Hereditary Angioedema Attack Triggers
Most HAE attacks occur spontaneously with no apparent reason; however anxiety, stress, minor trauma, surgery, and illnesses such as colds and flu are triggers that have been documented in studies of HAE kindreds. The trauma associated with dental procedures is particularly troubling for HAE patients because it increases vulnerability to airway attacks. Patients have also reported swelling in extremities following typing, prolonged writing, pushing a lawn mower, hammering, shoveling, and other physical activities.1
In women, menstruation and pregnancy seem to have a major effect on disease activity. Many female patients report an increase in the number of attacks during their menstrual periods. During pregnancy, some women note an increase in the frequency of attacks, while others have reported a decrease. Many women report that oral contraceptives and hormone replacement therapy cause an increase in the frequency and severity of attacks.
Angiotensin Converting Enzyme Inhibitors (ACE Inhibitors) are known to cause bouts of angioedema in patients with normal C1 inhibitor levels. Because ACE inhibitors appear to affect a vasoactive peptide that is believed to be responsible for causing HAE swelling in C1 inhibitor deficient patients, specialists caution that these drugs should never be prescribed to HAE patients.
