Diet, physical activity may trigger HAE attacks: Survey study
Some fruits, vegetables, bread, dairy linked to attacks, survey finds
Diet and physical activity may trigger swelling attacks in people with hereditary angioedema (HAE), according to a patient survey study conducted in Germany.
About a third of patients surveyed experienced swelling attacks related to the consumption of certain foods, including fruits, vegetables, bread, or dairy products, while some two-thirds of those participating in recreational sports experienced localized swelling.
“Avoidance or management of trigger factors is a crucial part of HAE counseling so that dietary habits, food allergies/intolerances, and physical activity should be taken into account when treating and advising patients with HAE,” the researchers wrote.
The study, “Dietary and physical trigger factors in hereditary angioedema: Self-conducted investigation and literature overview,” was published in Allergologie Select.
HAE is commonly caused by mutations in the SERPING1 gene that impair the production or function of the C1-inhibitor (C1-INH) protein, leading to the production of a molecule called bradykinin. High levels of bradykinin cause fluid to leak from blood vessels and accumulate in the deeper layers of the skin or mucous membranes, leading to swelling attacks. Such attacks may be triggered by physical and emotional stress, medical interventions, hormonal fluctuations, and infections.
Questionnaire aims to find triggers
Since there are “few studies in the current literature that investigate the effect of nutrition and recreational sports on HAE attacks,” the researchers wrote, they conducted a questionnaire-based study involving 30 HAE patients who were followed at University Hospital Leipzig.
Participants had a mean age of 49.5, and 77% were female. They experienced their first HAE symptoms at a mean age of 15.7, and were diagnosed at a mean age of 29.4.
Most patients had HAE type 1, which is characterized by low levels of C1-INH. Three had HAE type 2, which is marked by the production of a dysfunctional version of C1-INH, and five had HAE type 3, a rare HAE subtype in which the levels and activity of C1-INH are both normal.
Sixty percent of the patients were receiving prophylactic therapies to reduce the frequency of HAE attacks, while 40% were being treated with on-demand medications. Over the course of the disease, 29 patients required unplanned treatment for HAE attacks, either at the emergency room (23 patients), inpatient care (22 patients), or intensive care unit (eight patients, including two following surgery).
About one-third of the patients reported a relationship between certain foods and HAE attacks, with symptoms worsening following the consumption of legumes, stone fruit, wheat-containing products, spicy or acidic foods, and milk. Common symptoms reported with food-associated HAE attacks included abdominal symptoms, swelling in the extremities, or swelling in the face, throat, and genitals.
Four patients reported having food allergies, while two were lactose intolerant and one was intolerant to sorbitol, a sugar molecule present in certain fruits and vegetables.
Seventy percent of patients regularly practiced recreational sports, particularly cycling, running or hiking, and strength training. Of these, 62% reported their disease worsened due to recreational sports. Six stated they had an HAE attack due to mechanical pressure in the hands and feet after long hikes or strength training, while two reported genital swelling after intensive cycling.
HAE a burden for patients
Patients said the disease caused a significant burden in several areas of their lives, including difficulties with social activities and traveling (33%), education and work (27%), family planning (23%), romantic relationships (13%), and sexuality (7%). Sixty-three percent reported that disease-related swelling negatively affected their appearance.
Among women, 20 had a previous pregnancy, which in 55% caused a significant worsening of the frequency and severity of HAE attacks. Most patients had other family members affected by HAE, seven of whom died due to throat swelling.
Previous studies in other European countries demonstrated that the frequency or severity of HAE correlated with certain foods, and that skin swelling attacks could be triggered by sports. Prophylactic therapies could affect the influence of trigger factors, according to one study cited by the authors.
The researchers said their study was limited by the small number of patients, the self-reported nature of the study, and the lack of specific allergy tests. “In order to verify the relevance and mechanisms of diet-related factors on HAE, investigations should be carried out in larger study populations and include a thorough allergological workup,” they wrote.
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