Drug-induced angioedema: experience of Italian emergency departments

Abstract

Acute angioedema represents a cause of admission to the emergency department requiring rapid diagnosis and appropriate management to prevent airway obstruction. Several drugs, including angiotensin-converting enzyme inhibitors (ACE-I), nonsteroidal anti-inflammatory drugs (NSAIDs) and oral antidiabetics, have been reported to induce angioedema. The aim of this prospective observational study conducted in a setting of routine emergency care was to evaluate the incidence and extent of drug-induced non-histaminergic angioedema in this specific clinical setting, and to identify the class of drugs possibly associated with angioedema. Patients admitted to seven different emergency departments (EDs) in Rome with the diagnosis of angioedema and urticaria were enrolled during a 6-month period. Of the 120,000 patients admitted at the EDs, 447 (0.37 %) were coded as having angioedema and 655 (0.5 %) as having urticaria. After accurate clinical review, 62 cases were defined as drug-induced, non-histaminergic angioedema. NSAIDs were the most frequent drugs (taken by 22 out of 62 patients) associated with the angioedema attack. Of the remaining patients, 15 received antibiotic treatment and 10 antihypertensive treatment. In addition, we observed in our series some cases of angioedema associated with drugs (such as antiasthmatics, antidiarrheal and antiepileptics) of which there are few descriptions in the literature. The present data, which add much needed information to the existing limited literature on drug-induced angioedema in the clinical emergency department setting, will provide more appropriate diagnosis and management of this potentially life-threatening adverse event.

Angioedema in the emergency department: a practical guide to differential diagnosis and management

“…Less commonly, an increased risk of nonhistaminergic angioedema has been associated with other classes of drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and angiotensin receptor blockers (ARBs) [7, 32]. NSAID-related angioedema is estimated to occur in 0.1–0.3% of persons exposed to NSAIDs [33, 34].…”

“…Between 2280 and 5000 visits to US EDs each year are attributable to hereditary angioedema (HAE) [5, 6], accounting for a rate of 1.87:100,000 ED visits [5]; however, these figures may underrepresent the true level of angioedema-related ED use [2, 5, 6]. Similar data from Italy suggest that 0.37% of all ED visits are related to angioedema [7], and a recent Canadian study estimated that 1:1000 ED visits are angioedema related [8]. Finally, a survey in the UK revealed that 30% of patients with hereditary or acquired angioedema have visited the ED [9].…”

Copy number variation in ALOX5 and PTGER1 is associated with NSAIDs-induced urticaria and/or angioedema

“…They represent the most frequent cause of hypersensitivity drug reactions (HDRs) in adults [2,3] and are also frequent in children [4][5][6]. Recently, a new classification of HDRs to NSAIDs has been published, stratifying patients according to the time between drug intake and reaction (immediate or delayed), the mechanisms involved [selective or cross-intolerance (CI)], and clinical symptoms [7].…”

Acil Serviste Herediter Anjioödem’e Yaklaşım

“…lı olduğu bildirilmektedir. [3][4][5] Acil vizitlerinin herhangi bir nedene bağlı anjioödemilişkili olma oranı İtalya' da: 4/1.000, Kanada' da ise 1/1.000 olarak saptanmıştır.…”