HAE triggers do not affect everyone the same way and may not affect some people at all.
“They can vary by the person,” says Timothy Craig, DO, an allergist and immunologist with Penn State Health in Hershey, Pennsylvania.
Physical Stress
- Minor trauma such as a cut or bruise
- Surgery or medical procedures, especially those involving your throat or upper digestive tract
- Dental work, which can cause trauma to the mouth or gums, leading to swelling
- Repetitive hand movements such as typing, prolonged writing, hammering, shoveling, bouncing a ball, or lifting weights, which put pressure on your hands and can set off swelling
Illness
Being sick also puts physical stress on your body, so you may be more prone to an attack when you’re fighting off a bug. Your body releases stress hormones in these situations that may cause inflammation.
Common illness triggers can include:
- Viral infections, such as a cold, flu, or COVID-19
- Gastrointestinal infections
- Other infections
Emotional Stress
Stress such as anxiety or excitement may cause inflammation, and heightened emotions often accompany HAE attacks. But more research is needed to determine if emotional stress causes an HAE attack or is caused by the attack. It could be that physical changes that are happening in your body before an attack hits could cause you to feel a sense of doom, Dr. Craig says.
“So the stress might not actually be a trigger,” he says. “It might be part of the attack itself.”
Hormonal Changes
Possible triggers might include your period or pregnancy, though research is inconclusive as to whether pregnancy can trigger attacks or reduce their likelihood.
Certain Medications
If you are taking medications for other conditions and have HAE, it’s important to talk to your doctor about potential interactions. Medications that may be HAE triggers include:
- Systemic estrogen-based medications, such as hormonal birth control or hormone replacement therapy; these are generally discouraged for menopausal women with HAE.
- ACE inhibitors used to treat high blood pressure: “They can lead to swelling via an elevation in bradykinin, which is the same molecule that drives swelling attacks from HAE,” Dr. Oh says.
Allergens
HAE attacks aren’t allergic reactions. But if you have an allergy, you might find that exposure to your allergen can trigger an HAE attack.
“Anything that dysregulates your immune system, including allergens, can put you at higher risk of having a reaction,” Craig says.
Allergens that might be HAE triggers include:
- Pollen
- Contact allergens such as latex, certain metals, or chemicals
- Food
- Insect stings
- Pets
- Dust mites
- Mold
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