Hereditary angioedema (HAE) is a genetic condition featuring episodes of painful, rapid swelling under the skin. Stress is one of the most common triggers of HAE.

Hereditary angioedema is an inherited disorder. It’s caused when a genetic variant passed down from parent to child prevents your body from making enough of a protein called C1 esterase inhibitor (C1-INH) or prevents C1-INH from functioning properly.

Without enough C1-INH, your body becomes prone to episodes of painful fluid buildup just beneath the skin (angioedema). Swelling typically affects the face, extremities, and genitals but can also affect the gastrointestinal and respiratory systems.

HAE episodes can have a variety of triggers, and stress is one of the most commonly reported.

HAE episodes can have a variety of triggers. Psychological stress is one of the most commonly reported causes of HAE attacks.

Living with HAE can be its own source of stress. An observational study from 2021 found people with HAE experience a variety of negative mental health symptoms such as depression, paranoia about HAE attacks, anxiety, and isolation, all of which can compound psychological stress.

When you’re stressed because of HAE, it can lock you in a symptom cycle where stress triggers angioedema and developing angioedema results in more psychological distress.

HAE and stress are connected through a pathway in your body called the kallikrein-kinin system. When working correctly, this system helps your body regulate functions related to inflammation, pain, and blood pressure, among others.

Within the kallikrein-kinin system is a small peptide called bradykinin. Bradykinin has a primary role in altering vascular permeability and vasodilation (widening of blood vessels).

When you don’t have enough C1-INH, your kallikrenin-kinin system becomes dysregulated and bradykinin starts to accumulate. High amounts of bradykinin promote blood vessel widening and changes in vessel lining that allow fluid to move into surrounding tissues. The result is swelling just beneath the skin, called angioedema.

Anything that stimulates your kallikrein-kinin system can potentially trigger an HAE attack by increasing bradykinin levels.

Stress is a trigger that naturally activates this pathway in your body. When you’re experiencing stress, your body reacts with a cascade of physiological changes to help you overcome adversity. Activation of the kallikrein-kinin system is a natural part of this stress response.

Learning how to cope with and manage stress can have profound benefits, including reducing the likelihood of experiencing stress-related HAE attacks.

In-the-moment rescues

In-the-moment rescues are coping strategies you can use when stress is happening right now and you feel on the verge of overwhelm. These could be moments like being stuck in traffic or during a tense confrontation at work, for example.

When stress strikes quickly, consider these “right now” options:

  • Sensory grounding: By engaging one of your senses in the “now” — doing things like splashing your face with cold water or smelling a pleasant candle — you can interrupt the swirl of thoughts locking you in a moment of stress.
  • Progressive muscle relaxation: Tense a specific muscle group of your body and pay attention to the sensation as you release that tension. Move to another muscle group and repeat. You can do this with several muscle areas or start at your feet and work up to your head.
  • Moving your body: Moving helps stimulate chemical regulatory processes in your body. When you’re stressed, taking a quick walk or doing stationary exercises can help your body and your mind.
  • Repeat a positive affirmation: Repeating a positive phrase about yourself, to yourself, can help improve your reactions in situations where you might feel defensive or avoidant. Your phase can be anything empowering or uplifting, like: “I am capable and confident.”

Proactive strategies

Proactive stress management strategies are preventive habits that counteract stress in daily life.

To help neutralize the effects of stress in the long term, consider:

  • Meditation: Select a meditation framework that helps you align your body and your mind to achieve an inner state of peace and acceptance. Mindfulness meditation is an example of a popular meditation style.
  • Regular exercise: The benefits of movement extend beyond the moment. Regular exercise helps boost feel-good chemicals in your body and reduces inflammation.
  • Engaging in an enjoyable hobby: Making time for the experiences you enjoy in life gives you a break from stress and lets your body and mind experience beneficial mood changes and relaxation.
  • Healthy lifestyle changes: In addition to exercise, eating right, getting plenty of quality sleep, staying hydrated, and avoiding substance use all support stress reduction. Your physical health and your mental health are intertwined, and taking care of your body can reduce the impacts of psychological stress.
  • Engaging with others: Finding support from those around you can help ward off isolation and provide a sense of comfort, security, and encouragement.
  • Journaling: Getting your feelings out regularly can help prevent negative thoughts from getting “stuck” in your head and causing unhealthy rumination. Journaling can also help you explore the underlying causes of stress and brainstorm possible solutions.

It’s never too soon to discuss stress management with your doctor when you live with HAE. Even if stress is not one of your primary attack triggers, improving stress management can have benefits across many other areas of your life.

Talk with your doctor anytime you notice an increase or change in your HAE symptoms or if your current management strategies no longer seem effective.

HAE is a genetic condition passed down from parent to child. It features painful episodes of rapid swelling beneath the skin called angioedema.

A variety of triggers can cause HAE attacks, and stress is one of the most commonly reported. Developing in-the-moment and proactive stress reduction and management strategies can help reduce the likelihood of stress-related HAE attacks.