Triggers are a big concern for many people living with hereditary angioedema (HAE). Among the possible triggers of HAE attacks, emotional stress — or psychological distress — is one of the most common.

Physical stress may also trigger HAE attacks. Examples include repetitive motion, exercise, illness, heat exposure, medical or dental procedures, surgery, infection, and physical trauma.

Understanding how emotional and physical stress may trigger HAE can help you plan ahead and prepare for possible attacks. Here’s what to know about stress and HAE, including what to discuss with your healthcare team.

🗳️ Which types of stress most often trigger your hereditary angioedema (HAE) attacks?

Mental or emotional stress, such as anxiety, pressure, or major life events

Physical stress, such as exercise, illness, or physical trauma

Both types trigger my attacks equally.

Neither type triggers my attacks.

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Why Stress May Trigger HAE Attacks

Hereditary angioedema is a rare disease that causes attacks of sudden and sometimes severe swelling. Attacks can happen without warning, but some people notice certain triggers. Swelling can occur in different parts of the body, such as the:

• Face
• Throat
• Hands
• Feet
• Digestive tract
• Genitals

Symptoms can vary among people with HAE and may look like an allergic reaction. But allergy medications, such as antihistamines, corticosteroids, or epinephrine, usually don’t work for HAE attacks. HAE attacks can be life-threatening if swelling affects the airway.

In the most common types of HAE — types 1 and 2 — swelling is mainly linked to bradykinin (a chemical that helps control fluid movement in blood vessels). Too much bradykinin can make blood vessels leaky. This allows fluid to build up in nearby tissue, causing swelling.

Emotional or mental stress causes a release of hormones such as cortisol and adrenaline — which are known as “stress hormones.” Stress is a known trigger for some people with HAE, but health experts do not fully understand exactly how it leads to an attack.

Physical stress may also trigger an HAE attack. Possible triggers include:

• Hormonal changes, including those related to menstruation
• Infections
• Medical or dental procedures
• Surgery
• Intense exercise, illness, repetitive motion, or physical trauma

Can Stress Cause Angioedema?

It’s important to know that emotional and physical stress do not cause HAE itself. HAE is a genetic condition, meaning it can be passed down through families. Stress may increase the chances of an HAE attack for some people, but other factors or triggers may be involved at the same time.

How To Know if Stress Is a Factor in Your HAE Attacks

Tracking your triggers can help you better understand whether stress plays a role in your HAE attacks. Health experts often advise people with HAE to keep track of possible triggers, including emotional and physical stress.

Try noting what you were doing and what was happening around you before an attack. Over time, this may help you spot patterns. You can track physical and emotional stress in a journal, diary, or mobile phone app such as HAE TrackR.

One approach is to rate any stress you felt before an attack on a scale of 1 to 10, with 10 being the highest level of stress. Your doctor or healthcare team may also have advice on how to track your stress levels.

It’s especially helpful to look for patterns of physical or emotional stress that happen before HAE attacks, such as:

• Poor sleep
• Pain or illness
• Stressful events
• Heavy workload
• Exercise or other intensive physical activity

Stress Can Run High in People With HAE

Emotional stress is common among people living with HAE. People with the condition may feel fear or anxiety waiting for an attack with the knowledge they can be painful or, in some cases, life-threatening.

Swelling from an HAE attack can also make some people feel self-conscious or embarrassed.

HAE attacks can also add physical stress. For example, swelling can cause pain, and abdominal attacks can cause severe stomach pain or discomfort.

Research suggests that people with HAE have a higher risk of anxiety and depression than the general population. Some research suggests that managing anxiety may help reduce the risk of HAE attacks.

Managing Stress and the Possibility of Stress-Triggered Attacks

Sometimes, you can’t control a trigger. But you can take steps to manage stress, lower the chance of stress-related attacks, and be prepared for the possibility of an HAE attack during stressful times.

Here are some techniques that may help reduce stress.

Plan Ahead for Times of Predictable Stress

Some situations can be predictably stressful, such as travel, holidays and family gatherings, workplace demands, or school. Planning ahead as much as possible may help reduce stress that can build up before a possible attack.

At Work

With work, you can talk to your manager about when to expect a higher workload. That way, you can plan meals, take care of household tasks, or delegate responsibilities to other family members ahead of time. You can ask for breaks if your work requires repetitive physical action.

At School

Students living with HAE or their caregivers can ask for accommodations at the beginning of the school year. These may include more flexible deadlines on assignments, break times, or other adjustments. The school can help you determine which accommodations may be appropriate for you or your child.

While Traveling

With travel, start packing well in advance and plan ahead for any medication you need to take with you. Plan early for transportation, accommodations, and activities, so you’ll know what to expect and can avoid overplanning.

For holidays or family gatherings, consider shopping and preparing in the weeks before.

It’s important to travel with your own prescribed on-demand HAE medication (treatment used when an attack starts). Ask your healthcare team how much medication to bring and how to pack it safely.

Some emergency departments may not have HAE-specific treatment available, so it can also help to know where nearby hospitals are before you travel.

Remember To Rest

In any situation that may become stressful, make time for extra rest. Ask for help from family members, close friends, or other trusted people if something you need to do is too physically or emotionally demanding.

Talk to Your Healthcare Team Before Medical Procedures

It can be helpful to talk to your healthcare providers well before a medical or dental procedure. They can help you decide whether there are steps you can take to lower the risk of an HAE attack.

For instance, short-term prophylactic medication (preventive treatment used before a procedure or stressful event) may help reduce the risk of attacks during and after some procedures.

Hormonal changes may trigger HAE attacks in some people. Talk with your healthcare provider about birth control options, including whether you should avoid birth control pills that contain estrogen and which options may be safer for you.

Practice Relaxation Techniques

Relaxation techniques such as mindfulness, meditation, yoga, deep breathing, and other self-care practices can help manage stress in general and may help improve quality of life.

You can also practice responding to stressful situations as they arise. Deep breathing exercises or short breaks may help you feel more grounded.

Keep On-Demand Rescue Medication With You

Even if you take steps to prevent attacks, an attack may happen suddenly and unexpectedly when you’re under emotional or physical stress.

Because of the unpredictable nature of attacks, having your on-demand medication available at all times is essential. If you have questions about how to administer your on-demand medication, be sure to talk to your doctor.

Knowing you have your emergency medication on hand can help reduce stress as well.

Along with your on-demand medication, you should always have an emergency information card on you. This card should state your diagnosis, emergency treatment plan, and your doctor’s phone number. Because HAE is rare, some healthcare professionals may not be familiar with the condition and could mistake an attack for an allergic reaction.

Talk to your healthcare team if you need help preparing an emergency information card.

Join the Conversation

On myHAEteam, people share their experiences with hereditary angioedema, get advice, and find support from others who understand.

Is emotional or physical stress a trigger for your HAE attacks? Let others know in the comments below.