Table 1_Hereditary angioedema in Latin America: international recommendations, expert consensus, and reported implementation barriers.docx

Instrument validation (July-November 2024) showed high inter-rater agreement (Kendall W = 0.84; p < 0.001) and excellent internal consistency (Cronbach alpha = 0.92).</p>Results<p>Thirty experts from 10 countries completed the process (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela). The prespecified consensus threshold was met for core biochemical diagnostic work-up, selective genetic evaluation, first-line targeted LTP (pdC1-INH, lanadelumab, and berotralstat), continued availability of on-demand therapy, routine monitoring, and management of special populations.

The principal expert-reported implementation signal was limited feasibility: frequent or constant prophylaxis-supply interruptions were reported by 19/30 experts (63%), including 13/23 (57%) practicing in settings where public or insurance coverage was reported. Cost (19/30; 63%) and medicine availability (8/30; 27%) were the most frequently reported barriers. These reports were not independently verified against reimbursement, procurement, formulary, or inventory data.</p>Conclusion<p>Within this selected panel, expert consensus was broadly concordant with international HAE guidance.

Panelists reported barriers involving diagnostic testing, financing, medicine availability, and continuity of supply; however, these findings are perceptions and reported practices, not representative national or regional estimates or audited health-system data. They identify candidate implementation priorities that require confirmation through patient-level registries and objective access data.</p>