Influence of psychological factors on Hereditary Angioedema attacks in children and adolescents

Background: Hereditary Angioedema (HAE) is characterized by unexpected attacks, and its warning signs can vary significantly. However it is considered that stress or emotional and physical traumas are relevant to the development of HAE attacks. This contribution describes the first stage of a broader research on the influence of psychological factors on the development of HAE attacks in children and adolescents. The first stage of this research aimed at exploring the parents’ interpretations of the condition, based on the hypothesis that these interpretations could influence the way in which the parents cope with the condition and work through the experiences connected to it. Methods: The parents of 14 patients with HAE, between 4 and 18 years of age, who have been referred to Naples’s centre for the treatment of HAE, have been involved in the research. During an initial meeting the parents answered the questions of an interview about the history of the children and the meaning attributed to HAE. During a second meeting the parents completed the test Child Behaviour Checklist (CBCL). Results: According to the interviews each parent has constructed a more or less complex interpretation in order to make sense of the unpredictability of HAE: 14% of parents reported that the attacks arise in response to physical traumas; 7% reckoned that intense emotions represent a trigger; while 79% offered an explanation that refers both to emotional and physical stressors. Through the CBCL 52% of the parents recorded critical scores on the Activities subscale. Two children appeared to be at psychopathological risk. Conclusions: The hypothesises provided by parents seem to have the function of filling the void of meaning caused by the extremely variable and unexpected nature of the condition that creates a sense of confusion, which is managed subjectively. This seems to be closely connected to the burden of HAE on the patients, who are significantly limited in their daily activities.