Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers-Induced Angioedema at the Emergency Department.
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Sarah Micozzi, MD, Marta Seoane, MD, Dasha Roa Medellin, MD, Maria Elisa Caralli, MD, Ana Rodriguez, MD, Mercedes Sáenz de Santa María, MD, María L. Baeza, MD, PhD, Inés Torrado, MD
Rationale: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs) are important causes of angioedema (AE) at the Emergency Department (ED). Many times it becomes overlooked.

Methods: AE caused by ACEIs/ARBs attended at the ED of a 3th level hospital in Madrid, January 2013-March 2015, were reviewed. They were later studied at the Allergy Department.

Results: 339151 patients were attended at the ED; 505 (0.15%) referred AE without urticaria. 56 AE (11%) were caused by ACEIs and/or ARBs . Mean age: 67 years (±14), 59% males. 17.8% had recurrent AE, none had familiar AE and 39.3% were atopic. 30.5% received daily treatment with nonsteroidal antinflamatory drugs, 42.8% were smokers or ex-smokers. The antihypertensive mean duration was 55 months (±76.4; median 24; range 1-300). AE localized exclusively on face (44.6%) or oropharyngeal area (throat 39.3%, tongue 51.8%) with respiratory distress in 28.6%.  One patient required intubation. . At the ED, ACEIs/ARBs were unrecognized as inducers in 73,2%; 54 received corticoid/antihistamines, 8 icatibant, (6 of them after corticoid failure). Mean stay at ED: 8.8h (±13.6); range 25-1.5 h). Thirty eight patients stopped ACEIs or ARBs, 6 of them (15.8%) had new angioedema outbreaks in a follow up of 6-17 months.

Conclusions: The ACEi/ARBs are largely unrecognized but not uncommon causes of AEs at the Emergency Departments. It is mainly not peripheral AE, which very often affects the upper airways. Most of patients are not correctly diagnosed, thus they undergo inefficacious treatments and very often the causal agent is not removed.