Earthquake as a Trigger of Acute Attacks in People with Hereditary Angioedema

Abstract

Objectives: Two major earthquakes with 7.7 and 7.6 magnitudes struck the southeastern region of Turkey on February 6th, 2023. Hereditary angioedema (HAE) is an inherited disease that can be worsened by psychological factors and physical trauma.Our study aimed to evaluate the effect of earthquake and earthquake-related anxiety, depression and stress factors in HAE patients. Methods: The study was conducted on patients with HAE who are located in the southeastern region of Turkey.The mental-health-status was evaluated with Depression-Anxiety-Stress-Scale(DASS-21). Results: Sixty-three HAE patients were includedin the study. More than half(n:33, 52.4%) were female andthe median age was 31(26-42) years. DASS-Stress, DASS-Anxiety,and DASS-Depression scores revealed that 25(39.7%), 37(58.7%) and 32(50.8%) patients had abnormal stress, anxiety and depression status, respectively. The numbers of post-earthquake attacks and icatibant injections were significantly higher than the ones in the pre-earthquake period(p<0.001). The attacks in the post-earthquake period were more severe than those in the pre-earthquake period(p<0.001). In the correlation analysis, the damage level in the buildings significantly correlated with the number of attacks and attack severities in the post-earthquake period(p:0.025, r:0.281 and p:0.042, r:0.257; respectively). Conclusions: The study revealed an increase in both the number and severity of attacks among HAE patients following the earthquake. Positive correlations between the number, and severity of HAE attacks and DASS-21 anxiety, stress and depression were observed.Hence, it is crucial to offer psychological support to HAE patients in the event of an earthquake.

Keywords

• Earthquake
• Hereditary angioedema
• Depression-Anxiety-Stress
• Fear of Earthquake

References

1. 1. Zotter Z, Csuka D, Szabo E, et al. The influence of trigger factors on hereditary angioedema due to C1-inhibitordeficiency. Orphanet J Rare Dis. 2014; 9:44.
2. 2.Eyice Karabacak D, Demir S, Yeğit OO, et al. Impact ofanxiety, stress and depression related to COVID-19pandemic on the course of hereditary angioedema withC1-inhibitor deficiency. Allergy. 2021;76(8):2535-43.
3. 3. Maurer M, Magerl M, Ansotegui I,et al. The international WAO/EAACI guideline for the management of hereditaryangioedema‐the 2017 revision and update. Allergy.2018;73(8):1575‐96.
4. 4.Huskisson EC. Measurement of pain. Lancet.1974;2(7889):1127‐31.
5. 5.Brown TA, Chorpita BF, Korotitsch W, Barlow DH.Psychometric properties of the Depression Anxiety StressScales (DASS) in clinical samples. Behav Res Ther.1997;35(1):79-89.
6. 6.Yılmaz Ö, Boz H, Arslan A. Depresyon Anksiyete StresÖlçeğinin (DASS 21) Türkçe kısa formunun geçerlilik vegüvenirlik çalışması. Finans Ekonomi ve SosyalAraştırmalar Dergisi. 2017;2(2):78-91.
7. 7.Akın A, Çetin B. Depresyon, Anksiyete Stres Ölçeği(DASÖ): Geçerlik ve güvenirlik çalışması. Kuram veUygulamada Eğitim Bilimleri. 2007;7(1): 241-68.
8. 8.Prizmić-Larsen Z, Vujčić MT, Lipovčan LK. Fear ofCOVID-19 and Fear of Earthquake: Multiple DistressingEvents and Well-Being in Croatia. PsycholRep.2023;332941231156813.

9. 9.Alonso MLO, Valle SOR, Tortora RP, et al. Hereditaryangioedema: a prospective study of a Brazilian single-center cohort. Int J Dermatol. 2020;59(3):341-4.
10. 10.Jung JW, Suh DI, Park HJ, et al. Clinical features ofhereditary angioedema in Korean patients: A nationwidemulticenter study. Int Arch Allergy Immunol.2018;176(3-4):272-9.
11. 11.Fouche AS, Saunders EF, Craig T. Depression andanxiety in patients with hereditary angioedema. AnnAllergy Asthma Immunol. 2014;112(4):371–5.
12. 12.Caballero T, Aygören-Pürsün E, Bygum A, et al. Thehumanistic burden of hereditary angioedema resultsfrom the burden of illness study in Europe. AllergyAsthma Proc. 2014;35(1):47–53.
13. 13.Kobayashi N. Psychosomatic medicine and disaster:experiences from the Kumamoto earthquake. Japn JPsychosom Med. 2017;57:257–63.
14. 14.Cénat JM, McIntee SE, Blais-Rochette C. Symptoms ofposttraumatic stress disorder, depression, anxiety andother mental health problems following the 2010earthquake in Haiti: A systematic review and meta-analysis. J Affect Disord.2020;273:55-85.
15. 15.Christiansen SC, Lopes Veronez C,Smith TD, RiedlMA,Zuraw BL. Hereditary Angioedema: Impact of COVID-19 pandemic stress upon disease related morbidity andwell-being. Allergy Asthma Proc.2023;44(2):115-21.
16. 16.Albert PR. Why is depression more prevalent inwomen? J Psychiatry Neurosci. 2015; 40:219–21.
17. 17.Busse PJ, Christiansen SC. Hereditary angioedema. NEngl J Med. 2020; 382:1136–48.
18. 18.Tsuboya T, Aida J, Hikichi H, et al. Predictors ofdepressive symptoms following the Great East Japanearthquake: a prospective study. Soc Sci Med. 2016;161:47–54.