BACKGROUND: Angiotensin-converting enzyme inhibitors (ACE-Is) are associated with angioedema, a potentially life-threatening adverse reaction. Although multiple studies have been conducted in tertiary care emergency departments (EDs), scarce data are available about the presentation and management of ACE-I-induced angioedema (AIIA) in the community hospital ED. OBJECTIVE: To describe the frequency, presentation, and management of AIIA in patients seen in a community hospital ED. METHODS: A 5-year medical record review of all patients seen with angioedema at a community hospital ED. Data abstraction focused on demographic factors, initial clinical characteristics, and ED management and disposition of patients with AIIA. RESULTS: We identified 166 ED visits for angioedema, including a subset of 50 visits for AIIA (30%; 95% confidence interval, 23%-38%). The AIIA was significantly more likely to be associated with an age of 65 years or older (P = .02), unilateral symptoms (P = .02), and absence of urticaria or itching (P < .001). The ED treatment choices and admission rates were similar between patients with and without AIIA. Community hospital admission rates for AIIA (14%) were significantly lower than those from a comparable tertiary care study (41%) (P = .003); ambulance transport to the ED was nearly 3-fold higher in the tertiary care center study (P = .006). Admission was most strongly related to lack of improvement (P < .001) and history of angioedema in AIIA (P = .009). CONCLUSIONS: Angioedema frequency, presentation, and management are similar in community and tertiary care EDs (30%). Urticaria or itching may help differentiate AIIA from allergic reactions, which are otherwise similar in community ED presentation and management.
BACKGROUND:Angiotensin-converting enzyme inhibitors (ACE-Is) are associated with angioedema, a potentially life-threatening adverse reaction. Although multiple studies have been conducted in tertiary care emergency departments (EDs), scarce data are available about the presentation and management of ACE-I-induced angioedema (AIIA) in the community hospital ED. OBJECTIVE: To describe the frequency, presentation, and management of AIIA in patients seen in a community hospital ED. METHODS: A 5-year medical record review of all patients seen with angioedema at a community hospital ED. Data abstraction focused on demographic factors, initial clinical characteristics, and ED management and disposition of patients with AIIA. RESULTS: We identified 166 ED visits for angioedema, including a subset of 50 visits for AIIA (30%; 95% confidence interval, 23%-38%). The AIIA was significantly more likely to be associated with an age of 65 years or older (P = .02), unilateral symptoms (P = .02), and absence of urticaria or itching (P < .001). The ED treatment choices and admission rates were similar between patients with and without AIIA. Community hospital admission rates for AIIA (14%) were significantly lower than those from a comparable tertiary care study (41%) (P = .003); ambulance transport to the ED was nearly 3-fold higher in the tertiary care center study (P = .006). Admission was most strongly related to lack of improvement (P < .001) and history of angioedema in AIIA (P = .009). CONCLUSIONS:Angioedema frequency, presentation, and management are similar in community and tertiary care EDs (30%). Urticaria or itching may help differentiate AIIA from allergic reactions, which are otherwise similar in community ED presentation and management.
Authors: Cheng Gang; Christopher J Lindsell; Joseph Moellman; Wesley Sublett; Kim Hart; Sean Collins; Jonathan A Bernstein Journal: Allergy Asthma Proc Date: 2013 May-Jun Impact factor: 2.587
Authors: Joseph J Moellman; Jonathan A Bernstein; Christopher Lindsell; Aleena Banerji; Paula J Busse; Carlos A Camargo; Sean P Collins; Timothy J Craig; William R Lumry; Richard Nowak; Jesse M Pines; Ali S Raja; Marc Riedl; Michael J Ward; Bruce L Zuraw; Deborah Diercks; Brian Hiestand; Ronna L Campbell; Sandra Schneider; Richard Sinert Journal: Acad Emerg Med Date: 2014-04 Impact factor: 3.451
Authors: M Wadelius; S E Marshall; G Islander; L Nordang; M Karawajczyk; Q-Y Yue; I Terreehorst; E V Baranova; S Hugosson; K Sköldefors; M Pirmohamed; A-H Maitland-van der Zee; A Alfirevic; P Hallberg; C N A Palmer Journal: Clin Pharmacol Ther Date: 2014-06-24 Impact factor: 6.875