A 68-year-old male presents with right-sided tongue swelling

Educational Objective:

Discuss presentation and management of non-severe angioedema of the oropharynx.

Key Point:

ACE inhibitors can cause a special category of angioedema, which usually resolves within 72 hours of stopping the medication. This type of angioedema reaction mimics a type I hypersensitivity reaction, but appears to be bradykinin- rather than histamine-mediated and may continue to worsen. It responds poorly to antihistamines, epinephrine and steroids.

Explanation:

In the majority of angioedema cases, no specific allergen or other cause will be found.

Since it is difficult to treat and may continue to worsen,  admission for airway monitoring and aggressive airway management is recommended for cases of angioedema that may not be histamine-related.

Reference:

Barksdale AN. Allergy, Hypersensitivity, and Anaphylaxis. (Chapter 109) In: Walls R, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018: 1418 -1429.e2.

Moellman JJ, Bernstein JA, Lindsell C, et al; American College of Allergy, Asthma & Immunology; Society for Academic Emergency Medicine. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014;21(4):469-484