Different patterns of angioedema in patients with and without angiotensin-converting enzyme inhibitor therapy.
BACKGROUND
There is convincing evidence for a causal relationship between angiotensin converting enzyme inhibitor (ACEI) therapy and angioedema, but the clinical features of the patients remain unclear. The aim of the study was to compare patterns of angioedema in patients under ACEI therapy and those without ACEI therapy.


METHODS
One hundred and seventeen consecutive patients with angioedema treated in the emergency department of a 2000-bed tertiary care university hospital were included. A retrospective cohort study was performed, the exposure being ACEI therapy. The pattern of location of angioedema was the primary outcome measure.


RESULTS
Of 117 patients with angioedema, 25 (21%) received ACEI therapy. In a multivariate logistic regression model, angioedema of the cheeks, eyelids or nose was independently negatively associated with ACEI therapy [adjusted odds ratio 0.13 (95% confidence interval 0.03 to 0.49), p = 0.003]. Higher age was also significantly associated with ACEI therapy [adjusted odds ratio 1.85 (95% confidence interval 1.23 to 2.80), p = 0.003]. Furthermore, a trend towards an independent negative association between a history of allergies and angioedema under ACEI therapy was seen.


CONCLUSIONS
Patients with angioedema under ACE inhibitor therapy differ significantly from those receiving no ACEI therapy in terms of patterns of angioedema and age. The applicability of this observation as a tool for deciding whether to continue or terminate ACEI therapy requires prospective evaluation.
Herkner
H
H
Department of Emergency Medicine, Vienna General Hospital-Medical School, Vienna, Austria.
Temmel
A F
AF
Müllner
M
M
Havel
C
C
Hirschl
M M
MM
Kofler
J
J
Laggner
A N
AN
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D005145:Face; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors