HAE Prodromes: Early Warning Signs & Why They Matter

In this episode, Thomas welcomes Dr. Mar Guilarte, allergist at Hospital Universitari Vall d’Hebron in Barcelona, to explore an often overlooked topic in HAE care: prodromal signs — the early symptoms that may signal an HAE attack.

They discuss:

🔹 What are prodromal signs, and how common are they in HAE patients?

🔹 Do patients treat their attacks differently based on these signs?

🔹 How do UK and Spanish patients compare in their treatment decisions?

🔹 Could biomarkers help us distinguish true HAE prodromes?

Dr. Guilarte shares findings from her recent research, conducted with HAE patient groups in the UK and Spain, and discusses how early treatment can shorten attack duration and severity. She also explains how signs like erythema marginatum, abdominal discomfort, irritability, and fatigue vary across patients — and why clear definitions, education, and better diagnostic tools are urgently needed.

Join us for a thought-provoking discussion on the complexity of HAE prodromes — and how understanding them better can help optimize treatment and outcomes.

Key Learnings from the Episode:

Prodromes are early signs or symptoms that precede HAE attacks — up to 60–80% of patients report them.

Common prodromal symptoms include erythema marginatum, bloating, nausea, abdominal discomfort, irritability, and fatigue.

Each patient tends to have consistent prodromes, which can help predict attacks, though subjective symptoms vary widely.

Spanish patients tend to treat later than UK patients, possibly due to less specialist guidance or medication access.

Treating attacks early reduces duration and severity, but definitions of “early” vary — especially with injectable medications.

Oral on-demand therapies may encourage earlier intervention, as they’re easier to carry and administer.

Not all prodromes lead to attacks, and the severity of a prodrome does not always predict the severity of the attack.

There is a need for biomarkers to help determine whether a prodrome will be followed by an actual HAE attack.

Erythema marginatum is the only objective prodrome, but can be confused with urticaria, leading to misdiagnosis.

Education of both patients and physicians is critical to recognizing and acting on prodromal signs.

Chapters 

00:00 Introduction to Angioedema and Prodromal Signs

03:13 Understanding Prodromal Signs in HAE

04:04 Research Findings on Prodromal Signs

05:37 Common Prodromal Signs Reported by Patients

07:11 Comparative Analysis of Patient Responses

08:43 The Importance of Early Treatment

09:00 Challenges in Defining Early Treatment

11:23 Unanswered Questions in Prodromal Research

13:25 Differentiating Erythema Marginatum and Angioedema

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