Air Pollution and Angioedema.
OBJECTIVE
To identify environmental factors that may precipitate angioedema.


STUDY DESIGN
Case series with chart review.


SETTING
An urban tertiary care medical center.


SUBJECTS AND METHODS
After institutional review board approval was obtained, a chart review of all patients who presented to Temple University Hospital with angioedema from January 2012 to December 2014 was performed. Patient demographics and hospital course were gathered. Environmental data on the dates of presentation, including precipitation, humidity, and air pollution, were obtained from regional Environmental Protection Agency online data banks and used for statistical analysis.


RESULTS
In total, 408 patients, representing 450 episodes of angioedema, met the inclusion criteria for the study. Most patients were female (58%), African American (74%), and on an angiotensin-converting enzyme inhibitor (ACE-I) upon presentation (61%). Days with unhealthy levels of air pollution were associated with an increased likelihood of angioedema presentation (odds ratio [OR], 1.82; confidence interval [CI], 1.01-3.30; P = .046). Subgroup analysis revealed that elevated ground-level ozone was the primary air pollutant significantly associated with angioedema presentations (OR, 4.95; CI 1.92-12.76; P = .0009). Higher ground-level ozone was also associated with ACE-I angioedema presentations (P = .017) but not with non-ACE-I angioedema presentations (P = .86). Air quality was not predictive of angioedema severity or need for intubation.


CONCLUSION
Angioedema is a complex, multifactorial disease resulting in potentially life-threatening complications. This is the first study to demonstrate that higher levels of air pollution, specifically ground-level ozone, are associated with significantly increased rates of angioedema episodes, although not severity.
['Kedarisetty|Suraj|S|', 'Jones|Evan|E|', 'Tint|Derrick|D|', 'Soliman|Ahmed M S|AMS|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000397:Air Pollution D000799:Angioedema D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D055815:Young Adult
angioedema ozone ACE inhibitor C1 esterase inhibitor recurrent angioedema