I have been seeing a lot more cases of swelling, or the medical term is angioedema 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.
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. I typically hear a story where a patient has eaten at a restaurant(many times an Asian restaurant with various sauces) and within an hour the allergic reaction involves the lips or tongue, but can also affect the face or eyelids- think of Will Smith after he ate peanut in the movie Hitch. For these type of allergic reactions that are not obvious, food allergy testing through the blood or simple, non-invasive skin tests can provide the answer to prevent future reactions. Another common cause of swelling in these areas can be a contact dermatitis allergy. This is where a person touches a product that gets transfered from the fingers to the face and can trigger intense swelling. A recent example I just saw in the office was a woman who started coloring her hair to get the grey out. She put the home product of hair color on her scalp 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 safe to determine which chemical in the product caused the reaction. The other main cause of angioedema can be medications themselves. I have seen in my New York allergy practice 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 blood pressure medications called ACE-inhibitors. This class includes popular medications, such as Diovan.
The non-allergic causes of angioedema can be Hereditary Angioedema. This can be a dangerous cause of recurrent swelling involving the respiratory tract an cause asphyxiation. It also can be confused with Irritable Bowel Syndrome or Appendicitis, because the stomach pain can be very severe. There are specific blood tests that can be ordered called complement proteins which can diagnose 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, such as in inflammatory arthritis.
To go back to my title: “Why Benedryl isn’t the best choice for Allergic Swelling?”: the answer is that oral cortisone in short courses can quickly reverse the deep swelling and make you look normal again. This a safe option because in most cases it is not needed long-term- and for that the key is a complete medical evaluation to determine the cause. I hope if Will Smith reads this article he will remember not to drink the Benedry but call his doctor for some cortisone.
The medical name for allergic shock is anaphylaxis (ana-filaxis) and it can be a deadly form of allergic reaction. Anaphylaxis used to be most commonly associated with bee stings but today, food allergies are a much more common cause of this serious reaction. 
During my last 20 years as an allergist, the only advice I could offer to patients with a history of peanut allergies was to avoid peanuts and peanut products. Now, some new research has come out that may end our frustrations! Here’s what’s new: 
In my New York City office, I’ve noticed several patients are developing upper respiratory infections – nothing severe, as this is common in October and November with the change in weather. In many cases, I just prescribed nasal sprays, only a few patients required antibiotics for bronchitis or sinusitis. But this reminded me that flu season is just around the corner… and this is the optimal time to get your flu shot. 
