Symptoms

Tongue swelling – causes, treatment

Swelling of the tongue

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 causes the upper airways to narrow life-threateningly.

What is tongue swelling?

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

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

In addition, tongue swelling as a transient (temporary) phenomenon is distinguished from a permanent enlargement of the tongue (macroglossia) due to vascular new or malformations (including hemangiomas, lymphangiomas), Down syndrome (trisomy 21), sarcoidosis (Boeck’s disease), amyloidosis (intra- and extracellular accumulation of abnormal proteins) or tongue carcinoma.

Causes

Tongue swelling can be attributed to various causes. Thus, this can occur as Quincke’s edema, an angioedema occurring in the subcutis or submucosa, for which also bulging-elastic swelling in the facial area (lips, tongue, cheeks, forehead) are characteristic.

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 can cause swelling of the lip, laryngeal and intestinal mucosa as well as swelling of the tongue. Due to the C1 inhibitor deficiency, bradykinin, a peptide that increases the permeability (permeability) of vessels as a vasodilator (“vasodilator”) and can, among other things, lead to fluid accumulation in the tongue, is increasingly released.

In addition, angioedema is in many cases associated with the intake of ACE inhibitors, which block bradykinin degradation. Angioedema as well as tongue swelling can also be caused by allergic reactions (including food, cross-allergies between pollen and food, insect bites, medication).

Diseases with this symptom

  • Quincke’s edema

Diagnosis & course

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

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 severe tongue swelling can lead to upper airway obstruction and should be treated accordingly.

Complications

Tongue swelling often occurs as a symptom of injury or irritation of the tongue and usually heals on its own. However, with constant irritation, healing may be delayed. This may lead to infections, which in individual cases take severe courses. Tongue swelling also occurs in the context of poisoning and burns.

Here, possible complications can develop due to the poisons themselves. Often tongue swelling is a warning signal for an advanced infection in the mouth area with poor oral hygiene, cariesperiodontitis or gingivitis. Sometimes it is also caused by an allergy. This can lead to shortness of breath because the swelling often extends to the esophagus and trachea.

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

Furthermore, there is also a hereditary form of angioneurotic edema, which forms swelling of 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 to go to the doctor?

In the case of a swollen tongue, the affected person should definitely go to the doctor. The swelling of the tongue can take on threatening proportions in severe cases. 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 with the doctor’s visit. This applies not only to children, but in general. The cause of tongue swelling should be determined promptly. But the question is how much the tongue is swollen. The doctor’s visit may wait if the tongue appears only slightly swollen and does not change further.

However, if the swelling is more pronounced and accompanying symptoms such as breathing problems, swallowing difficulties or foaming in front of the mouth are added, the immediate visit to the doctor is unavoidable. It is best to call an . In less acute cases, paediatricians or family doctors are the right contact persons. They know the patient best and can determine through questions and initial examinations whether a specialist should be consulted.

Specialist medical care may be necessary, for example, in the case of an inflamed piercing. An is the best contact person if an allergy is suspected. However, since numerous circumstances can lead to swelling of the tongue, it is difficult for the person concerned to recognize it himself.

Treatment & Therapy

The primary therapeutic measures are aimed at eliminating the underlying cause of tongue swelling. If there is a life-threatening obstruction of the upper respiratory tract as a result of tongue swelling, emergency medical measures such as intravenous application of cortisone (for allergic 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 larynx) may be required to ensure oxygen supply. If the swelling of the tongue is due to an allergic reaction, antihistamines can be used as part of symptomatic and prophylactic therapy. Within acute therapy, or adrenaline can also be applied.

In addition, allergen avoidance (avoidance of exposure to the triggering allergen) is recommended in the case of allergy-related tongue swelling. Those affected by hereditary angioedema are usually treated with a C1 inhibitor concentrate in 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 (intravenously), the bradykinin antagonist icatibant (subcutaneously) or fresh frozen plasma containing the C1 inhibitor.

In addition, 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 as part of long-term therapy, depending on the specific person affected and the severity and frequency of the edema attacks. If those affected are treated with estrogens or ACE inhibitors that inhibit the degradation of bradykinin, these should be discontinued in order to avoid future edema attacks and, accordingly, 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 as the body has completely broken down or digested the ingredient in question. In the further course of the disease, the affected person must do without the respective food so that tongue swelling does not occur again.

Complications can arise if the patient can no longer inhale enough air due to the swelling of the tongue and there is a risk of suffocation. In this case, immediate treatment must be initiated to prevent death.

However, tongue swelling can also be a symptom of inadequate Oral hygiene , which can lead to bleeding gums and tooth decay. In most cases, however, these causes can be treated relatively easily.

If the tongue swelling does not cause any dangerous symptoms, no medical treatment is necessary. In the case of severe swelling with shortness of breath , the patient is given medication that relieves the symptoms. A possible allergy can also be treated so that the affected person no longer suffers from the swelling in the future. Discomfort in the oral cavity can also be treated well by a dentist.

Prevention

An allergic tongue swelling can be prevented by avoiding exposure to the triggering allergen (including food, medication) (allergen absence). In the presence of a usually recurrent hereditary angioedema, the frequency and severity of edema attacks and thus the risk of tongue swelling can be minimized as part of individually adapted 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.

In general, swelling can be alleviated by cooling measures. Cool drinks, a damp washcloth on the tongue or sucking ice cubes have proven themselves here. Acidic or sugary drinks can further irritate the tongue and should be avoided. Alcohol, and spicy or hot food and drinks are also better avoided. Sugar is the ideal breeding ground for pathogens and should therefore also be removed from the diet.

Otherwise, careful oral hygiene helps against tongue swelling. Mouthwashes and dental floss remove pathogens from the oral cavity and contribute to rapid swelling. 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 themselves. After applying these measures, the tongue swelling should subside relatively quickly. If this is not the case, a doctor must clarify the symptoms.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.