Tongue swelling usually occurs as a result of an allergic reaction to food, medications, or insect bites, or in association with genetic angioedema. A pronounced allergic reaction can condition tongue swelling, which causes life-threatening narrowing of the upper airway.
What is tongue swelling?
Tongue swelling is not understood as a disease entity in its own right, but rather as an accompanying symptom of allergy (including foods, medications, insect bites) or hereditary and episodic Quincke’s edema (angioedema). Tongue swelling is an edematous (due to fluid accumulation) enlargement of the tongue that can be attributed to various causes. Tongue swelling is not understood as a disease entity in its own right, but rather as an accompanying symptom of allergy (including food, drugs, insect bites) or hereditary and episodic Quincke’s edema (angioedema). In addition, tongue swelling as a transitory (transient) phenomenon is distinguished from permanent tongue enlargement (macroglossia) due to vascular neoplasms or malformations (including hemangiomas, lymphangiomas), Down syndrome (trisomy 21), sarcoidosis (Boeck disease), amyloidosis (intracellular and extracellular accumulation of abnormal proteins), or tongue carcinoma.
Causes
Tongue swelling can be attributed to a variety of causes. For example, it can occur as Quincke’s edema, an angioedema occurring in the subcutis or submucosa, for which bulging swelling in the facial area (lips, tongue, cheeks, forehead) is also characteristic. In hereditary angioedema, a genetic defect leads to a deficiency of the C1 esterase inhibitor (also C1 esterase inhibitor, C1-INH), which can cause swelling of the tongue in addition to swelling of the mucosa of the lips, larynx, and intestines in infectious or trauma-related diseases. C1 inhibitor deficiency leads to increased release of bradykinin, a peptide that acts as a vasodilator to increase the permeability of blood vessels and can lead to fluid accumulation in the tongue. In addition, angioedema is often associated with the use of ACE inhibitors, which block the breakdown of bradykinin. Angioedema, like tongue swelling, can also be caused by allergic reactions (including food allergies, cross-allergies between pollen and food, insect stings, and medications).
Diseases with this symptom
- Allergy
- Insect venom allergy
- Quincke’s edema
Diagnosis and course
In the case of tongue swelling, the diagnostic measures are aimed primarily at determining the triggering factor. If an allergic reaction is suspected, the triggering allergen should be determined within the framework of a medical history as well as allergy diagnostics (including determination of the concentration of characteristic IgE antibodies in the blood, prick test). Hereditary angioedema can usually be determined by a reduced concentration of the C1 esterase inhibitor or a reduced value of the complement factors C2 and C4. In addition, hereditary angioedema does not respond to cortisone preparations and/or antihistamines. With early diagnosis and adequate therapy, tongue swelling can usually be controlled, especially if the cause is clear. Severe allergic reactions with severe tongue swelling can lead to upper airway obstruction and should receive appropriate emergency medical care.
Complications
Tongue swelling often occurs as a symptom of injury or irritation to the tongue and usually heals on its own. However, if irritation is constant, healing may be delayed. This may lead to infections, which in individual cases can take a severe course. Tongue swelling also occurs in the context of poisoning and chemical burns. Here, possible complications may develop due to the poisons themselves. Often, tongue swelling is a warning signal of an advanced infection in the mouth area due to poor oral hygiene, caries, periodontitis or gingivitis. Sometimes it is also caused by an allergy. Respiratory distress may occur because the swelling often extends into the esophagus and trachea.In extreme cases, the patient suffers anaphylactic shock, which can even be fatal without treatment. Tongue swelling can also develop in the context of Quincke’s edema or angioedema. It then often occurs suddenly and sometimes leads to severe respiratory distress. In this context, edema also develops in other parts of the body, sometimes leading to severe complications. Furthermore, there is also a hereditary form of angioneurotic edema that develops swellings on the tongue, intestinal mucosa and other body regions on certain occasions, such as infections or traumas. In addition to respiratory distress, acute abdomen with shock may develop.
When should you see a doctor?
In case of a swollen tongue, the affected person should definitely go to the doctor. In severe cases, the swelling of the tongue can reach threatening proportions. It can interfere with breathing or swallowing. Regardless of whether it is an allergic event, a wasp sting in the mouth or an inflammatory internal disease, those affected should not wait to see a doctor. This applies not only to children, but in general. The cause of the tongue swelling should be determined promptly. The question, however, is how much the tongue is swollen. The visit to the doctor can wait if the tongue appears only slightly swollen and does not change further. However, if the swelling is more pronounced and there are accompanying symptoms such as breathing problems, difficulty swallowing or foaming at the mouth, the immediate visit to the doctor is unavoidable. It is best to call an emergency physician. In less acute cases, pediatricians or family doctors are the right people to contact. They know the patient best and can determine whether a specialist should be consulted by asking questions and performing initial examinations. Specialist care may be necessary for an inflamed piercing, for example. An allergist is the best person to contact if an allergy is suspected. However, since numerous circumstances can lead to swelling of the tongue, it is difficult for the affected person to recognize it himself.
Treatment and therapy
The primary therapeutic measures for tongue swelling are aimed at eliminating the underlying cause. If life-threatening upper airway obstruction occurs as a result of tongue swelling, emergency medical measures such as intravenous administration of cortisone (for allergy-related tongue swelling) or C1-INH concentrate (hereditary angioedema) should be initiated immediately. If necessary, an additional supply of oxygen or a coniotomy (artificial access in the area of the larynx) may be required to ensure oxygen supply. If the swelling of the tongue is due to an allergic reaction, antihistamines may be used as part of symptomatic and prophylactic therapy. In addition, corticosteroids or adrenaline can be applied during acute therapy. In addition, allergen avoidance (avoidance of exposure to the triggering allergen) is recommended in cases of tongue swelling due to allergy. Patients with hereditary angioedema who have very frequent attacks are usually treated with a C1 inhibitor concentrate, which can also be used prophylactically to reduce the duration and severity of the attacks. Acute attacks can be treated with injected C1-INH concentrate (intravenously), the bradykinin antagonist Icatibant (subcutaneously) or fresh frozen plasma containing the C1 inhibitor. Furthermore, in addition to C1-INH concentrate, androgen derivatives (including danazol, oxandrolone, stanozolol), which increase C1-INH synthesis in the liver, or tranexamic acid are used in long-term therapy, depending on the specific patient and the severity and frequency of the edema attacks. If affected individuals are being treated with estrogens or ACE inhibitors that inhibit the breakdown of bradykinin, these should be discontinued to prevent future edema attacks and, correspondingly, tongue swelling.
Outlook and prognosis
Usually, tongue swelling can be treated relatively well and does not lead to dangerous situations or discomfort. As a result of an allergic reaction, the swelling will decrease over time when the body has completely broken down or digested the ingredient in question. In the further course, the affected person must refrain from eating the respective food so that tongue swelling does not occur again.Complications can arise if the patient can no longer breathe in enough air due to the swelling of the tongue and is in danger of suffocating. In this case, immediate treatment must be initiated to prevent death. However, tongue swelling can also be a symptom of insufficient oral hygiene, with which bleeding gums and tooth decay can develop. In most cases, however, these causes can be treated relatively easily. If the tongue swelling does not lead to any dangerous symptoms, no medical treatment is necessary. In the case of severe swelling with shortness of breath, the patient is given medication to relieve the symptoms. A possible allergy can also be treated so that the patient does not suffer from the swelling in the future. Complaints in the oral cavity can also be treated well by a dentist.
Prevention
Tongue swelling due to allergy can be prevented by avoiding exposure to the triggering allergen (including foods, medications) (allergen abstinence). In the presence of generally recurrent hereditary angioedema, the frequency and severity of edema attacks and thus the risk for tongue swelling can be minimized as part of an individually tailored long-term therapy.
What you can do yourself
If the tongue is swollen, a doctor should clarify the causes and, if necessary, initiate treatment. To alleviate the symptoms, various measures and home remedies are recommended. Generally, swelling can be relieved by cooling measures. Cool drinks, a damp washcloth on the tongue or sucking ice cubes have proven effective. Acidic or sugary drinks can further irritate the tongue and should be avoided. It is also better to avoid alcohol, nicotine and spicy or hot foods and drinks. Sugar is the ideal breeding ground for pathogens and should therefore also be eliminated from the diet. Otherwise, careful oral hygiene helps against tongue swelling. Mouth rinses and dental floss remove pathogens from the oral cavity and contribute to rapid decongestion. The tongue can be cared for with a tongue scraper or the back of a suitable toothbrush. Tongue swelling as a result of inflammation can be treated with antibiotics. Sage or saline solutions as well as pain-relieving teas have also proven effective. After applying these measures, the tongue swelling should subside relatively quickly. If it does not, a physician must clarify the symptoms.
