BACKGROUND: Beta-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs) have been associated with an increased risk and severity of anaphylaxis. However, the evidence supporting these findings is contradictory. OBJECTIVE: We carried out a systematic review and meta-analysis of studies that assess the influence of BBs and ACEIs on anaphylaxis. METHODS: We searched PubMed/MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Web of Science for relevant observational studies. We searched for studies where the presence and severity of anaphylaxis were compared between patients taking BBs, ACEIs, both types of drug, or neither type of drug. We performed a meta-analysis using a random-effects model. RESULTS: A total of 21 studies met the study criteria. Of these, 15 assessed the severity and 9 the incidence of anaphylaxis. The studies brought together 22,313 anaphylaxis episodes for the severity studies and 18,101 anaphylaxis episodes for the studies of new cases of anaphylaxis. BBs and ACEIs increased the severity of anaphylaxis (BBs, odds ratio [OR] 2.19, 95% confidence interval [CI] 1.25-3.84; ACEIs, OR 1.56, 95% CI 1.12-2.16), but not the presence of new cases of anaphylaxis (BBs, OR 1.40, 95% CI 0.91-2.14; ACEIs, OR 1.38, 95% CI 0.39-4.86). It was not possible to perform an analysis adjusted for cardiovascular diseases, because only 1 study each for BBs and ACEIs, respectively, had adjusted data. CONCLUSIONS: The quality of evidence showing that the use of BBs and ACEI increases the severity of anaphylaxis is low owing to differences in the control of confounders arising from the concomitant presence of cardiovascular diseases.
BACKGROUND: Beta-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs) have been associated with an increased risk and severity of anaphylaxis. However, the evidence supporting these findings is contradictory. OBJECTIVE: We carried out a systematic review and meta-analysis of studies that assess the influence of BBs and ACEIs on anaphylaxis. METHODS: We searched PubMed/MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Web of Science for relevant observational studies. We searched for studies where the presence and severity of anaphylaxis were compared between patients taking BBs, ACEIs, both types of drug, or neither type of drug. We performed a meta-analysis using a random-effects model. RESULTS: A total of 21 studies met the study criteria. Of these, 15 assessed the severity and 9 the incidence of anaphylaxis. The studies brought together 22,313 anaphylaxis episodes for the severity studies and 18,101 anaphylaxis episodes for the studies of new cases of anaphylaxis. BBs and ACEIs increased the severity of anaphylaxis (BBs, odds ratio [OR] 2.19, 95% confidence interval [CI] 1.25-3.84; ACEIs, OR 1.56, 95% CI 1.12-2.16), but not the presence of new cases of anaphylaxis (BBs, OR 1.40, 95% CI 0.91-2.14; ACEIs, OR 1.38, 95% CI 0.39-4.86). It was not possible to perform an analysis adjusted for cardiovascular diseases, because only 1 study each for BBs and ACEIs, respectively, had adjusted data. CONCLUSIONS: The quality of evidence showing that the use of BBs and ACEI increases the severity of anaphylaxis is low owing to differences in the control of confounders arising from the concomitant presence of cardiovascular diseases.
Authors: Jean Bousquet; Ioana Agache; Hubert Blain; Marek Jutel; Maria Teresa Ventura; Margitta Worm; Stefano Del Giacco; Athanasios Benetos; Beatrice Maria Bilo; Wienczyslawa Czarlewski; Amir Hamzah Abdul Latiff; Mona Al-Ahmad; Elizabeth Angier; Isabella Annesi-Maesano; Marina Atanaskovic-Markovic; Claus Bachert; Annick Barbaud; Anna Bedbrook; Kazi S Bennoor; Elena Camelia Berghea; Carsten Bindslev-Jensen; Sergio Bonini; Sinthia Bosnic-Anticevich; Knut Brockow; Luisa Brussino; Paulo Camargos; G Walter Canonica; Victoria Cardona; Pedro Carreiro-Martins; Ana Carriazo; Thomas Casale; Jean-Christoph Caubet; Lorenzo Cecchi; Antonio Cherubini; George Christoff; Derek K Chu; Alvaro A Cruz; Dejan Dokic; Yehia El-Gamal; Motohiro Ebisawa; Bernadette Eberlein; John Farrell; Montserrat Fernandez-Rivas; Wytske J Fokkens; Joao A Fonseca; Yadong Gao; Gaëtan Gavazzi; Radoslaw Gawlik; Asli Gelincik; Bilun Gemicioğlu; Maia Gotua; Olivier Guérin; Tari Haahtela; Karin Hoffmann-Sommergruber; Hans Jürgen Hoffmann; Maja Hofmann; Martin Hrubisko; Maddalena Illario; Carla Irani; Zhanat Ispayeva; Juan Carlos Ivancevich; Kaja Julge; Igor Kaidashev; Musa Khaitov; Edward Knol; Helga Kraxner; Piotr Kuna; Violeta Kvedariene; Antti Lauerma; Lan T T Le; Vincent Le Moing; Michael Levin; Renaud Louis; Olga Lourenco; Vera Mahler; Finbarr C Martin; Andrea Matucci; Branislava Milenkovic; Stéphanie Miot; Emma Montella; Mario Morais-Almeida; Charlotte G Mortz; Joaquim Mullol; Leyla Namazova-Baranova; Hugo Neffen; Kristof Nekam; Marek Niedoszytko; Mikaëla Odemyr; Robyn E O'Hehir; Yoshitaka Okamoto; Markus Ollert; Oscar Palomares; Nikolaos G Papadopoulos; Petr Panzner; Giovanni Passalacqua; Vincenzo Patella; Mirko Petrovic; Oliver Pfaar; Nhân Pham-Thi; Davor Plavec; Todor A Popov; Marysia T Recto; Frederico S Regateiro; Jacques Reynes; Regina E Roller-Winsberger; Yves Rolland; Antonino Romano; Carmen Rondon; Menachem Rottem; Philip W Rouadi; Nathalie Salles; Boleslaw Samolinski; Alexandra F Santos; Faradiba S Sarquis; Joaquin Sastre; Jos M G A Schols; Nicola Scichilone; Anna Sediva; Mohamed H Shamji; Aziz Sheikh; Isabel Skypala; Sylwia Smolinska; Milena Sokolowska; Bernardo Sousa-Pinto; Milan Sova; Rafael Stelmach; Gunter Sturm; Charlotte Suppli Ulrik; Ana Maria Todo-Bom; Sanna Toppila-Salmi; Ioanna Tsiligianni; Maria Torres; Eva Untersmayr; Marilyn Urrutia Pereira; Arunas Valiulis; Joana Vitte; Alessandra Vultaggio; Dana Wallace; Jolanta Walusiak-Skorupa; De-Yun Wang; Susan Waserman; Arzu Yorgancioglu; Osman M Yusuf; Mario Zernotti; Mihaela Zidarn; Tomas Chivato; Cezmi A Akdis; Torsten Zuberbier; Ludger Klimek Journal: Allergy Date: 2021-10 Impact factor: 14.710
Authors: Paul J Turner; Stefania Arasi; Barbara Ballmer-Weber; Alessia Baseggio Conrado; Antoine Deschildre; Jennifer Gerdts; Susanne Halken; Antonella Muraro; Nandinee Patel; Ronald Van Ree; Debra de Silva; Margitta Worm; Torsten Zuberbier; Graham Roberts Journal: Allergy Date: 2022-04-28 Impact factor: 14.710
Authors: C Pitsios; M Tsoumani; M B Bilò; G J Sturm; P Rodríguez Del Río; R Gawlik; F Ruëff; G Paraskevopoulos; E Valovirta; O Pfaar; M A Calderón; P Demoly Journal: Clin Transl Allergy Date: 2019-09-11 Impact factor: 5.871