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Clinical Features and Outcomes Associated with Angioedema in the Emergency Department
Benjamin J Sandefur1, Lucas Oliveira J E Silva1,2, Christine M Lohse3
1Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
The Western Journal of Emergency Medicine
|September 21, 2019
Summary
Nonhistaminergic angioedema, often linked to ACE inhibitors or ARBs, is more likely to present later and without urticaria or dyspnea compared to histaminergic angioedema. Identifying these features aids in faster, targeted treatment for angioedema patients.
Area of Science:
- Emergency Medicine
- Clinical Pharmacology
Background:
- Angioedema is localized swelling with varied etiologies.
- Nonhistaminergic and histaminergic angioedema have different treatment responses.
- Distinguishing angioedema types in the emergency department (ED) is crucial but challenging.
Purpose of the Study:
- To describe clinical characteristics and outcomes of angioedema patients in the ED.
- To differentiate between nonhistaminergic and histaminergic angioedema based on clinical features.
- To identify factors aiding in the rapid initiation of targeted angioedema therapies.
Main Methods:
- A 10-year retrospective study of adult angioedema patients in the ED.
- Data abstracted from electronic health records.
- Multivariable logistic regression used to model nonhistaminergic vs. histaminergic angioedema.
Main Results:
- Nonhistaminergic angioedema was associated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) use (OR 60.9).
- Late presentation (≥1 hour prior to ED arrival) was more common in nonhistaminergic angioedema (OR 5.91).
- Urticaria (OR 0.05), dyspnea (OR 0.23), and periorbital/lip edema (ORs 0.25-0.32) were less frequent in nonhistaminergic angioedema.
Conclusions:
- Patients with nonhistaminergic angioedema are more likely to use ACEI/ARBs and present later.
- Nonhistaminergic angioedema is less commonly associated with urticaria, dyspnea, or facial edema.
- Recognizing these differentiating features can improve the timely administration of appropriate angioedema treatments.
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