Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis - 30/03/13
Corresponding author: Ronna L. Campbell, MD, PhD, Department of Emergency Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.Abstract |
Background |
Risk factors for increased anaphylaxis severity are poorly understood. Angiotensin-converting enzyme (ACE) inhibitors have been associated with severe anaphylactic reactions in patients with hymenoptera venom allergy. Studies evaluating the association between beta-blockers and severe anaphylaxis have been conflicting.
Objective |
To evaluate the association between antihypertensive medication use and increased anaphylaxis severity.
Methods |
We included emergency department anaphylaxis patients aged 18 years and older. Markers of severe anaphylaxis were defined as (1) syncope, hypotension, or hypoxia; (2) signs and symptoms involving 3 or more organ systems; and (3) hospitalization. Antihypertensive medications evaluated included beta-blockers, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and diuretics. Simple and multiple logistic regression analyses were conducted to estimate the association between antihypertensive medication use and markers of increased anaphylaxis severity.
Results |
Among 302 patients with anaphylaxis, 55 (18%) had syncope, hypoxia, or hypotension, 57 (19%) required hospitalization, and 139 (46%) had 3 or more organ system involvement. After adjusting for age, gender, suspected trigger, and preexisting lung disease, beta-blocker, ACE-inhibitor, diuretic, or antihypertensive medication use in aggregate remained associated with both 3 or more organ system involvement and need for hospital admission. The adjusted associations between antihypertensive medication use in aggregate and 3 or more organ system involvement yielded an odds ratio of 2.8 (95% CI, 1.5-5.2; P = .0008) and with hospitalization an odds ratio of 4.0 (95% CI, 1.9-8.4; P = .0001).
Conclusions |
In emergency department anaphylaxis patients, antihypertensive medication use is associated with increased organ system involvement and increased odds of hospital admission, independent of age, gender, suspected trigger, or preexisting lung disease.
Le texte complet de cet article est disponible en PDF.Key words : Anaphylaxis, antihypertensive medications, angiotensin-converting enzyme inhibitor, beta-blocker, risk factors, emergency department
Abbreviations used : ACE, CCB, ED, NIAID/FAAN, OR, SBP
Plan
| This publication was supported by National Institutes of Health/NCRR/NCATS CTSA grant no. UL1 RR024150. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. |
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| Disclosure of potential conflict of interest: S. Lee, E. P. Hess, D. M. Nestler, V. R. Bellamkonda Athmaram, M. F. Bellolio, W. W. Decker, V. Manivannan, S. C. Vukov, and R. L. Campbell have received research support from the National Institutes of Health (NIH). J. T. C. Li has received research support from the NIH and has stock options in Novartis, Abbott, and Johnson & Johnson. J. B. Hagan has received research support from the NIH, National Heart, Lung, and Blood Institute, National Institute of Allergy and Infectious Diseases, and MedImmune; was chairman of the Dyax Adjudication panel of KALBITOR; and has held stock in Johnson & Johnson and TEVA in the last 3 years. |
Vol 131 - N° 4
P. 1103-1108 - avril 2013 Retour au numéro
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