Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department

Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology (Impact Factor: 2.6). 04/2008; 100(4):327-32. DOI: 10.1016/S1081-1206(10)60594-7
Source: PubMed


Recent data are lacking about the number of patients with angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema who present to the emergency department (ED). Current management of the condition and clinical outcomes also are not known.
To describe the clinical epidemiology of ACEI-induced angioedema in patients who present to the ED.
We performed a medical record review of ACEI-induced angioedema in patients who presented to 5 EDs in the Emergency Medicine Network. A structured data abstraction form was used to collect each patient's demographic factors, medical history, and details about the angioedema that prompted the ED visit. The medical record review also focused on treatment provided in the ED and subsequent need for hospitalization.
We identified a total of 220 patients with ACEI-induced angioedema. The frequency of ACEI-induced angioedema among all patients with angioedema who presented to the ED was 30% (95% confidence interval, 26%-34%). The annual rate of visits for ACEI-induced angioedema was 0.7 per 10,000 ED visits. The most frequent presenting signs were shortness of breath, lip and tongue swelling, and laryngeal edema. Most patients (58%) were sent home directly from the ED, whereas 12% were regular inpatient admissions, 11% were admitted to the intensive care unit, and 18% were admitted under observation status (<24 hours). Pharyngeal swelling and respiratory distress were independent predictors of hospital admission and longer length of stay.
ACEI-induced angioedema accounted for almost one-third of angioedema treated in the ED, although it remains a rare ED presentation. A subgroup of these patients still needs inpatient hospitalization for management of upper airway angioedema.

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Available from: Carlos A Camargo, Oct 13, 2015
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    • "Etiologies of this condition include; idiopathic, genetic, allergic, toxic or drugs. Common drugs associated with angioedema: Non-steroidal anti-inflammatory drugs including aspirin, angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor antagonists (ARBs).[1234567] "
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    ABSTRACT: Angioedema (AE) is edema of the skin, subcutaneous tissue and/or submucosal tissues, resulting from extravasation of intravascular fluid. Swelling of the supraglottic mucosa can lead to airway obstruction with consequent hypoxia, brain damage and death. To date, fiberoptic bronchoscope (FOB) intubation of the spontaneously breathing patient is the preferred method for an anticipated difficult intubation. However, other alternative devices can be utilized to intubate angioedema successfully. A retrospective chart review was performed over a three-year period (2008-2010) of all patients with angioedema that required airway intervention. We hypothesized that fiberoptic intubation would have a higher success rate for intubation attempts; however, would take longer to perform when compared to videolaryngoscopic (VL) intubation. Outcomes for FOB versus VL intubations were reviewed, along with alternative miscellaneous methods of tracheal intubation in the setting of angioedema. Thirty-three patients were grouped, according to the chosen method of intubation into FOB (n=12), VL (n=11), and miscellaneous (n=10) groups. No significant difference was found in first intubation attempts or number of intubation attempts between the three groups. Duration of time to perform successful intubation revealed a significantly shorter intubation time (P<0.05) in the VL group (6.9±0.9 min) and miscellaneous group (9.1±2.0 min) than that of the FOB group (10.4±0.7 min). This retrospective review of intubation methods showed that VL could be performed faster than FOB without an increase in adverse events.
    04/2013; 3(2):108-12. DOI:10.4103/2229-5151.114267
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    • "At 6-month followup, the patient remained free of abdominal pain. Approximately 30% of all ED visits for angioedema are from ACEI, while the annual rate of ED visits for ACEIinduced angioedema is 0.7 per 10,000 [11] [12]. Angioedema is asymmetrical nonpitting edema of the skin or mucus membrane and a well-documented side effect of ACEI [13]. "
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    ABSTRACT: Angiotensin converting enzyme inhibitor ACEI-induced angioedema of the intestine is a rare occurrence and often unrecognized complication of ACEI. We present a case of a 45-year-old Hispanic female with angioedema of the small bowel progressing to facial and oral pharyngeal angioedema. Patients are typically middle-aged females on ACEI therapy who present to the emergency department with abdominal pain, nausea, vomiting, and diarrhea. This is a diagnosis of exclusion, and physicians must have a high index of suspicion to make the diagnosis. Symptoms typically resolve within 24-48 hours after ACE inhibitor withdrawal. Recognizing these signs and symptoms, and discontinuing the medication, can save a patient from unnecessary, costly, and invasive procedures.
    Case Reports in Medicine 12/2010; 2010:690695. DOI:10.1155/2010/690695
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    ABSTRACT: Les angioedèmes bradykiniques sont caractérisés par des oedèmes sous-cutanés ou sous-muqueux, intermittents, en l’absence de prurit le plus souvent. Ils touchent la face et les extrémités. Les crises douloureuses abdominales et l’oedème laryngé font la gravité de la maladie. Ils peuvent être d’origine héréditaire ou acquise, en particulier secondaire à un traitement par inhibiteur de l’enzyme de conversion de l’angiotensine. Les crises graves sont traitées par l’administration précoce de traitements spécifiques. Ils comprennent l’icatibant, un antagoniste des récepteurs B2 de la bradykinine ou les concentrés de C1-inhibiteur.
    Réanimation 09/2013; DOI:10.1007/s13546-013-0696-5
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