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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...

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Autores principales: Curtis, R. Mason, Felder, Sarah, Borici-Mazi, Rozita, Ball, Ian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2016
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.
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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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