title: Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis.
abstract: BACKGROUND
  Risk factors for increased anaphylaxis severity are poorly understood. Angiotensin-converting enzyme (ACE) inhibitors have been associated with severe anaphylactic reactions in patients with hymenoptera venom allergy. Studies evaluating the association between beta-blockers and severe anaphylaxis have been conflicting.
  
  
  OBJECTIVE
  To evaluate the association between antihypertensive medication use and increased anaphylaxis severity.
  
  
  METHODS
  We included emergency department anaphylaxis patients aged 18 years and older. Markers of severe anaphylaxis were defined as (1) syncope, hypotension, or hypoxia; (2) signs and symptoms involving 3 or more organ systems; and (3) hospitalization. Antihypertensive medications evaluated included beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and diuretics. Simple and multiple logistic regression analyses were conducted to estimate the association between antihypertensive medication use and markers of increased anaphylaxis severity.
  
  
  RESULTS
  Among 302 patients with anaphylaxis, 55 (18%) had syncope, hypoxia, or hypotension, 57 (19%) required hospitalization, and 139 (46%) had 3 or more organ system involvement. After adjusting for age, gender, suspected trigger, and preexisting lung disease, beta-blocker, ACE-inhibitor, diuretic, or antihypertensive medication use in aggregate remained associated with both 3 or more organ system involvement and need for hospital admission. The adjusted associations between antihypertensive medication use in aggregate and 3 or more organ system involvement yielded an odds ratio of 2.8 (95% CI, 1.5-5.2; P=.0008) and with hospitalization an odds ratio of 4.0 (95% CI, 1.9-8.4; P=.0001).
  
  
  CONCLUSIONS
  In emergency department anaphylaxis patients, antihypertensive medication use is associated with increased organ system involvement and increased odds of hospital admission, independent of age, gender, suspected trigger, or preexisting lung disease.
authors: Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Sangil
authors: S
authors: Lee
authors: Erik P
authors: EP
authors: Hess
authors: David M
authors: DM
authors: Nestler
authors: Venkatesh R
authors: VR
authors: Bellamkonda Athmaram
authors: M Fernanda
authors: MF
authors: Bellolio
authors: Wyatt W
authors: WW
authors: Decker
authors: James T C
authors: JT
authors: Li
authors: John B
authors: JB
authors: Hagan
authors: Veena
authors: V
authors: Manivannan
authors: Samuel C
authors: SC
authors: Vukov
authors: Ronna L
authors: RL
authors: Campbell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000494:pharmacology; D000328:Adult; D000707:Anaphylaxis / Q000209:etiology* / Q000473:pathology; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects* / Q000494:pharmacology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000494:pharmacology; D002121:Calcium Channel Blockers / Q000009:adverse effects* / Q000494:pharmacology; D004232:Diuretics / Q000009:adverse effects* / Q000494:pharmacology; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics