Pollen Count and Presentation of Angiotensin-Converting Enzyme Inhibitor-Associated Angioedema

Brittany Straka, Hui Nian, Chantel Sloan, James Brian Byrd, Alencia Woodard-Grice, Chang Yu, Elizabeth Stone, Gary Steven, Tina Hartert, Koon K. Teo, Guillaume Pare, Catherine A. McCarty, Nancy J. Brown

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: The incidence of angiotensin-converting enzyme (ACE) inhibitor-associated angioedema is increased in patients with seasonal allergies. Objective: We tested the hypothesis that patients with ACE inhibitor-associated angioedema present during months when pollen counts are increased. Methods: Cohort analysis examined the month of presentation of ACE inhibitor-associated angioedema and pollen counts in the ambulatory and hospital setting. Patients with ACE inhibitor-associated angioedema were ascertained through (1) an observational study of patients presenting to Vanderbilt University Medical Center, (2) patients presenting to the Marshfield Clinic and participating in the Marshfield Clinic Personalized Medicine Research Project, and (3) patients enrolled in The Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). Measurements include date of presentation of ACE inhibitor-associated angioedema, population exposure to ACE inhibitor by date, and local pollen counts by date. Results: At Vanderbilt, the rate of angioedema was significantly associated with tree pollen months (P= .01 from χ2 test). When separate analyses were conducted in patients with a history of seasonal allergies and patients without, the rate of ACE inhibitor-associated angioedema was increased during tree pollen months only in patients with a history of seasonal allergies (P= .002). In Marshfield, the rate of angioedema was significantly associated with ragweed pollen months (P= .025). In ONTARGET, a positive trend was observed between the ACE inhibitor-associated angioedema rate and grass season, although it was not statistically significant (P= .057). Conclusions: Patients with ACE inhibitor-associated angioedema are more likely to present with this adverse drug eventduring months when pollen counts are increased.

Original languageEnglish (US)
Pages (from-to)468-473.e4
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume1
Issue number5
DOIs
StatePublished - Sep 2013

Keywords

  • Angioedema
  • Angiotensin-converting enzyme inhibitor
  • Bradykinin
  • Pollen
  • Seasonal allergies
  • Substance P

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