What is the treatment for tongue swelling due to an allergic reaction?

Treatment for Tongue Swelling Due to Allergic Reaction

Epinephrine is the first-line treatment for tongue swelling due to allergic reaction, especially when there are signs of airway compromise or systemic symptoms. 1, 2

Initial Assessment and Management

• Determine severity of reaction: mild (isolated urticaria/itching) vs. severe (anaphylaxis with respiratory compromise, reduced blood pressure, or persistent GI symptoms) 3

• For severe reactions with tongue swelling (potential airway obstruction):

  • Administer epinephrine immediately as first-line treatment 2, 3
  • Recommended dose: 0.01 mg/kg in children (up to 0.3 mg) and 0.3 to 0.5 mg in adults via intramuscular injection in the anterolateral thigh 2
  • Position patient in recumbent position with elevated lower extremities to increase venous return 3

• For patients with hypotension or significant vomiting:

  • Administer intravenous fluid bolus with Ringer's lactate (10-20 mL/kg) 3

Second-Line Treatments

• H1 antihistamines:

  • Diphenhydramine 25-50 mg (adults) or 1-2 mg/kg (children) IV or oral 4
  • Cetirizine 10 mg for adults 3
  • Continue every 6 hours for 2-3 days after discharge 4

• H2 antihistamines:

  • Ranitidine 1-2 mg/kg per dose (maximum 75-150 mg) or famotidine as adjunctive therapy 4
  • The combination of H1 and H2 antihistamines works better than either alone 4

• Corticosteroids:

  • Prednisone 1 mg/kg (maximum 60-80 mg) orally 4
  • Short course of oral corticosteroids for severe cases 2
  • Primarily used to prevent recurrent or protracted anaphylaxis 4

Important Considerations

• Never delay epinephrine administration to give antihistamines in cases of anaphylaxis 4

• Fatal reactions have been associated with delay in administration of epinephrine 2

• Antihistamines should not be used in place of epinephrine for severe reactions 2

• Monitor vital signs every 15 minutes until symptoms resolve and continue monitoring for at least 2-4 hours after resolution 3

• For severe reactions, consider longer observation periods (up to 24 hours) due to risk of biphasic reactions 3

Follow-up Care

• Prescribe an epinephrine autoinjector (2 doses) for patients at risk of recurrent anaphylaxis with proper training on its use 4

• Provide education on allergen avoidance and an anaphylaxis emergency action plan 4

• Schedule follow-up appointment with primary care physician or allergist 4

• Consider referral to an allergist for proper identification of allergens and long-term management 2

Special Situations

• For patients on beta-blockers who may have reduced response to epinephrine, glucagon should be available as an additional treatment option 4

• In patients with refractory hypotension, glucagon can be administered at 20-30 μg/kg for children or 1-5 mg for adults 4

Common Pitfalls to Avoid

• Misdiagnosing angioedema as infection and inappropriately prescribing antibiotics 2

• Using antihistamines as primary treatment instead of epinephrine for severe reactions 4

• Delaying epinephrine administration in favor of other medications 2, 4

• Failing to monitor patients adequately after initial symptom resolution due to risk of biphasic reactions 3