Determining the clinical impact of attack triggers in patients with hereditary angioedema.

Authors

Sukran Aslan Savas, Fatih Colkesen, Mehmet Emin Gerek, Ummugulsum Yilmaz Ergun, Emrah Harman, Secim Kolak, Ferhat Sagun, Ismail Yigitdol, Sevket Arslan

Published in

Allergy and asthma proceedings. Volume 47. Issue 5. Pages 354-361. Sep 01, 2026.

Abstract

Background: Hereditary angioedema is a rare bradykinin-mediated disorder characterized by recurrent, unpredictable swelling attacks that can substantially impair quality of life. Objective: The objectives were to describe attack triggers reported during the previous 4 weeks, compare the clinical impact of emotional and physical and/or organic triggers on attack outcomes, Angioedema Control Test (AECT) based disease control, and quality of life; and, secondarily, to examine the associations of the attack burden with the AECT and Angioedema Quality of Life (AE-QoL) Questionnaire scores. Methods: This single-center retrospective cross-sectional study included 50 adults with type I or type II hereditary angioedema followed up between January 2019 and October 2025. Data extracted from medical records included the number of attacks during the preceding 4 weeks, characteristics of the most severe attack, trigger category, disease control assessed by the AECT, and quality of life assessed by the AE-QoL Questionnaire. Triggers were grouped as emotional (stress/sadness) or physical/organic (trauma, infection, physical exertion, hormonal/metabolic). Results: The median age was 40.5 years, 54% of the patients were women, the median diagnostic delay was 16.5 years, and 82% had a positive family history of hereditary angioedema. Emotional stress was the most commonly reported trigger of the most severe attack (60%). No significant differences were observed between emotional and physical/organic trigger groups in attack frequency, duration or severity of the most severe attack, emergency department visits, AECT-based disease control, or quality-of-life scores (all p > 0.05). Attack frequency was negatively correlated with AECT-based disease control (r = -0.631; p < 0.001) and positively correlated with quality-of-life impairment (r = 0.428; p = 0.002), with the strongest association in the fear/shame domain (r = 0.500; p < 0.001). AECT-based disease control was strongly inversely correlated with quality-of-life impairment (r = -0.734; p < 0.001). Conclusion: Emotional stress was the most frequently reported trigger of recent hereditary angioedema attacks. Although clinical outcomes did not differ according to trigger type, a higher attack frequency was associated with poorer AECT-based disease control and worse quality of life.

PMID:
42698160
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

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