Risk factors associated with severe and recurrent angioedema: An epidemic linked to ACE-inhibitors

Patricia A. Loftus, Melin Tan-Geller, Gunj Patel, Juan Lin, Sam Helman, Arvind Badhey, Eugenie Du, Richard V. Smith, Marvin P. Fried, Thomas J. Ow

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives/Hypothesis To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population. Study Design Institutional review board-approved retrospective review of a large, urban population. Methods Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded. Results The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies. Conclusions Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations.

Original languageEnglish (US)
Pages (from-to)2502-2507
Number of pages6
JournalLaryngoscope
Volume124
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Angioedema
Angiotensin-Converting Enzyme Inhibitors
Documentation
Hypersensitivity
Urban Population
Electronic Health Records
Research Ethics Committees
Hispanic Americans
Health Personnel
Population
Medical Records
Glass

Keywords

  • ace inhibitor
  • ace inhibitor angioedema
  • acquired angioedema
  • Angioedema
  • angioedema ace
  • angioedema review

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Medicine(all)

Cite this

Risk factors associated with severe and recurrent angioedema : An epidemic linked to ACE-inhibitors. / Loftus, Patricia A.; Tan-Geller, Melin; Patel, Gunj; Lin, Juan; Helman, Sam; Badhey, Arvind; Du, Eugenie; Smith, Richard V.; Fried, Marvin P.; Ow, Thomas J.

In: Laryngoscope, Vol. 124, No. 11, 01.11.2014, p. 2502-2507.

Research output: Contribution to journalArticle

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title = "Risk factors associated with severe and recurrent angioedema: An epidemic linked to ACE-inhibitors",
abstract = "Objectives/Hypothesis To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population. Study Design Institutional review board-approved retrospective review of a large, urban population. Methods Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded. Results The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6{\%}]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2{\%} of patients experienced recurrent attacks of angioedema; of those patients, 25.9{\%} were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1{\%} of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies. Conclusions Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations.",
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