title: Angiotensin-converting enzyme inhibitor-induced angioedema in a community hospital emergency department.
abstract: 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.affiliation: Montgomery Family Practice Residency Program, Montgomery Hospital Medical Center, Norristown, Pennsylvania, USA.
authors.forename: Hazel M
authors.initials: HM
authors.lastname: Bluestein
authors.forename: Todd A
authors.initials: TA
authors.lastname: Hoover
authors.forename: Aleena Suryadevara
authors.initials: AS
authors.lastname: Banerji
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: Avner
authors.initials: A
authors.lastname: Reshef
authors.forename: Paul
authors.initials: P
authors.lastname: Herscu
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000799:Angioedema / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006633:Histamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data; D006764:Hospitals, Community; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006633:Histamine Antagonists; D004837:Epinephrine