title: Epidemiology of ACE Inhibitor Angioedema Utilizing a Large Electronic Health Record.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors (ACEIs) are a common cause of drug-induced angioedema in the United States. Most epidemiologic ACEI angioedema data are from large multicenter clinical trials.
  
  
  OBJECTIVE
  The objective of this study was to identify the incidence of and risk factors for ACEI angioedema using a large integrated electronic health record (EHR).
  
  
  METHODS
  We conducted a retrospective cohort study of all ACEI prescriptions in the outpatient setting of a large academic center between January 1, 2000, and September 30, 2008. We determined frequency, timing, and risk factors for ACEI angioedema within 5 years of prescription. All data were derived from EHR sources, with angioedema defined by EHR reactions of angioedema, swelling, edema, or lip, eye, face, tongue, throat or mouth swelling.
  
  
  RESULTS
  Among 134,945 patients prescribed an ACEI, 0.7% (n = 888) developed angioedema during the subsequent 5 years. Sex was similar but patients who developed ACEI angioedema were younger (61.5 vs 62.7 years, P = .007). Patients with ACEI angioedema were more likely to have a history of nonsteroidal anti-inflammatory drug allergy compared with patients who did not develop angioedema (7.1% vs 4.2%, P < .001). We identified a 0.07% incidence of ACEI angioedema within 1 month of prescription and a 0.23% incidence during the first year. Incidence of angioedema was relatively constant annually over the subsequent 4 years (0.10% to 0.12%).
  
  
  CONCLUSIONS
  The incidence of ACEI angioedema within a large EHR is consistent with large clinical trial data. We observed a persistent and relatively constant annual risk; however, angioedema risk factors and underlying genetic and pathophysiological mechanisms require further study.
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass. Electronic address: abanerji@partners.org.
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.affiliation: Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass.
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Blumenthal
authors.affiliation: Clinical Quality and Analysis, Information Systems, Partners Healthcare System, Boston, Mass.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Lai
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, Mass; Clinical Quality and Analysis, Information Systems, Partners Healthcare System, Boston, Mass; Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Clinical Informatics, Partners eCare, Partners Healthcare System, Boston, Mass.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
mesh_terms: D000367:Age Factors; D000485:Allergens / Q000276:immunology*; D000799:Angioedema / Q000453:epidemiology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000276:immunology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000276:immunology; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000453:epidemiology*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology
chemical_list: D000485:Allergens; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Angioedema; Angiotensin-converting enzyme; Drug allergy; Drug hypersensitivity; Electronic health record; Epidemiology