What is the treatment for tongue swelling?

From the Guidelines

The treatment for tongue swelling, particularly in cases of angioedema, should prioritize immediate medical attention and may include self-administration of icatibant or seeking emergency care for epinephrine administration, as guided by clinical goals of reducing morbidity, avoiding death, and improving quality of life 1.

Causes and Initial Assessment

Tongue swelling can result from various causes, including allergic reactions, infections, and inflammatory conditions. Identifying the underlying cause is crucial for appropriate treatment. For mild allergic reactions, over-the-counter antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours can help reduce swelling.

Severe Allergic Reactions (Angioedema)

For more severe allergic reactions causing significant tongue swelling (angioedema), immediate medical attention is necessary as this can be life-threatening. The US Hereditary Angioedema Association (US HAEA) guidelines from 2013 advocate for the early administration of on-demand treatment outside of the healthcare setting, guided by clinical goals rather than attack location 1. Patients experiencing laryngeal, tongue, or throat swelling are instructed to self-administer treatment and seek emergency care.

Emergency Treatment

Emergency treatment for angioedema may include:

• Epinephrine (via an EpiPen 0.3mg for adults, 0.15mg for children)
• Intravenous antihistamines
• Corticosteroids like prednisone (typically 40-60mg daily for 3-5 days)
• Icatibant, a selective bradykinin B2 receptor antagonist, for hereditary angioedema

Supportive Care

While waiting for medical help, supportive care measures can provide some relief:

• Sitting upright
• Applying cold compresses to the neck
• Avoiding potential allergens

Importance of Immediate Medical Attention

It's crucial to seek immediate medical attention if tongue swelling affects breathing or swallowing, as airway protection may be necessary in severe cases. The treatment should always prioritize reducing morbidity, mortality, and improving the quality of life, as emphasized by the US HAEA guidelines 1.

Recent Evidence

Recent studies, such as the KONFIDENT trial, have shown that sebetralstat, an investigational oral agent, can significantly reduce the time to beginning of symptom relief in patients with hereditary angioedema, highlighting the importance of early and effective treatment 1. However, the primary recommendation for tongue swelling treatment, especially in the context of angioedema, remains focused on immediate medical intervention and the use of medications like icatibant and epinephrine, as supported by the most recent and highest quality evidence 1.

From the FDA Drug Label

The signs and symptoms associated with anaphylaxis include ... swelling of the eyelids, lips, and tongue. The treatment for tongue swelling, in the context of anaphylaxis, is epinephrine (IM), as it is used for emergency treatment of allergic reactions, including anaphylaxis, which may cause tongue swelling 2.

• Key symptoms of anaphylaxis that may be associated with tongue swelling include airway swelling and laryngospasm.
• Administration of epinephrine is via intramuscular or subcutaneous use.

From the Research

Treatment for Tongue Swelling

The treatment for tongue swelling depends on the underlying cause. Here are some possible treatments:

• For tongue abscess, treatment typically involves incision and drainage of the abscess, followed by antibiotic therapy to cover gram-positive and gram-negative anaerobes 3, 4.
• In cases of angioedema caused by angiotensin-converting enzyme (ACE) inhibitors, discontinuation of the medication is necessary, and treatment with corticosteroids, antihistaminics, and epinephrine may be required 5, 6.
• For allergic angioedema, treatment typically involves administration of antihistamines and glucocorticoids, while epinephrine is given if there is fear of laryngeal edema 7.
• In severe cases of tongue swelling, tracheotomy may be indicated to prevent airway obstruction 5, 7.

Causes of Tongue Swelling

Tongue swelling can be caused by various factors, including:

• Tongue abscess, a rare disease that can compromise the airway 3, 4.
• Angioedema, which can be caused by ACE inhibitors 5, 6 or allergies to certain allergens 7.
• Other causes, such as food allergies, allergic reactions to environmental factors, or hereditary angioneurotic edema 5.