No abstract

No abstract

Penicillin and other beta-lactams are the most commonly used antibiotics due to their narrow spectrum of activity, low cost and safety profile. However, an "allergy" to Penicillin is also the most commonly reported allergy. Approximately, 5-10% of all patients self-report an allergy to Penicillin and of these <10% are found to have true IgE mediated allergy on skin testing. Numerous studies have confirmed the usefulness and strong negative predictive value (>99%) of skin testing to rule out true IgE mediated Penicillin allergy. Less than 10% of patients with a history of penicillin allergy are found to be actually allergic to penicillin on skin testing. Despite this, most physicians forgo further investigations in favor of the usage of alternative antibiotics.

RATIONALE: Angiotensin Converting Enzyme Inhibitors (ACEI) are a common cause of Emergency Room presentation for angioedema. Although no treatment guidelines exist, C1 esterase inhibitor concentrate (C1-INH) is used on an off label basis for management of ACE I acquired angioedema (ACEI AAE). We are evaluating the efficacy of C1-INH in management of ACEI AAE. METHODS: This is a retrospective chart review of treatment with C1-INH therapy for ACEI AAE. The primary end point is defined as time to symptom resolution from start of C1-INH. Exclusion criteria is angioedema from any other cause. RESULTS: 8 patients, from 3 academic sites, were identified through Allergy Service consultation data and records from Diagnostic Services Manitoba, Canada from 2010-2015. Less than 20 hours from time of C1-INH infusion to resolution of angioedema was defined as a positive response to treatment 1. 6/8 patients required endotracheal intubation prior to initiation of C1-INH. 4/8 patients had resolution of angioedema between 12-13.5 hours (median 12.75) and no recurrence. One patient had transient symptom resolution in 14 hours, however, recurrence of angioedema required reintubation. CONCLUSIONS: Our findings demonstrate a therapeutic response with C1-INH in 50 % of patients with severe ACEI AAE.