Relationship Between Anaphylaxis and Use of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies

Tejedor-Alonso, Miguel A; Farias-Aquino, E; Pérez‐Fernández, Elia; Grifol-Clar, Eulalia; Moro‐Moro, Mar; Rosado, Ana

doi:10.1016/j.jaip.2018.10.042

Cited by 45 publications

(30 citation statements)

References 44 publications

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“…We did not find a significant difference about some factors often reported as a cause of increased risk or increased severity of anaphylactic reactions such as use of some antihypertensive drugs (21,26) and history of angioedema or mastocytosis (18), due to the rarity of cases in our study population.…”

Section: F O R P U B L I C a T I O Ncontrasting

confidence: 71%

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Voltolini¹,

Cofini

Murzilli³

et al. 2022

Eur Ann Allergy Clin Immunol

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Objectives. The purpose of the study was to describe the characteristics of patients experiencing hypersensitivity reactions (HRs) to iodinated contrast media (ICM) in a large Italian population and to investigate potential risks factors in order to obtain a risk stratification, helpful in the management of these patients.Methods. Data of 407 patients investigated in 9 Italian Allergy Centers for suspected HRs to ICM were analyzed and compared with a control group of 152 subjects that tolerated one or more ICM-enhanced examinations. The univariate and multivariate logistic regression model was used to evaluate associated factors.Results. The mean age of reactive patients was 61 years and 60% were female; 67% of patients reported immediate reactions and 35% experienced the reaction, more frequently with immediate onset, at the first examination in life.Iomeprol, iopromide and iodixanol were the most frequent culprit agents and 20% of patients showed a positive skin test result. Previous adverse reactions to ICM were reported by 15.6% of patients. , The multivariate analysis showed that male gender and age >65 were associated with ICM reactions as protective factors [ORadj=0.

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Section: F O R P U B L I C a T I O Ncontrasting

confidence: 71%

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Voltolini¹,

Cofini

Murzilli³

et al. 2022

Eur Ann Allergy Clin Immunol

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“…Other limitation of this study is that reactions were not categorized according to the degree of severity. Moreover, other limitations also related to the severity evaluation, are the fact that the serum tryptase levels were not included in the questionnaire, nor the concurrent medications such as beta-blockers and angiotensin-converting enzyme inhibitors, which are known to increase the severity of anaphylaxis [1,23,44]. Gastrointestinal symptoms, although present across all age groups, were more common in children, especially in preschoolers, as described by others [16,45].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

Gáspár

Santos

Faria

et al. 2022

J Investig Allergol Clin Immunol

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“…A systematic review and meta-analysis revealed that evidence of an increased risk of more severe anaphylaxis in patients who take β-blockers and ACEI was tenuous owing to the heterogeneous control of confounding variables. 28 Importantly, higher age is an established risk factor for more severe sting reactions. [8][9][10] Previous data had already suggested that older patients are more likely to take β-blockers and ACEI and that older age was the relevant predictor for severe anaphylaxis 16,17 or SSR.…”

Section: Discussionmentioning

confidence: 99%

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

Sturm¹,

Herzog²,

Aberer³

et al. 2020

Preprint

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Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629)

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Relationship Between Anaphylaxis and Use of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies

Cited by 45 publications

References 44 publications

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Hypersensitivity reactions to iodinate contrast media in Italy: a retrospective study. Characteristics of patients and risk factors

Anaphylaxis: A Decade of a Nationwide Allergy Society Registry

β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy

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