Tongue swelling

A Tongue swelling Usually occurs as a result of an allergic reaction to food, medication, or insect bites, or in connection with genetic angioedema. A pronounced allergic reaction can cause tongue swelling, which narrows the upper airways, which is life-threatening.

What is tongue swelling?

Tongue swelling is not understood as an independent disease entity, but rather as an accompanying symptom of an allergy (including food, medication, insect bites) or the hereditary and episodic Quincke edema (angioedema).

Tongue swelling is an edematous enlargement of the tongue (caused by the accumulation of fluid), which can be attributed to various causes.

Tongue swelling is not understood as an independent disease entity, but rather as an accompanying symptom of an allergy (including food, medication, insect bites) or the hereditary and episodic Quincke edema (angioedema).

In addition, tongue swelling is a transitory (temporary) phenomenon of permanent tongue enlargement (macroglossia) as a result of new vascular formations or malformations (including hemangiomas, lymphangiomas), Down's syndrome (trisomy 21), sarcoidosis (Boeck's disease), amyloidosis (intra - and extracellular accumulation of abnormal proteins) or a tongue carcinoma.

causes

Tongue swelling can be attributed to various causes. This can occur as Quincke's edema, an angioedema that occurs in the subcutis or submucosa and is also characterized by bulging, elastic swellings in the face area (lips, tongue, cheeks, forehead).

In hereditary angioedema, a genetic defect leads to a deficiency of the C1 esterase inhibitor (also C1 esterase inhibitor, C1-INH), which in infectious or trauma-related diseases, in addition to swelling of the lip, larynx and intestinal mucosa, also causes swelling the tongue can condition. The C1 inhibitor deficiency increases bradykinin, a peptide that acts as a vasodilator ("vasodilator") increases the permeability (permeability) of vessels and, among other things, can lead to a build-up of fluid in the tongue.

In many cases, angioedema is also 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 bites, medication).

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Diseases with this symptom

• allergy

• Insect venom allergy

• Quincke's edema

Diagnosis & course

In the case of tongue swelling, the diagnostic measures are primarily aimed at determining the triggering factor. If an allergic reaction is suspected, anamnesis and allergy diagnostics (includingDetermination of the concentration of the characteristic IgE antibodies in the blood, prick test) the triggering allergen can be determined.

Hereditary angioedema can usually be determined on the basis of 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 brought under control, especially if the cause is clarified. Severe allergic reactions with pronounced swelling of the tongue can lead to an obstruction of the upper airways and should receive appropriate emergency medical care.

Complications

Tongue swelling is often a symptom of an injury or irritation to the tongue and usually heals on its own. However, if the irritation is constant, healing may be delayed. This can lead to infections, which in individual cases can be severe. Tongue swellings also arise from poisoning and chemical burns.

Possible complications from the toxins themselves can develop here. The tongue swelling is often a warning signal for an advanced infection in the mouth area with poor oral hygiene, tooth decay, periodontitis or gingivitis. Sometimes it is also caused by an allergy. This can lead to shortness of breath because the swelling often extends into the esophagus and trachea.

In extreme cases, the patient suffers anaphylactic shock, which without treatment can even be fatal. Tongue swelling can also develop as part of Quincke's edema or angioedema. It then often occurs suddenly and sometimes leads to severe shortness of breath. In this context, edema also develops in other parts of the body, some of which lead to serious complications.

Furthermore, there is also a hereditary form of angioneurotic edema, which forms swellings on the tongue, intestinal mucosa and other parts of the body on certain occasions such as infections or trauma. In addition to shortness of breath, an acute abdomen with shock can also develop here.

When should you go to the doctor?

If you have a swollen tongue, you should definitely see a doctor. In severe cases, the tongue swelling can take on threatening proportions. It can make breathing or swallowing difficult.

Regardless of whether it is an allergic event, a wasp sting in the mouth or an internal inflammatory 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 is, how much is the tongue swollen? The visit to the doctor can wait if the tongue appears only slightly swollen and does not change any further.

However, if the swelling is more pronounced and there are accompanying symptoms such as breathing problems, difficulty swallowing or foaming at the mouth, an immediate doctor's visit is inevitable. It's best to call an ambulance. In less acute cases, paediatricians or general practitioners are the right people to contact. They know the patient best and can use questions and initial examinations to determine whether a specialist should be consulted.

Specialist care may be necessary, for example, with an inflamed piercing. 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 those affected to recognize this for themselves.

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Treatment & Therapy

The primary therapeutic measures aim to eliminate the underlying cause of tongue swelling. If a life-threatening obstruction of the upper airways occurs as a result of the tongue swelling, emergency medical measures such as intravenous application of cortisone (for allergic tongue swelling) or C1-INH concentrate (hereditary angioedema) must be initiated.

If necessary, an additional supply of oxygen or a cricothyrotomy (artificial access in the area of ​​the larynx) may be necessary to ensure the oxygen supply. If the tongue is due to an allergic reaction, antihistamines can be used as part of symptomatic and prophylactic therapy. Corticosteroids or adrenaline can also be administered as part of acute therapy.

In addition, allergen avoidance (avoidance of exposure to the triggering allergen) is recommended if the tongue is swollen due to allergies. Those affected by hereditary angioedema are usually treated with a C1 inhibitor concentrate for very frequent seizures, which can also be used prophylactically to reduce the duration and severity of the seizures. Acute attacks can be treated with injected C1-INH concentrate (intravenous), the bradykinin antagonist Icatibant (subcutaneous) or fresh frozen plasma containing the C1 inhibitor.

In addition, as part of long-term therapy, in addition to C1-INH concentrate, androgen derivatives (including danazol, oxandrolone, stanozolol), which increase the C1-INH synthesis in the liver, or tranexamic acid are used, depending on the specifically affected person as well as the severity and frequency of the edema attacks Commitment. Should those affected be treated with estrogens or ACE inhibitors, which inhibit the breakdown of bradykinin, these should be discontinued in order to avoid future edema attacks and, accordingly, also tongue swelling.

Outlook & forecast

As a rule, 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 relevant ingredient. In the further course, the person concerned has to do without the respective food so that the tongue does not swell again.

Complications can arise if the patient can no longer breathe enough air due to the swelling of the tongue and threatens to suffocate. In this case, immediate treatment must be instituted to prevent death.

The tongue swelling can also be a symptom of inadequate 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 dangerous symptoms, no medical treatment is necessary. In the event of severe swelling with difficulty breathing, the patient is given medication to relieve symptoms. A possible allergy can also be treated so that the person affected no longer suffers from the swelling in the future. Oral problems can also be treated well by a dentist.

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prevention

An allergic swelling of the tongue can be prevented by avoiding exposure to the triggering allergen (e.g. food, medication) (allergen avoidance). In the case of recurrent hereditary angioedema, the frequency and severity of the edema attacks and thus the risk of tongue swelling can be minimized as part of an individually adapted long-term therapy.

You can do that yourself

If the tongue is swollen, a doctor should clarify the cause and, if necessary, initiate treatment. Various measures and home remedies are recommended to alleviate symptoms.

In general, swelling can be relieved by cooling measures. Cool drinks, a damp washcloth on the tongue or sucking ice cubes have proven useful here. Acid or sugary drinks can irritate the tongue and should be avoided. It is also better to avoid alcohol, nicotine and spicy or hot food and drinks. Sugar is the ideal breeding ground for pathogens and should therefore also be removed from the menu.

Otherwise, careful oral hygiene will help prevent 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 due to inflammation can be treated with antibiotics.

Sage or saline solutions as well as pain relieving teas have also proven themselves. After applying these measures, the tongue swelling should subside relatively quickly. If this is not the case, a doctor must clarify the symptoms.