title: Bradykinin-mediated angioedema: factors prompting ED visits.
abstract: OBJECTIVE
  Bradykinin-mediated angioedema (AE) is characterized by periodic subcutaneous or submucosal swelling, with the absence of urticaria and itching. It affects the face and extremities. Attacks of abdominal pain and obstruction of the upper airways are the hallmarks of disease severity. The aim of this study was to determine the factors prompting patients to turn up at the hospital emergency department (ED) in the event of an attack.
  
  
  METHODS
  This was a retrospective review of attacks experienced by all patients with bradykinin-mediated AE (hereditary, acquired, or drug-induced) who visited our ED between January 2002 and March 2011. Characteristics of attacks prompting ED visits and attacks when patients stayed at home were compared using logistic regression with generalized estimating equations to take into account the correlation between multiple attacks from the same patient.
  
  
  RESULTS
  A total of 55 patients were included, of whom 39 had hereditary AE; 13, drug-induced AE; and 3, acquired C1 inhibitor deficiency. The median follow-up was 32 months (interquartile range, 10-99 months). The attack was severe in 324 (58%) of 559 cases. Thirty-two patients (58%) visited the ED for a total of 75 attacks. First attack and laryngeal edema were significantly associated with more frequent ED visits (odds ratio, 5.28 [95% confidence interval, 2.42-11.5] and 4.83 [1.54-15.5], respectively]. C1 inhibitor concentrate and icatibant treatment was significantly more often administered in the ED than at home (odds ratio, 4.9 [2.43-9.88] and 8.25 [2.4-28.3], respectively).
  
  
  CONCLUSIONS
  First attack of bradykinin AE and swelling of the larynx were significantly associated with visits to the ED.
authors.affiliation: Service des Urgences, Centre de Référence associé sur les angiœdèmes à kinines, Assistance Publique-Hôpitaux de Paris, Hôpital Jean Verdier, Groupe hospitalier Hôpitaux Universitaires Paris Seine-Saint-Denis, Université Paris 13, Bondy, France. nicolas.javaud@jvr.aphp.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Javaud
authors.forename: Ahmed
authors.initials: A
authors.lastname: Karami
authors.forename: Jérôme
authors.initials: J
authors.lastname: Stirnemann
authors.forename: Florence
authors.initials: F
authors.lastname: Pilot
authors.forename: Albanne
authors.initials: A
authors.lastname: Branellec
authors.forename: Marouane
authors.initials: M
authors.lastname: Boubaya
authors.forename: Cécile
authors.initials: C
authors.lastname: Chassaignon
authors.forename: Frédéric
authors.initials: F
authors.lastname: Adnet
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
mesh_terms: D000328:Adult; D000799:Angioedema / Q000175:diagnosis* / Q000628:therapy*; D001920:Bradykinin / Q000502:physiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D001920:Bradykinin