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Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patients are able to foretell the onset of attacks by having a prodrome. However, the clinical significance and practical value of prodromes as predictors of attacks needs to be assessed by objective measures. Objective: To prospectively evaluate associations between prodromes and attacks. Methods: 48 patients reported four occasions of prodromes, attacks or both. Pre-defined domains and scalable dimensions were assessed in each episode by a disease-specific instrument. Results: Participants reported 192 different events. Significant differences were found across all dimensions, indicating that prodromes are distinct from attacks. Positive correlations were found between the same attributes of prodromes and attacks. Specifically, pain was correlated in the extremities (r = .291, p < .05) and oropharyngeal clusters (r = .936, p < .01). Impairment was correlated across all clusters, most notably in the abdomen (r = .288, p < .05) and face (r = .588, p < .05) clusters. Dysfunction correlated for the abdomen (r = .366, p < .01), facial (r = .882, p < .01), extremities (r = .381, p < .05) and oropharyngeal (r = .790, p < .05) clusters. Experiencing a prodrome is associated with higher risk of attack in the abdomen (RR=2.30), urogenital (RR=16.39), facial (RR=2.94), extremities (RR=5.55) and oropharyngeal (RR=33.31) locations. Conclusions: Prodromes can be distinguished from attacks. Most patients with prodrome had subsequent attack, and their clinical features correlated in certain body locations. Experiencing prodromal signs and symptoms increase likelihood of having an attack. |
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