Sudden swelling around the face, lips, tongue, or throat is scary. Angioedema can come from an allergy or from changes in a chemical called bradykinin. Treatments differ depending on the cause, so knowing which type you’re dealing with makes a big difference.
If the swelling comes with hives, itching, or happens right after a sting, food, or new medicine, it’s usually histamine-driven. First-line care often includes an oral antihistamine (like cetirizine or diphenhydramine) and, for more severe cases, a short course of steroids prescribed by your doctor. If breathing is tight, or your throat feels closed, use your epinephrine auto-injector and call emergency services immediately.
Bradykinin-related angioedema does not respond well to antihistamines, steroids, or epinephrine. This type can be caused by ACE inhibitors or by hereditary angioedema (HAE). If an ACE inhibitor is suspected, stop the drug and call your prescriber. For HAE or severe ACEi angioedema, hospitals can give targeted drugs such as C1 esterase inhibitor concentrate or icatibant, which block the bradykinin pathway. In emergencies, some centers use tranexamic acid or fresh frozen plasma when specific drugs aren’t available.
Minor facial or lip swelling without breathing trouble can often be managed at home with an oral antihistamine and close monitoring. Sit upright, avoid tight clothing around the neck, and avoid triggers you already know — certain foods, alcohol, NSAIDs, and specific drugs can set off episodes.
If you’ve had angioedema before, keep a written action plan. Carry a list of your triggers, your current meds, and whether you have a diagnosis like HAE. If you were prescribed an emergency drug (epinephrine auto-injector or HAE medication), keep it with you and check expiration dates regularly. Wearing a medical ID helps first responders act fast.
For people with recurrent HAE, preventive options exist: routine injections of C1-INH, newer monoclonal antibodies like lanadelumab, and other prophylactic therapies. Talk with a specialist to weigh benefits and side effects — some older options like androgens work but have more risks.
When to call emergency services: any trouble breathing, swallowing, drooling, noisy breathing, voice changes, or fast progression of swelling. Don’t wait. Quick assessment and airway support save lives.
If angioedema is new, unexplained, or happening more than once, see a doctor. A simple investigation can identify ACE inhibitors, allergies, or hereditary causes and point to the right treatment. You don’t have to guess — there are clear steps to keep you safe and reduce future episodes.
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