Recurrent angioedema: Experience at a tertiary care urban medical center

Objective To determine the demographics, presentation, management, and outcomes of patients with recurrent angioedema. To compare the findings to patients with ACE inhibitor related angioedema. Methods Retrospective case series with chart review of patients who presented to a tertiary‐care hospital between January 2010 and December 2017 with two or more episodes of angioedema. Excluded were patients with anaphylactic reaction, medication induced angioedema, or angioedema secondary to an infectious etiology. A group of 88 patients who presented during the same time period with ACE inhibitor related angioedema was used as a control. Statistical analysis was conducted using a two‐tailed Fisher exact test and a multivariate logistical regression model to determine significant associations. Results Ninety‐one patients were identified; 61 met the selection criteria and had 217 total episodes of angioedema episodes presenting to the emergency department. Fifty percent were Caucasian or Hispanic. The average number of episodes was 3.5 (range: 2‐23). The lips and tongue were the most commonly affected sites (37% and 39%). The larynx and floor of mouth were least likely to be involved (7% and 6%). Only 1 patient was found to have C1 esterase inhibitor deficiency. Twenty‐eight percent of patients had asthma, allergic rhinitis, food allergies, or atopic dermatitis. Only 11% of episodes required airway intervention. No patients required airway intervention after admission. Conclusion Recurrent angioedema was primarily idiopathic, was less severe than ACE inhibitor angioedema, and was associated with an atopic history. There was less frequent worsening of symptoms after admission, and recurrences occurred more frequently are at the same anatomic subsite. Level of Evidence IV. This retrospective case series comparing recurrent idiopathic angioedema to ACE inhibitor angioedema at a large tertiary care institution in an urban city hospital. We have determined that patients with recurrent angioedema are more likely to be Caucasian or Hispanic and are more likely to have an atopic history than patients with ACE‐I related angioedema. They are less likely to have lip and laryngeal involvement and are also less likely to require intubation or tracheotomy. While these findings were noted in a single, large, ethnically diverse urban university hospital and need further studies to determine causality and generalizability, they provide useful insight into a less common clinical var