From the Guidelines
Tongue swelling can indeed be referred to as angioedema, particularly when it involves the deeper layers of the skin and mucous membranes, as seen in hereditary angioedema (HAE) or acquired C1 inhibitor deficiency 1.
Definition and Causes
Angioedema is characterized by swelling in the deeper layers of the skin and mucous membranes, including the tongue, lips, face, and throat. This swelling can be caused by various factors, including allergic reactions, medication side effects (notably ACE inhibitors), and hereditary conditions like HAE. The primary mediator of swelling in patients with HAE is bradykinin 1.
Clinical Presentation and Management
Tongue swelling, or angioedema, can manifest as part of a broader syndrome involving the extremities, abdomen, genitourinary tract, face, oropharynx, or larynx. Attacks of swelling in patients with HAE generally follow a stereotypical pattern, worsening over 24 hours, peaking, and then slowly resolving over the following 48 hours 1. Management of HAE attacks can involve symptomatic treatment based on the region of body swelling, and for oropharyngeal and laryngeal attacks, the primary focus is on maintaining the patency of the airway 1.
Treatment Approaches
Treatment for angioedema, including tongue swelling, depends on the underlying cause. For allergic reactions, antihistamines, corticosteroids, or epinephrine may be prescribed. In cases of hereditary angioedema, specific medications like C1 inhibitor concentrates, icatibant, or ecallantide might be used 1. It's crucial for individuals with recurrent episodes to identify and avoid triggers and potentially carry emergency medication.
Importance of Medical Attention
Given the potential for tongue swelling or angioedema to obstruct airways and become life-threatening, seeking immediate medical attention is paramount. The management of individual attacks, especially those involving the oropharynx and larynx, requires careful monitoring and the ability to perform interventions such as intubation or tracheostomy if necessary 1.
From the Research
Definition and Causes of Angioedema
- Angioedema is characterized by acute subcutaneous edema that can occur in various parts of the body, including the tongue, lips, extremities, and intestinal wall 2.
- The causes of angioedema can be allergic or non-allergic, including the use of angiotensin-converting enzyme inhibitors (ACE), allergies to certain allergens, C1 inhibitor deficiency, or unknown causes 2, 3, 4.
- Angioedema can be potentially life-threatening if the upper respiratory tract is involved, particularly if the pharynx and larynx are swollen 5.
Tongue Swelling and Angioedema
- Tongue swelling can be referred to as angioedema, as it is a common site of swelling in patients with angioedema 2, 3, 4, 6.
- Angioedema of the tongue can be a life-threatening emergency situation, requiring rapid evaluation and intervention if airway compromise occurs 6.
- The tongue can remain edematous for prolonged periods if biting trauma occurs, and in some cases, a partial glossectomy may be indicated if the macroglossia does not resolve in a reasonable amount of time 3.
Diagnosis and Treatment
- The diagnosis of angioedema involves determining the potential allergen, which can be performed with cutaneous tests, such as prick tests 2.
- The treatment of acute angioedema includes administration of antihistamines, glucocorticoids, and epinephrine if there is fear of laryngeal edema 2, 3.
- Early management of acute angioedema and macroglossia is crucial to prevent airway obstruction and other complications 3.