Date:
Patient:
MRN:
Clincian: (Allergist/Immunologist, Dermatologist)
Reason for Visit:
Evaluation for suspected or confirmed HAE
Review of symptoms and attack characteristics
Discussion of treatment plan and preventative measures
History of Present Illness:
Briefly describe the onset, frequency, and duration of HAE attacks:
Location of swelling (facial, laryngeal, abdominal, genital)
Severity of swelling (mild, disabling)
Associated symptoms (nausea, vomiting, abdominal pain with abdominal attacks)
Family history of similar episodes (crucial for diagnosis)
Triggering factors (stress, menstruation, trauma, medications) – may be absent
Past Medical History:
Previous diagnoses of allergic reactions (may be mistaken for HAE)
Previous treatments for HAE attacks (if any)
Other relevant medical history (e.g., autoimmune diseases)
Social History:
Medications (estrogen, angiotensin-converting enzyme [ACE] inhibitors are triggers)
Family history of HAE (essential for diagnosis)
Physical Exam:
During an attack:
Localized edema (swelling) of affected area (face, lips, extremities, abdomen)
Consider mentioning erythema (redness) if present (may not always be present)
Laryngeal involvement (hoarseness, stridor) may be life-threatening and requires urgent intervention.
Between attacks:
May not show any physical findings.
Labs:
Complete blood count (CBC):
May be normal or show signs of inflammation during an attack.
C4 level:
Low C4 level is a supportive finding in HAE, but not diagnostic.
Genetic testing (preferred for definitive diagnosis):
Identifies mutations in the C1 inhibitor gene to confirm HAE type (HAE-1, HAE-2, rare types).
Imaging:
Imaging studies are not diagnostic for HAE but may be used to rule out other causes of swelling (e.g., CT scan for abdominal pain).
Assessment:
Summarize the diagnosis of HAE based on clinical presentation (characteristic swelling attacks), family history, and supportive findings on labs or genetic testing (if available).
Discuss the type of HAE if genetic testing has been performed (HAE-1, HAE-2, rare types).
Consider mentioning the frequency and severity of attacks to assess disease burden.
Plan:
Outline the treatment plan based on the type and severity of HAE:
Acute Attack Treatment:
Depending on severity:
Oral medications (histamines or bradykinin receptor antagonists) for mild attacks.
Subcutaneous or intravenous C1 inhibitor concentrate for moderate to severe attacks, especially laryngeal involvement.
Consider mentioning the importance of early recognition and treatment of attacks to prevent complications.
Preventative Measures:
Androgen therapy (danazol) or antifibrinolytics (tranexamic acid) for frequent attacks or prophylaxis before surgery or stressful events.
Hormonal management for women with menstrual-related attacks.
Patient education on avoiding triggers and recognition of early symptoms.
Consider mentioning referral to an allergist/immunologist with expertise in HAE for comprehensive management.
Prognosis:
Briefly discuss the prognosis. HAE is a lifelong chronic illness, but symptoms can be effectively controlled with proper treatment and preventative measures.
Early diagnosis and adherence to treatment plan are crucial to prevent complications (upper airway obstruction, risk of surgery).
Education:
Document any education provided to the patient regarding:
The nature of HAE and its hereditary component
The importance of early recognition and treatment of attacks
Trigger avoidance strategies
The benefits and potential side effects of medications
The importance of wearing a medical alert bracelet
The availability of support groups for patients with HAE
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have about medication side effects, breakthrough attacks, or long-term management.
Address the potential emotional impact of a chronic illness and offer support or referral for mental health services if needed.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with an allergist/immunologist or dermatologist with expertise in HAE for diagnosis, treatment recommendations, and prognosis.