ABSTRACT
Introduction: There is scarce information regarding potential triggers for PFAPA attacks. Objectives: To examine whether an emotional stress serves as a trigger for these attacks. Methods: Active PFAPA Patients aged 3-12 years from two Israeli centers were enrolled. Patients parents were reached via phone call and asked about the occurrence of PFAPA attacks in the preceding 2 weeks of a 'stressful period' which was assumed to be (and later validated by an emotional distress scale questionnaire) within two weeks of returning to school after the first Israeli COVID-19 lockdown. Each patient served as its own control and parents were re-reached two weeks during summer break where COVID-19 outbreak was in remission (i.e. un-stressful period). The difference between occurrences of attacks during these 2 periods was recorded Results: One hundred and six pediatric patient were enrolled in the study. Mean age was 7.37± 2.9. The mean emotional distress questionnaire was higher in the first period compared to the second period (35.6± 8.1 versus 32.1± 7.7, respectively, P = 0.047). In the 'Stressful period' 41 (38.7%) reported at least 1 attack during the preceding 2 weeks compared to 24 (22.6%) in the 'unstresfull period' (p = 0.017). Conclusion: Here we provide first evidence that emotional stress may induce PFAPA attack.