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On physical examination, the patient had significant facial edema. Nasal fiber-optic visualization revealed extensive airway edema involving the supraglottic region and the arytenoids. The patient was successfully intubated through the collective teamwork of ENT, anesthesia, and critical care teams. He was managed in the intensive care unit until recovery. Workup for markers for allergic causes of angioedema were within normal limits. Further investigation revealed that symptoms developed following the initiation of a dipeptidyl peptidase 4 (DPP-IV) inhibitor. The angiotensin-converting enzyme and DPP-IV play a significant role in the metabolism of bradykinin and substance P to their inactive metabolites. The complex interplay between the enzymes in the high-molecular-weight kininogen (HWMK) system may increase the risk of angioedema in patients with a known history of ACE inhibitor\u2013associated angioedema when placed on a DPP-IV inhibitor. This case report highlights the pathophysiology involved.<\/jats:p>","DOI":"10.1177\/23247096211033049","type":"journal-article","created":{"date-parts":[[2021,7,31]],"date-time":"2021-07-31T02:03:06Z","timestamp":1627696986000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["DPP-IV Inhibitor\u2013Associated Angioedema in Patient With Known History of ACE Inhibitor Angioedema"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1989-9779","authenticated-orcid":false,"given":"Chidinma","family":"Ejikeme","sequence":"first","affiliation":[{"name":"Trinitas Regional Medical Center, Elizabeth, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinedu","family":"Nwachukwu","sequence":"additional","affiliation":[{"name":"Trinitas Regional Medical Center, Elizabeth, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Luis","family":"Viechweg","sequence":"additional","affiliation":[{"name":"Trinitas Regional Medical Center, Elizabeth, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ifunanya","family":"Ejikeme","sequence":"additional","affiliation":[{"name":"Kansas City University, Kansas City, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micheal","family":"Brescia","sequence":"additional","affiliation":[{"name":"Trinitas Regional Medical Center, Elizabeth, NJ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,7,30]]},"reference":[{"key":"bibr1-23247096211033049","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.096552"},{"key":"bibr2-23247096211033049","doi-asserted-by":"publisher","DOI":"10.1016\/j.peptides.2003.12.010"},{"key":"bibr3-23247096211033049","doi-asserted-by":"publisher","DOI":"10.1096\/fj.01-0939fje"},{"key":"bibr4-23247096211033049","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1307684"},{"key":"bibr5-23247096211033049","doi-asserted-by":"publisher","DOI":"10.1007\/BF00291980"},{"key":"bibr6-23247096211033049","unstructured":"Januvia (sitagliptin tablets) prescribing information. 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