Simon N1, Boccon Gibod I1, Bocquet A1 and Bouillet L1,2*
1Department of Internal Medicine, Grenoble University Hospital (CHUGA), France 2Department of Internal Medicine, Grenoble Alpes University (UGA), FranceFulltext PDF
Introduction: Angioedema (AE) is a reason for emergency care when it is severe. Care is difficult when the diagnostic is not known before the attack: Mast Cell (MC) or Bradykinin (BK) mediated. One is very common but often benign, the other rare but potentially fatal. The French national reference center of AE (CREAK) provides emergency physicians with a hotline and a guideline to help them manage their patients. Objective: This study aimed to describe the clinical features of AE episodes prompting a call on the CREAK hotline and classify patients depending on the suspected cause of the AE. Methods: It’s a retrospective study between March and August 2018. Each physician calling on the CREAK hotline was asked to fill a clinical description form for the AE emergency. Known patients of CREAK were excluded. Results: A 84 patients were included. 41 (48.8%) in the angiotensin converting enzyme inhibitors induced AE (ACEi-AAE), 39 (46.4%) in the MC-AE, and 4 (4.8%) in the BK-AE. The MC-AE patients have more history of hives than ACEi-AAE: 29%, 3% vs. 2%, 4%, p=0.0004. The ACEi- AAE patients are older: 69 (28-58) years vs. 40, 5 (62-75) years, p<0.00001. ACEi-AAE mainly affected the tongue and ENT: 58%, 5% vs. 25%, 6%, p=0.003 and 29%, 3% vs. 13%, p=0.001. ACEi- AAE is more transferred to intensive care units. Conclusion: All the doctors who called the hotline appreciate this tele-expertise especially in case of ACEi-AAE presumptions. In addition to providing rapid AE expertise, this service also allows to educate physicians in the management of AE irrespective of its origin.
Angioedema; Emergency department; Hotline; ACEi; Tele-expertise
Simon N, Boccon Gibod I, Bocquet A, Bouillet L. Profile of Serious Angioedema Requiring an Urgent Advice from a National Reference Call Center. Int J Intern Emerg Med. 2019; 2(2): 1023.