{"pk":12543,"title":"Clinical Features and Outcomes Associated with Angioedema in the Emergency Department","subtitle":null,"abstract":"Introduction:\n Angioedema represents self-limited, localized swelling of submucosal or subcutaneous tissues. While the underlying etiology may be undeterminable in the emergent setting, nonhistaminergic and histaminergic angioedema respond differently to therapeutic interventions, with implications for empiric treatment. Clinical features and outcome differences among nonhistaminergic vs histaminergic angioedema patients in the emergency department (ED) are poorly characterized. We aim to describe the clinical characteristics and outcomes among ED patients with angioedema by suspected etiology.\nMethods:\n This was a 10-year retrospective study of adult ED patients with angioedema, using data abstracted from the electronic health record. We evaluated univariable associations of select clinical features with etiology and used them to develop a multivariable logistic regression model for nonhistaminergic vs histaminergic angioedema.\nResults:\n Among 450 adult angioedema patients, the mean +/- standard deviation age was 57 +/- 18 years, and 264 (59%) were female. Among patients, 30% had suspected nonhistaminergic angioedema, 30% had suspected histaminergic angioedema, and 40% were of unknown etiology. As compared to histaminergic angioedema, nonhistaminergic angioedema was associated with angiotensin-converting enzyme inhibitors (ACEI) or use of angiotensin II receptor blockers (ARB) (odds ratio [OR] [60.9]; 95% confidence interval [CI], 23.16-160.14) and time of onset one hour or more prior to ED arrival (OR [5.91]; 95% CI,1.87-18.70) and was inversely associated with urticaria (OR [0.05]; 95% CI, 0.02-0.15), dyspnea (OR [0.23]; 95% CI, 0.08-0.67), and periorbital or lip edema (OR [0.25]; 95% CI, 0.08-0.79 and OR [0.32]; 95% CI, 0.13-0.79, respectively).\nConclusion:\n As compared to histaminergic angioedema, patients with nonhistaminergic angioedema were more likely to present one hour or more after symptom onset and take ACEI or ARB medications, and were less likely to have urticaria, dyspnea, or periorbital or lip angioedema. Identification of characteristics associated with the etiology of angioedema may assist providers in more rapidly initiating targeted therapies.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3nq3h9s8","frozenauthors":[{"first_name":"Benjamin","middle_name":"J.","last_name":"Sandefur","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Lucas","middle_name":"","last_name":"Oliveira J. e Silva","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota\n\nFederal University of Rio Grande do Sul, Department of Medicine, Rio Grande do Sul","department":"None"},{"first_name":"Christine","middle_name":"M.","last_name":"Lohse","name_suffix":"","institution":"Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota","department":"None"},{"first_name":"Kiran","middle_name":"A.","last_name":"Goyal","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"David","middle_name":"W.","last_name":"Barbara","name_suffix":"","institution":"Mayo Clinic, Department of Anesthesiology & Perioperative Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Ana","middle_name":"","last_name":"Castaneda-Guarderas","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"},{"first_name":"Xiao-wei","middle_name":"","last_name":"Liu","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota\n\nThe First Affiliated Hospital of China Medical University, Department of Emergency Medicine, Liaoning, Shenyang","department":"None"},{"first_name":"Ronna","middle_name":"L.","last_name":"Campbell","name_suffix":"","institution":"Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota","department":"None"}],"date_submitted":"2019-02-26T02:41:27+11:00","date_accepted":"2019-02-26T02:41:27+11:00","date_published":"2019-08-07T06:19:13+10:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/12543/galley/6651/download/"}]}