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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    • "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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    • "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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