title: Multicenter study of patients with angiotensin-converting enzyme inhibitor-induced angioedema who present to the emergency department.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To describe the clinical epidemiology of ACEI-induced angioedema in patients who present to the ED.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA. abanerji@partners.org
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Michelle
authors.initials: M
authors.lastname: Blanda
authors.forename: Frank
authors.initials: F
authors.lastname: LoVecchio
authors.forename: Brian
authors.initials: B
authors.lastname: Snyder
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors