I have been seeing a lot more cases of swelling, or angioedema to use the medical term, over the past month. Angioedema can be easily treated and reversed with the proper medication – but Benedryl is not the best choice. Why? Angioedema involves the swelling of the deeper soft tissue in the body and antihistamines, such as Benedryl, Claritin, Allegra, or Zyrtec don’t have the ability to fully reverse this type of inflammation.
Angioedema from food allergies
The location of the swelling should help your doctor determine if the cause of your angioedema is allergic, or due to another medical condition. For example, swelling of the lips, face or eyelids in many cases is due to an allergic trigger. One of the most common causes of angioedema in these locations is a food allergy. Typically, I hear that a patient has eaten at a restaurant, many times an Asian restaurant where the food is served with many sauces, and within an hour the allergic reaction has affected the lips or tongue, and maybe also the face or eyelids – think of Will Smith after he ate peanuts in the movie Hitch. If the allergic reaction is not so obvious, a blood test or a simple, non-invasive skin test can reveal the cause.
Angioedema from contact dermatitis allergies
Another common cause of swelling in these areas can be from a contact dermatitis allergy. This is where a person touches a substance that gets transfered from the fingers to the face and can trigger intense swelling. Recently in our office, I was visited by a woman who started coloring her hair. She applied the hair color on Friday and by Sunday her eyelids were swollen so badly she could hardly see! This is an example of what we call a delayed allergic reaction – meaning, the allergic swelling doesn’t take full effect until 48 hours after the application. My office does skin patch testing which is a safe way to determine which chemical in the product caused the reaction.
Angioedema from medications
The other main cause of angioedema can be medications themselves. I have seen several cases where common drugs like Aspirin or Advil have caused the reaction. Another well-known cause of facial or neck angioedema can be from the a specific type of blood pressure medications called ACE-inhibitors, which includes popular medications such as Diovan.
Angioedema is not only caused by allergic reactions, it can also be hereditary. Hereditary Angioedema can involve a dangerous, recurring swelling of the respiratory tract that can cause asphyxiation. It is often confused with Irritable Bowel Syndrome or Appendicitis, because of the severe stomach pains it can cause.There are specific blood tests that can be ordered called complement proteins which can reveal if you have this disorder. The good news is that there is a replacement medication to prevent these attacks today. Non-allergic causes of swelling can be infectious and require antibiotics or autoimmune medications, such as in inflammatory arthritis.
So if Benedryl isn’t a good treatment for allergic swelling, what is? The answer is oral cortisone. The short term use of oral cortisone can quickly reverse the deep swelling and make you look normal again. The next step is to visit your allergist for a complete medical evaluation to determine the cause. I hope if Will Smith reads this article he will remember not to drink Benedryl but to call his doctor for some cortisone!