Contributions of the study
This study adds to the current knowledge about HAE prodromes and their
importance as attack-predicting harbingers. It presents a new robust,
sensitive and specific instrument that employs the attributes of
prodromes, its expressions, typology, consistency and power to predict
the occurrence of attacks. Early detection of impending attack is
expected to assist in clinical decision-making regrading the timing of
an early response (”prodrome-triggered intervention”) expected to
shorten or avert the attacks. The study findings can be applied to
similar conditions with relapsing-remitting patterns, whose attacks are
also antedated by prodromes. 25-28 A similar approach
was recently employed in the treatment of acute Familial Mediterranean
Fever (FMF) attacks by Babaoglu et al. 29 This
strategy can improve the patients’ self-management skills and contribute
to improved quality of life. The newly developed PRO instrument can be
used to alert patients to approaching attacks and allow fast deployment
of therapeutic strategies to preempt the attack. It can be used by HAE
patients worldwide as an internet-based application after cross-cultural
translation and validation, to monitor prodromes and attacks over time,
transmit real-time data, obtain treatment directions and communicate
with the medical staff. 30 We propose to include
prodrome reports in disease registries data and management guidelines of
diagnosis and treatment of HAE.31-33