C32-05 Unmasking an Uncommon Culprit: Beta-Blocker-Related Angioedema in Clinical Practice

Abstract Introduction Angioedema is a rare side effect in patients taking antihypertensive medication, particularly linked to ACE inhibitors. However, angioedema has also been reported in patients taking beta-blockers. We present a patient presenting with angioedema after recently starting carvedilol. Case Report An 83-year-old female with history of hypertension, CKD, hyperlipidemia, grade 2 diastolic dysfunction presented for worsening dyspnea and swelling of the mouth after being started on carvedilol by her cardiologist 3 days prior. Of note, patient had a documented allergy to valsartan, endorsing swelling when trying that medication. She denied any new foods, medications, travel, or exposures in this time frame. In the ED, patient was hypoxic requiring supplemental oxygen and progressively becoming more altered, with increase in tongue swelling, prompting emergent intubation for airway protection and management of hypercapnic and hypoxic respiratory failure. Chest XR and CT imaging of the neck were significant for a significantly enlarged tongue and extensive oropharyngeal swelling causing airway obstruction. Our patient was treated in the ICU with steroids, antihistamines, and was extubated 3 days later after improvement in oropharyngeal swelling and was downgraded to general medical floor for further management. Discussion Angioedema is a serious and life threatening adverse even that manifests as swelling of the lips, tongue, and airway. Beta-blockers have even been used as a control to base the risk of angioedema off of other medications that directly target the RAAS system. However, studies have showed that despite being rare, angioedema is a complication that has been seen in some patients taking beta blockers, including a 72-year-old patient who was admitted for flash pulmonary edema requiring intubation and experienced severe angioedema after receiving IV metoprolol. Of note, patient had no history of using beta blockers in the past and also had a documented allergy to lisinopril, similar to our presented patient who had a documented valsartan allergy. A retrospective study in 2012 compared the incidence of angioedema and severe hypersensitivity reactions between different beta blockers, including long and short acting carvedilol, and found that there was no statistical or meaningful clinical significance between incidence rates of angioedema between different beta blockers, but did note an increased incidence of angioedema seen in females. Conclusion Despite being a rare side effect, angioedema can be seen in patients on beta blocker therapy. Future studies of beta blockers and hypersensitivity reactions are encouraged, particularly in patients with documented allergies to ACE inhibitors or ARBs. This abstract is funded by: none