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

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

doi:10.1016/j.jaci.2013.01.011

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

Journal article

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

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

Journal of allergy and clinical immunology, Vol.131(4), pp.1103-1108

04/01/2013

DOI: 10.1016/j.jaci.2013.01.011

PMID: 23453138

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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. (J Allergy Clin Immunol 2013; 131:1103-8.)

Immunology

Allergy

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Antihypertensive medication use is associated with increased organ system involvement and hospitalization in emergency department patients with anaphylaxis
Creators: Sangil Lee - Mayo Clinic
Erik P. Hess - Mayo Clinic in Florida
David M. Nestler - Mayo Clinic
Venkatesh R. Bellamkonda Athmaram - Mayo Clinic
M. Fernanda Bellolio - Mayo Clinic
Wyatt W. Decker - Mayo Clinic
James T. C. Li - Mayo Clinic
John B. Hagan - Division of Allergic Diseases, Mayo clinic, Rochester, Minn
Veena Manivannan - Mayo Clinic
Samuel C. Vukov - Mayo Clinic
Ronna L. Campbell - Mayo Clinic
Resource Type: Journal article
Publication Details: Journal of allergy and clinical immunology, Vol.131(4), pp.1103-1108
DOI: 10.1016/j.jaci.2013.01.011
PMID: 23453138
NLM abbreviation: J Allergy Clin Immunol
ISSN: 0091-6749
eISSN: 1097-6825
Publisher: Elsevier
Number of pages: 6
Grant note: National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) National Institutes of Health (NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA UL1 RR024150 / National Institutes of Health/NCRR/NCATS CTSA MedImmune; AstraZeneca; Medimmune National Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) UL1RR024150 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR)
Language: English
Date published: 04/01/2013
Academic Unit: Emergency Medicine; Injury Prevention Research Center
Record Identifier: 9984297139902771

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