title: Risk factors associated with severe and recurrent angioedema: an epidemic linked to ACE-inhibitors.
abstract: OBJECTIVE
  To evaluate the etiology and risk factors for severe manifestation and recurrent episodes of angioedema; to evaluate efficacy of short-term and long-term management strategies for angioedema among a high-risk population.
  
  
  METHODS
  Institutional review board-approved retrospective review of a large, urban population.
  
  
  METHODS
  Data from 875 adult patients treated from January 2008 to December 2013 with the diagnosis of angioedema were obtained using the Clinical Looking Glass utility and review of medical records. Demographic and clinicopathologic risk factors were recorded. The major outcomes evaluated were hospital admission, need for airway intervention, and recurrent episodes of angioedema following the first presentation. Initial treatment strategy and follow-up recommendations were also recorded.
  
  
  RESULTS
  The most common cause of angioedema was angiotensin converting enzyme inhibitor (ACEi)-induced (496 [56.6%]). Significant risk factors for severe cases of angioedema included older age, Hispanic race, ACEi-induced angioedema type, American Society of Anesthesiologists class III or above, coexistent cardiopulmonary disease, and a positive smoking history. A total of 17.2% of patients experienced recurrent attacks of angioedema; of those patients, 25.9% were still taking an ACEi at subsequent presentation. Risk factors for recurrent episodes included older age, idiopathic angioedema type, and coexistent cardiopulmonary disease. Only 54.1% of patients who experienced ACEi-induced angioedema had electronic medical record documentation of these allergies.
  
  
  CONCLUSIONS
  Knowledge of risk factors for severe and recurrent episodes of angioedema and improved education for both healthcare providers and patients, specifically related to ACEi use and allergy documentation, may significantly decrease the burden and morbidity of angioedema among high risk populations.
  
  
  METHODS
  2b.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, U.S.A.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Loftus
authors.forename: Melin
authors.initials: M
authors.lastname: Tan
authors.forename: Gunj
authors.initials: G
authors.lastname: Patel
authors.forename: Juan
authors.initials: J
authors.lastname: Lin
authors.forename: Sam
authors.initials: S
authors.lastname: Helman
authors.forename: Arvind
authors.initials: A
authors.lastname: Badhey
authors.forename: Eugenie
authors.initials: E
authors.lastname: Du
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.forename: Marvin P
authors.initials: MP
authors.lastname: Fried
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ow
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000799:Angioedema / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D055815:Young Adult
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angioedema; ace inhibitor; ace inhibitor angioedema; acquired angioedema; angioedema ace; angioedema review