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ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm
INTRODUCTION: Upper airway angioedema is a life-threatening emergency department (ED) presentation with increasing incidence. Angiotensin-converting enzyme inhibitor induced angioedema (AAE) is a non-mast cell mediated etiology of angioedema. Accurate diagnosis by clinical examination can optimize p...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899059/ https://www.ncbi.nlm.nih.gov/pubmed/27330660 http://dx.doi.org/10.5811/westjem.2016.2.29224 |
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author | Curtis, R. Mason Felder, Sarah Borici-Mazi, Rozita Ball, Ian |
author_facet | Curtis, R. Mason Felder, Sarah Borici-Mazi, Rozita Ball, Ian |
author_sort | Curtis, R. Mason |
collection | PubMed |
description | INTRODUCTION: Upper airway angioedema is a life-threatening emergency department (ED) presentation with increasing incidence. Angiotensin-converting enzyme inhibitor induced angioedema (AAE) is a non-mast cell mediated etiology of angioedema. Accurate diagnosis by clinical examination can optimize patient management and reduce morbidity from inappropriate treatment with epinephrine. The aim of this study is to describe the incidence of angioedema subtypes and the management of AAE. We evaluate the appropriateness of treatments and highlight preventable iatrogenic morbidity. METHODS: We conducted a retrospective chart review of consecutive angioedema patients presenting to two tertiary care EDs between July 2007 and March 2012. RESULTS: Of 1,702 medical records screened, 527 were included. The cause of angioedema was identified in 48.8% (n=257) of cases. The most common identifiable etiology was AAE (33.1%, n=85), with a 60.0% male predominance. The most common AAE management strategies included diphenhydramine (63.5%, n=54), corticosteroids (50.6%, n=43) and ranitidine (31.8%, n=27). Epinephrine was administered in 21.2% (n=18) of AAE patients, five of whom received repeated doses. Four AAE patients required admission (4.7%) and one required endotracheal intubation. Epinephrine induced morbidity in two patients, causing myocardial ischemia or dysrhythmia shortly after administration. CONCLUSION: AAE is the most common identifiable etiology of angioedema and can be accurately diagnosed by physical examination. It is easily confused with anaphylaxis and mismanaged with antihistamines, corticosteroids and epinephrine. There is little physiologic rationale for epinephrine use in AAE and much risk. Improved clinical differentiation of mast cell and non-mast cell mediated angioedema can optimize patient management. |
format | Online Article Text |
id | pubmed-4899059 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-48990592016-06-17 ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm Curtis, R. Mason Felder, Sarah Borici-Mazi, Rozita Ball, Ian West J Emerg Med Diagnostic Acumen INTRODUCTION: Upper airway angioedema is a life-threatening emergency department (ED) presentation with increasing incidence. Angiotensin-converting enzyme inhibitor induced angioedema (AAE) is a non-mast cell mediated etiology of angioedema. Accurate diagnosis by clinical examination can optimize patient management and reduce morbidity from inappropriate treatment with epinephrine. The aim of this study is to describe the incidence of angioedema subtypes and the management of AAE. We evaluate the appropriateness of treatments and highlight preventable iatrogenic morbidity. METHODS: We conducted a retrospective chart review of consecutive angioedema patients presenting to two tertiary care EDs between July 2007 and March 2012. RESULTS: Of 1,702 medical records screened, 527 were included. The cause of angioedema was identified in 48.8% (n=257) of cases. The most common identifiable etiology was AAE (33.1%, n=85), with a 60.0% male predominance. The most common AAE management strategies included diphenhydramine (63.5%, n=54), corticosteroids (50.6%, n=43) and ranitidine (31.8%, n=27). Epinephrine was administered in 21.2% (n=18) of AAE patients, five of whom received repeated doses. Four AAE patients required admission (4.7%) and one required endotracheal intubation. Epinephrine induced morbidity in two patients, causing myocardial ischemia or dysrhythmia shortly after administration. CONCLUSION: AAE is the most common identifiable etiology of angioedema and can be accurately diagnosed by physical examination. It is easily confused with anaphylaxis and mismanaged with antihistamines, corticosteroids and epinephrine. There is little physiologic rationale for epinephrine use in AAE and much risk. Improved clinical differentiation of mast cell and non-mast cell mediated angioedema can optimize patient management. Department of Emergency Medicine, University of California, Irvine School of Medicine 2016-05 2016-04-26 /pmc/articles/PMC4899059/ /pubmed/27330660 http://dx.doi.org/10.5811/westjem.2016.2.29224 Text en © 2016 Curtis et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Diagnostic Acumen Curtis, R. Mason Felder, Sarah Borici-Mazi, Rozita Ball, Ian ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title | ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title_full | ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title_fullStr | ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title_full_unstemmed | ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title_short | ACE-I Angioedema: Accurate Clinical Diagnosis May Prevent Epinephrine-Induced Harm |
title_sort | ace-i angioedema: accurate clinical diagnosis may prevent epinephrine-induced harm |
topic | Diagnostic Acumen |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4899059/ https://www.ncbi.nlm.nih.gov/pubmed/27330660 http://dx.doi.org/10.5811/westjem.2016.2.29224 |
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