Angioedema Activity Score (AAS): A Valid and Reliable Tool to Use in Asian Patients

Abstract

The Angioedema Activity Score (AAS) is recommended by the EAACI/GA2LEN/EDF/WAO guidelines for urticaria as the standard measure for assessing disease activity in patients with recurrent angioedema (RAE). To date, it has been translated into 80 languages for use in 52 countries, but it has not been formally validated in Asian patient populations. As RAE may be different in Asian and non-Asian patients, it is important to validate and characterize the reliability of tools to assess RAE disease activity in Asian patients. This study proposed to demonstrate the validity and reliability of the AAS in Asian patients. Accordingly, this study aimed to generate and validate the Thai version of the AAS and to characterize its reliability in Asian patients, specifically in Thailand. A structured translation was conducted with approval from the original authors. The Patient Global Assessment of Disease Activity (PGA-DA) was used as an instrument to compare with the Thai version of the AAS. In total, 86 patients with RAE participated in the study. Seventy-six (88%) patients had RAE with chronic spontaneous urticaria. The Thai AAS was found to be a valid and reliable instrument, with high convergent and known-groups validities, excellent internal consistency, and good test-retest reliability. The validity and reliability of the AAS for assessing RAE disease activity in Asian patients have been demonstrated by our study, making it the first to do so. This will help promote the use of the AAS, in clinical trials and practice, in Asia. It will also facilitate the comparison of disease activity in patients with RAE inside and outside Asia in future studies. However, a limitation of this study was its small number of patients.

Urticaria: Collegium Internationale Allergologicum (CIA) Update 2020

“…In patients with wheals (with or without angioedema), the Urticaria Activity Score (UAS) [42][43][44][45], the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) [46][47][48][49], and the Urticaria Control Test (UCT) [50][51][52][53][54] are the PROMs of choice to measure disease activity, impact, and control, respectively. In patients with predominant angioedema (with or without wheals), the Angioedema Activity Score (AAS) [55,56], the Angioedema Quality of Life Questionnaire (AE-QoL) [57][58][59], and the Angioedema Control Test (AECT) [59] should be used ( Table 2).…”

Differences and Similarities in the Mechanisms and Clinical Expression of Bradykinin-Mediated vs. Mast Cell–Mediated Angioedema

“…Patients with MCM-AE due to CSU are held to show the highest average frequency of swelling episodes. Of note, disease activity including rates of attacks, with the help of suitable tools such as the angioedema activity score (AAS, [ 65 , 66 ]), has not yet been assessed and compared prospectively across patient population with MCM-AE and BK-AE.…”

Assessment of disease activity and quality of life in patients with recurrent bradykinin-mediated versus mast cell-mediated angioedema

“…This study includes validation of the AAS and AE-QoL to Turkish which showed excessive internal consistency (Cronbach's a Asian versus Turkish version AAS28 0.97 vs 0.96, original German versus Turkish version AE-QoL 0.89 vs 0.93). 17,35 AAS28 indicated good reproducibility and both AE-QoL total score and domains scores demonstrated excellent reproducibility. As expected the AAS28 showed strong correlations with anchors for disease activity and the AE-QoL total scores showed moderate correlations with PatGA-QoL, indicating sufficient levels of convergent validity for the AAS28 and the AE-QoL.…”