title: Pollen count and presentation of angiotensin-converting enzyme inhibitor-associated angioedema.
abstract: BACKGROUND
  The incidence of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema is increased in patients with seasonal allergies.
  
  
  OBJECTIVE
  We tested the hypothesis that patients with ACE inhibitor-associated angioedema present during months when pollen counts are increased.
  
  
  METHODS
  Cohort analysis examined the month of presentation of ACE inhibitor-associated angioedema and pollen counts in the ambulatory and hospital setting. Patients with ACE inhibitor-associated angioedema were ascertained through (1) an observational study of patients presenting to Vanderbilt University Medical Center, (2) patients presenting to the Marshfield Clinic and participating in the Marshfield Clinic Personalized Medicine Research Project, and (3) patients enrolled in The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). Measurements include date of presentation of ACE inhibitor-associated angioedema, population exposure to ACE inhibitor by date, and local pollen counts by date.
  
  
  RESULTS
  At Vanderbilt, the rate of angioedema was significantly associated with tree pollen months (P = .01 from χ(2) test). When separate analyses were conducted in patients with a history of seasonal allergies and patients without, the rate of ACE inhibitor-associated angioedema was increased during tree pollen months only in patients with a history of seasonal allergies (P = .002). In Marshfield, the rate of angioedema was significantly associated with ragweed pollen months (P = .025). In ONTARGET, a positive trend was observed between the ACE inhibitor-associated angioedema rate and grass season, although it was not statistically significant (P = .057).
  
  
  CONCLUSIONS
  Patients with ACE inhibitor-associated angioedema are more likely to present with this adverse drug event during months when pollen counts are increased.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Vanderbilt School of Medicine, Nashville, Tenn.
authors.forename: Brittany
authors.initials: B
authors.lastname: Straka
authors.affiliation: Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tenn.
authors.forename: Hui
authors.initials: H
authors.lastname: Nian
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Chantel
authors.initials: C
authors.lastname: Sloan
authors.affiliation: Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Mich.
authors.forename: James Brian
authors.initials: JB
authors.lastname: Byrd
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Vanderbilt School of Medicine, Nashville, Tenn.
authors.forename: Alencia
authors.initials: A
authors.lastname: Woodard-Grice
authors.affiliation: Department of Biostatistics, Vanderbilt School of Medicine, Nashville, Tenn.
authors.forename: Chang
authors.initials: C
authors.lastname: Yu
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Vanderbilt School of Medicine, Nashville, Tenn.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stone
authors.affiliation: Allergy, Asthma & Sinus Center, Greenfield, Wis.
authors.forename: Gary
authors.initials: G
authors.lastname: Steven
authors.affiliation: Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.
authors.forename: Tina
authors.initials: T
authors.lastname: Hartert
authors.affiliation: Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Pare
authors.affiliation: Essentia Institute of Rural Health, Duluth, Minn.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: McCarty
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Vanderbilt School of Medicine, Nashville, Tenn. Electronic address: nancy.j.brown@vanderbilt.edu.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D031164:Ambrosia / Q000276:immunology; D000799:Angioedema / Q000139:chemically induced* / Q000453:epidemiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057685:Plant Weeds / Q000276:immunology; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology*; D006255:Rhinitis, Allergic, Seasonal / Q000453:epidemiology*; D014197:Trees / Q000276:immunology
chemical_list: D000485:Allergens; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin-converting enzyme inhibitor; angioedema; bradykinin; pollen; seasonal allergies; substance P