Angioedema Without Urticaria, at the Emergency Department

RationaleTo determine the incidence and characteristics of Angioedema without urticaria (AE) at the Emergency room (ER) of a third level Hospital.MethodsObservational study between january-december 2013. Patients older than 14 years old, with AE, were included.ResultsA total of 149.194 patients were attended. Incidence: 0.18%. Mean age: 47.8 years. Females: 66.77%. Facial location in 83.69%, 21.74% had pharyngolaryngeal involvement, one needed intubation. The 84.78% responded to antihistamines and corticoids, 6.75% did not respond (mean age 43.9 and 53.45, p< 0,05), no gender differences). The response in 7.43 % was uncertain. At the ER drug allergy was suspected in 17%, food in 15%. The average stay in the ER was of 251 and 455 minutes, for the antihistamine responders and non-responders respectively. P<0,005; 148 were finally studied at the Allergy Unit. After reevaluation, 11.48% were diagnosed with anaphylaxis and withdrawn from the study. Not having a suspected cause at the ER was a motive to seek for the allergy workout (OR: 1.72, p<0.05). After the study, 67.17% were histaminérgic (10.34 % drugs, 8.04% food, 13.79% Anisakis simplex, 39.08% idiopathic), and 32.82% non-histaminergic (4.65% hereditary AE, 90.69 % ACEi related AE,4.65% idiopathic). Only 12.36% of drug or food allergy suspicion was confirmed.ConclusionsThe incidence of AE without urticaria is low. It is more often histaminergic, in females, with frequent facial and uncommonly severe faring-laryngeal involvement. Not having a suspected cause at the ER is a motivation to seek for allergy study. The etiology impression at the ER is rarely confirmed. RationaleTo determine the incidence and characteristics of Angioedema without urticaria (AE) at the Emergency room (ER) of a third level Hospital. To determine the incidence and characteristics of Angioedema without urticaria (AE) at the Emergency room (ER) of a third level Hospital. MethodsObservational study between january-december 2013. Patients older than 14 years old, with AE, were included. Observational study between january-december 2013. Patients older than 14 years old, with AE, were included. ResultsA total of 149.194 patients were attended. Incidence: 0.18%. Mean age: 47.8 years. Females: 66.77%. Facial location in 83.69%, 21.74% had pharyngolaryngeal involvement, one needed intubation. The 84.78% responded to antihistamines and corticoids, 6.75% did not respond (mean age 43.9 and 53.45, p< 0,05), no gender differences). The response in 7.43 % was uncertain. At the ER drug allergy was suspected in 17%, food in 15%. The average stay in the ER was of 251 and 455 minutes, for the antihistamine responders and non-responders respectively. P<0,005; 148 were finally studied at the Allergy Unit. After reevaluation, 11.48% were diagnosed with anaphylaxis and withdrawn from the study. Not having a suspected cause at the ER was a motive to seek for the allergy workout (OR: 1.72, p<0.05). After the study, 67.17% were histaminérgic (10.34 % drugs, 8.04% food, 13.79% Anisakis simplex, 39.08% idiopathic), and 32.82% non-histaminergic (4.65% hereditary AE, 90.69 % ACEi related AE,4.65% idiopathic). Only 12.36% of drug or food allergy suspicion was confirmed. A total of 149.194 patients were attended. Incidence: 0.18%. Mean age: 47.8 years. Females: 66.77%. Facial location in 83.69%, 21.74% had pharyngolaryngeal involvement, one needed intubation. The 84.78% responded to antihistamines and corticoids, 6.75% did not respond (mean age 43.9 and 53.45, p< 0,05), no gender differences). The response in 7.43 % was uncertain. At the ER drug allergy was suspected in 17%, food in 15%. The average stay in the ER was of 251 and 455 minutes, for the antihistamine responders and non-responders respectively. P<0,005; 148 were finally studied at the Allergy Unit. After reevaluation, 11.48% were diagnosed with anaphylaxis and withdrawn from the study. Not having a suspected cause at the ER was a motive to seek for the allergy workout (OR: 1.72, p<0.05). After the study, 67.17% were histaminérgic (10.34 % drugs, 8.04% food, 13.79% Anisakis simplex, 39.08% idiopathic), and 32.82% non-histaminergic (4.65% hereditary AE, 90.69 % ACEi related AE,4.65% idiopathic). Only 12.36% of drug or food allergy suspicion was confirmed. ConclusionsThe incidence of AE without urticaria is low. It is more often histaminergic, in females, with frequent facial and uncommonly severe faring-laryngeal involvement. Not having a suspected cause at the ER is a motivation to seek for allergy study. The etiology impression at the ER is rarely confirmed. The incidence of AE without urticaria is low. It is more often histaminergic, in females, with frequent facial and uncommonly severe faring-laryngeal involvement. Not having a suspected cause at the ER is a motivation to seek for allergy study. The etiology impression at the ER is rarely confirmed.