What are the causes of facial edema?

From the Guidelines

Face swelling can result from various causes, including hereditary angioedema (HAE), acquired C1 inhibitor deficiency, and angiotensin-converting enzyme inhibitor-associated angioedema, as well as allergic reactions, infections, trauma, and systemic diseases. According to the study by 1, HAE is characterized by relatively prolonged attacks of angioedema involving the extremities, abdomen, genitourinary tract, face, oropharynx, or larynx. The primary mediator of swelling in patients with HAE is bradykinin.

Causes of Face Swelling

• Hereditary angioedema (HAE)
• Acquired C1 inhibitor deficiency
• Angiotensin-converting enzyme inhibitor-associated angioedema
• Allergic reactions to foods, medications, or insect bites
• Infections such as sinusitis, dental abscesses, or cellulitis
• Trauma or injury to the face
• Inflammatory conditions like angioedema or dermatitis
• Systemic diseases including kidney disease, thyroid disorders, or Cushing's syndrome
• Fluid retention from hormonal changes or certain medications

Diagnosis and Treatment

Diagnosis of the underlying cause is crucial for effective treatment. For HAE, diagnosis involves measurement of C4 and C1INH levels, as well as a thorough medical history and physical examination 1. Treatment depends on the underlying cause, and for HAE, it may involve C1INH replacement, a plasma kallikrein inhibitor, or a bradykinin B2 receptor antagonist. For allergic reactions, antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or cetirizine (Zyrtec) 10mg daily may help reduce swelling. Infections typically need antibiotics, and applying cold compresses for 15-20 minutes several times daily can reduce swelling from injuries or inflammation.

Important Considerations

If face swelling is sudden, severe, accompanied by difficulty breathing, or persists for more than a few days, seek immediate medical attention as it could indicate a serious condition requiring prompt treatment. Additionally, patients with a history of HAE or acquired C1 inhibitor deficiency should avoid angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs), as these can trigger angioedema attacks 1.

From the Research

Causes of Face Swelling

• Face swelling can be a symptom of anaphylaxis, a life-threatening systemic reaction that occurs within one to two hours of exposure to an allergen 2, 3
• The most common triggers of anaphylaxis include:
  • Medications
  • Stinging insect venoms
  • Foods
  • Unidentified triggers (in up to one-fifth of cases) 2
• Anaphylaxis can also cause other symptoms such as:
  • Urticaria
  • Difficulty breathing
  • Mucosal swelling 2, 3
• Coexisting conditions such as asthma, mast cell disorders, older age, underlying cardiovascular disease, peanut and tree nut allergy, and drug-induced reactions can increase the risk of severe or fatal anaphylactic reactions 2

Anaphylaxis Symptoms

• Cutaneous symptoms, including angioedema, urticaria, erythema, and pruritus, are common signs of anaphylaxis 3
• Airway and/or breathing and/or circulation problems can also occur rapidly in anaphylaxis 4
• Face swelling, in particular, can be a symptom of anaphylaxis, highlighting the importance of prompt recognition and treatment 2, 3

Diagnosis and Management

• The diagnosis of anaphylaxis is often based on clinical presentation, and immediate intramuscular administration of epinephrine is the first-line therapy, even if the diagnosis is uncertain 3, 4
• The management of anaphylaxis involves removal of the trigger, supportive care, and observation for potential biphasic reactions 2
• Adjunct medications such as histamine H1 and H2 antagonists, corticosteroids, beta2 agonists, and glucagon may be considered after epinephrine administration 2