Angioedema severity and impacts on quality of life: chronic
histaminergic angioedema versus chronic spontaneous urticaria
Abstract
Background: Chronic histaminergic angioedema (CHA) is defined
as recurrent episodes of isolated angioedema (without hives) of unknown
cause that respond to the same treatment as chronic spontaneous
urticaria (CSU). Quality of life (QoL) studies have not been performed
for CHA, except those carried out in the context of CSU associated with
angioedema attacks (CSU-AE). Moreover, biomarkers for monitoring disease
activity in CHA have not been identified. We aim to describe the burden
of CHA and impact on patient QoL, compare the findings to those in
CSU-AE patients, and investigate biomarker associations with disease
severity and QoL parameters. Methods: We performed a
prospective multicenter study that included 68 patients with CHA and 63
patients with CSU-AE. Demographic and clinical variables were collected.
Validated patient-reported questionnaires were employed to analyze the
quality of life and disease activity. Blood and serological parameters,
including blood cell count, C-reactive protein, D-dimer and total IgE,
were also analyzed. Results: Angioedema disease activity was
significantly higher in CSU-AE patients (median AAS7, IQR: 1,
[0–1]) than CHA patients (0, [0–1]; p= 0.022). A considerable
impact on QoL was found in both groups, although significantly worse
values were found for CSU-AE (median AEQoL, IQR: 37, [10–65];
p=0.005). CHA patients were older than CSU-AE patients, and female
predominance was not observed. Conclusions: Angioedema severity
and QoL impacts are significantly worse in CSU than in chronic
histaminergic angioedema. Angioedema should be included in severity
urticaria scores (UAS) as well as in specific quality of life urticaria
scales.