Possible montelukast-induced angioedema

Abstract

Purpose. A possible case of montelukast-induced angioedema is reported. Summary. A 46-year-old woman with a history of severe allergies, including food allergies, and angioedema was evaluated at the emergency department (ED) for an acute episode of angioedema. Upon arrival at the ED, the patient had severe jaw tightness, facial numbness, uncontrollable cheek lifting, swollen eyes, and a swollen protruding tongue and was unable to catch her breath. Her dyspnea was apparent, and she was unable to talk and instead used hand and face gestures for affirmative and negative responses. The patient was treated with 0.3 mg epinephrine intramuscularly into the right thigh. After treatment, she had a temperature of 37 °C, a pulse of 90 beats/ min, a blood pressure value of 100/59 mm Hg, a respiratory rate of 16 breaths/min, and 100% oxygen saturation on room air. After stabilization, she reported that her allergies had been adequately controlled with ebastine 10 mg daily, montelukast 10 mg daily, and vitamins (unspecified). The patient reported that since she started montelukast one month prior, she experienced three similar episodes, the first occurring five days after starting the drug. She mentioned being diagnosed and adequately treated these three times in the ED for angioedema. The patient denied any changes in eating habits or in her medications except for starting montelukast. She was observed at the ED for an hour and then discharged after stabilization on hydroxyzine hydrochloride 25 mg orally daily and fexofenadine hydrochloride 180 mg orally daily. Montelukast was discontinued. Conclusion. A patient developed angioedema four times during one month of treatment with montelukast.