Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis

Lee, Sangil; Hess, Erik P.; Nestler, David M.; Athmaram, Venkatesh R. Bellamkonda; Bellolio, M. Fernanda; Decker, Wyatt W.; Li, James T.C.; Hagan, John B.; Manivannan, Veena; Vukov, Samuel C.; Campbell, Ronna L.

doi:10.1016/j.jaci.2013.01.011

Cited by 93 publications

(74 citation statements)

References 16 publications

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“…To date, beta blockers have been observed to be risk factors for iodinated CM-induced hypersensitivity reactions only [1][2][3][4], while GBCA have not been mentioned in this context. GBCA are generally associated with far fewer hypersensitivity reactions than ICM: the overall rate of adverse events with GBCAs is 0.1% [10].…”

Section: Aes?mentioning

confidence: 98%

“…Therefore, it is not clear what should a physician, general practitioner, cardiologist or an internal specialist do. Moreover, in both single cases and observational clinical studies, severe hypersensitivity reactions have reported in patients taking beta blockers who underwent ICM-enhanced radiological procedures [1][2][3][4].…”

Section: Do Beta Blockers Increase the Risk For CM Adverse Events?mentioning

confidence: 99%

“…Another study showed that antihypertensive medication use (i.e. beta-blockers, ACE inhibitors) is associated with increased organ system involvement and increased odds of hospital admission, independent of age, gender, suspected trigger, or preexisting lung disease [3].…”

Section: Do Beta Blockers Increase the Risk For CM Adverse Events?mentioning

confidence: 99%

“…Evidence in the medical literature suggests that beta blockers do not increase the frequency of anaphylaxis, but do increase the risk for severe anaphylaxis and for treatment-refractory conditions [3,4,11]. Interestingly, the older the paper the more harmful the CM-application in 4 concert with patients who receive beta blockers.…”

Section: Conclusion and Practical Recommendationmentioning

confidence: 99%

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Beta blockers and intravenous roentgen contrast materials: Which risks do exist?

Boehm

Morelli

Nairz

et al. 2016

European Journal of Internal Medicine

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pindolol) are broadly used to treat diseases like hypertension, tachycardia, cardiac arrhythmia, congestive heart failure, essential tremor, migraine prophylaxis, and myocardial infarction for example. Both beta blockers and iodinated radio-contrast media (ICM) are frequently used, so that a relevant proportion of patients undergoing ICM-enhanced computed tomography (CT) or other X-ray related imaging procedures can be estimated to be under treatment with beta blockers. Usually, ICM are well tolerated and safe. However, adverse events (AEs) and hypersensitivity reactions (HSRs) do still occur in a small percentage of patients. Especially, patients at risk will acquire AEs/HSRs. Therefore, the identification of risks is mandatory to efficiently avoid ICM-side effects. While a history of a previous ICM-reaction/-allergy is a well-known risk and a clear indication for a prophylactic task, other risks such as intake of beta-blockers are less clear and therefore, still a matter of debate. Since GPs should be involved in the decision process to safely manage the application of ICM, we summarized the current knowledge concerning beta-blocker medication while undergoing ICM-enhanced radiological imaging procedure.

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Section: Aes?mentioning

confidence: 98%

Section: Do Beta Blockers Increase the Risk For CM Adverse Events?mentioning

confidence: 99%

Section: Do Beta Blockers Increase the Risk For CM Adverse Events?mentioning

confidence: 99%

Section: Conclusion and Practical Recommendationmentioning

confidence: 99%

See 2 more Smart Citations

Beta blockers and intravenous roentgen contrast materials: Which risks do exist?

Boehm

Morelli

Nairz

et al. 2016

European Journal of Internal Medicine

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“…The classic risk factors for more severe anaphylaxis are older age, cardiovascular and respiratory disease, antihypertensive drugs (principally ß-blockers and ACE inhibitors), drugs, venom, and uncontrolled asthma [4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

Nieto-Nieto

Tejedor-Alonso

Farias-Aquino

et al. 2017

J Investig Allergol Clin Immunol

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Background: Studies assessing the severity of anaphylaxis lack a comprehensive approach to collecting data on comorbidities that may worsen prognosis. Objective: Using the Elixhauser score (a systematic index associated with longer stay, hospital charges, and mortality), we determined which comorbidities were associated with more severe anaphylaxis. Methods: We based our study on the Spanish Ministry of Health database of hospital discharges in Spain between 1997 and 2011. We constructed logistic regression models in which the dependent variables were outcomes related to greater severity (death, cardiac arrest, need for invasive mechanical ventilation or vasopressor drugs, admission to the intensive care unit, and length of stay) and the independent variables were the 30 comorbidities that comprise the Elixhauser score, age, sex, and main causes of anaphylaxis. Results: We found that a higher risk of severe anaphylaxis was associated (3 or more logistic regressions) with age >50 years or having experienced cardiac arrhythmia, coagulation disorder, associated fluid-electrolyte imbalance, chronic pulmonary disease, or Echinococcus anaphylaxis. Likewise, in the adjusted analysis, a higher Elixhauser score was associated with most of the outcomes analyzed for severity of anaphylaxis. Conclusions: Cardiovascular and respiratory diseases increase the severity of anaphylaxis, and the resulting poor health status (represented as a higher Elixhauser score) is associated with more severe anaphylaxis.

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International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

151

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis

Cited by 93 publications

References 16 publications

Beta blockers and intravenous roentgen contrast materials: Which risks do exist?

Beta blockers and intravenous roentgen contrast materials: Which risks do exist?

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

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