases associated with angiotensin- onverting enzyme (ACE) inhibitor therapy have been recognized; the incidence has been estimated to be 0.1% to 0.2% [2]. We have recently observed a higher-than-expected incidence in black patients. We examined the literature on ACE inhibitor-associated angioneurotic edema to determine whether others had noted such a trend. We reviewed 38 articles reporting cases of ACE inhibitor-associated angioneurotic edema since 1980. In 18 articles, patient race was reported for at least one case. Fifty-two of 67 patients whose race was reported were black. Fourteen patients were white, and 1 was Hispanic. Unfortunately, no information about race was provided for most (n = 360) of the cases reported. We therefore cannot conclude whether the apparently high proportion of blacks among patients with ACE inhibitor-associated angioneurotic edema reflects true prevalence or a reporting bias. If real, the high proportion of blacks among patients with ACE inhibitor-associated angioneurotic edema contrasts with the low proportion of blacks among all patients treated with ACE inhibitors [3, 4]. This finding suggests that the incidence of angioneurotic edema in blacks treated with ACE inhibitors may be much higher than the 0.1% to 0.2% cited in the literature. Rigorous pharmacoepidemiologic studies are needed to confirm or refute this observation. In the meantime, we are interested in knowing what racial distribution others have observed among patients with ACE inhibitor-associated angioneurotic edema.