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. 2017 May-Jun;5(3):744-749.
doi: 10.1016/j.jaip.2017.02.018. Epub 2017 Apr 1.

Epidemiology of ACE Inhibitor Angioedema Utilizing a Large Electronic Health Record

Aleena Banerji  1 , Kimberly G Blumenthal  2 , Kenneth H Lai  3 , Li Zhou  4
Affiliations

Epidemiology of ACE Inhibitor Angioedema Utilizing a Large Electronic Health Record

Aleena Banerji et al. J Allergy Clin Immunol Pract. 2017 May-Jun.

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEIs) are a common cause of drug-induced angioedema in the United States. Most epidemiologic ACEI angioedema data are from large multicenter clinical trials.

Objective: The objective of this study was to identify the incidence of and risk factors for ACEI angioedema using a large integrated electronic health record (EHR).

Methods: We conducted a retrospective cohort study of all ACEI prescriptions in the outpatient setting of a large academic center between January 1, 2000, and September 30, 2008. We determined frequency, timing, and risk factors for ACEI angioedema within 5 years of prescription. All data were derived from EHR sources, with angioedema defined by EHR reactions of angioedema, swelling, edema, or lip, eye, face, tongue, throat or mouth swelling.

Results: Among 134,945 patients prescribed an ACEI, 0.7% (n = 888) developed angioedema during the subsequent 5 years. Sex was similar but patients who developed ACEI angioedema were younger (61.5 vs 62.7 years, P = .007). Patients with ACEI angioedema were more likely to have a history of nonsteroidal anti-inflammatory drug allergy compared with patients who did not develop angioedema (7.1% vs 4.2%, P < .001). We identified a 0.07% incidence of ACEI angioedema within 1 month of prescription and a 0.23% incidence during the first year. Incidence of angioedema was relatively constant annually over the subsequent 4 years (0.10% to 0.12%).

Conclusions: The incidence of ACEI angioedema within a large EHR is consistent with large clinical trial data. We observed a persistent and relatively constant annual risk; however, angioedema risk factors and underlying genetic and pathophysiological mechanisms require further study.

Keywords: Angioedema; Angiotensin-converting enzyme; Drug allergy; Drug hypersensitivity; Electronic health record; Epidemiology.

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Figures

Figure 1
Figure 1
Timing of reactions to ACE inhibitors documented in EHRs
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