What are the treatment options and when to seek emergency help for an angioedema reaction?

Patient Education for Angioedema: When to Go to the Emergency Department

What You Need to Know About Angioedema

If you experience swelling of your face, lips, tongue, or throat, especially with difficulty breathing, voice changes, or trouble swallowing, go to the emergency department immediately—this is a life-threatening emergency. 1, 2

Angioedema is swelling that occurs beneath the skin or in the mucous membranes. Unlike typical swelling, it doesn't respond to ice or elevation. The most dangerous locations are the throat and airway, which can close off your breathing. 3, 4

Emergency Warning Signs—Go to the ED Immediately If You Have:

Airway Involvement (Life-Threatening)

• Change in your voice (hoarseness, muffled speech) 5, 1
• Difficulty swallowing or inability to swallow saliva 5, 2
• Difficulty breathing or shortness of breath 5, 1
• Swelling of the tongue, throat, or neck 1, 6
• Feeling like your throat is closing 2, 3

Severe Symptoms Requiring Immediate Evaluation

• Swelling around the mouth or lips that is rapidly progressing 3, 4
• Severe abdominal pain with nausea and vomiting (this can be angioedema of the intestines) 5, 7
• Swelling that develops within minutes to hours after taking medication (especially ACE inhibitors like lisinopril, enalapril) 3, 8
• Any facial swelling if you have a history of hereditary angioedema 1, 9

What to Expect at the Emergency Department

When you arrive at the ED, medical staff will:

• Immediately assess your airway and breathing—this is the first priority 1, 2
• Monitor you closely in a facility capable of performing emergency intubation (breathing tube) or tracheostomy if your airway becomes compromised 5, 1
• Determine what type of angioedema you have, as treatments differ significantly 2, 9
• Keep you under observation even if symptoms seem mild, as throat swelling can worsen over hours 5, 2

Important Information About Treatment

If Your Angioedema is Allergic (with hives/itching):

• You will receive epinephrine, antihistamines (like diphenhydramine), and steroids 1, 2
• These medications work quickly for allergic reactions 3, 6

If Your Angioedema is NOT Allergic (hereditary or medication-related):

• Standard allergy treatments (epinephrine, antihistamines, steroids) will NOT work 1, 2, 9
• You will need specialized medications like icatibant or C1 inhibitor replacement 1, 9, 10
• If you have hereditary angioedema, tell the ED staff immediately so they can give you the correct treatment 9, 8

Critical Safety Information

For Patients Taking ACE Inhibitors:

• If you develop angioedema while taking blood pressure medications ending in "-pril" (lisinopril, enalapril, etc.), you must stop this medication permanently 1, 2
• This type of angioedema can occur even after years of safely taking the medication 3, 7
• Never restart an ACE inhibitor after having angioedema 1, 2

For Patients with Hereditary Angioedema:

• Keep emergency medication with you at all times and use it at the first sign of an attack 9
• Early treatment is critical—don't wait to see if it gets better 9
• Even if you self-treat at home, go to the ED for throat or tongue swelling 5, 1
• Laryngeal (throat) attacks have historically caused death in approximately 30% of untreated cases 1

When Observation is Needed (Even Without Severe Symptoms)

Go to the ED for monitoring even if breathing seems okay if you have:

• Any swelling inside the mouth or throat area 5, 2
• Swelling that started after dental work or surgery 5, 9
• Known hereditary angioedema with any new swelling episode 1, 9
• Rapidly progressing swelling anywhere on the face 3, 4

The observation period varies based on location and severity, but throat involvement typically requires several hours of monitoring in a facility with airway management capabilities. 5, 2

Common Mistakes to Avoid

• Don't wait at home to "see if it gets better" when throat symptoms are present—airway swelling can progress rapidly 1, 2
• Don't assume Benadryl will fix all types of angioedema—it only works for allergic types 1, 9
• Don't leave the ED too early—swelling can worsen even after initial treatment 5, 2
• Don't take ACE inhibitors again after having angioedema from them—the reaction can be worse the next time 1, 2

Bottom Line

Angioedema involving the airway is a medical emergency with potential for death if untreated. When in doubt, go to the emergency department—it is always safer to be evaluated than to wait at home with throat or tongue swelling. 1, 2