Angioedema: Sudden Swelling of the Lips, Eyes or Face

What angioedema looks and feels like

Angioedema is swelling of the deeper layers of the skin (dermis and fat underneath) and of the mucous membranes lining the mouth, throat and gut. It differs from ordinary swelling:

• it develops over minutes to hours
• it is often lopsided, such as one lip or one eyelid
• it is non-pitting: pressing it does not leave a dent
• skin may look normal colored or slightly pink
• it burns, tingles or feels tight more than it itches
• it usually resolves completely within 1 to 3 days

Common sites are the lips, around the eyes, tongue, cheeks, hands, feet and genitals. Swelling of the bowel wall causes cramping belly pain, vomiting and diarrhea without any visible swelling.

Angioedema with hives vs without hives

This is the most useful practical distinction.

About half of people with chronic hives also get angioedema.

Common causes

Allergic reactions

Foods (peanuts, tree nuts, shellfish, fish, eggs, milk), insect stings, latex and medicines such as penicillin can cause angioedema within minutes, often with hives. It can be part of anaphylaxis.

Medicines

• ACE inhibitors (blood pressure drugs ending in "-pril", such as lisinopril and ramipril) cause angioedema in a small percentage of users. It can start in the first weeks or after years. It typically affects the lips, tongue and throat and does not respond to antihistamines.
• NSAIDs such as ibuprofen and aspirin can trigger hives and swelling in sensitive people.
• ARBs, gliptins and some other medicines are less common causes.

Chronic spontaneous urticaria

Recurring hives and swelling for more than 6 weeks without an external trigger. Stress, infections, heat and NSAIDs can make episodes worse.

Hereditary and acquired angioedema

Hereditary angioedema is a rare genetic deficiency of C1-inhibitor. Attacks start in childhood or adolescence, last several days, include painful belly attacks, and are often triggered by minor injury, dental work, stress or estrogen. Acquired C1-inhibitor deficiency appears later in life, sometimes with lymphoma.

Other triggers

Cold, pressure, vibration, exercise and infections can all set off episodes in some people.

Swelling that is not angioedema

• Eyelid swelling from a stye, conjunctivitis or sleeping face down
• Facial cellulitis or dental abscess: red, hot, tender, with fever
• Contact dermatitis: itchy, red, scaly or blistered skin
• Fluid retention from kidney, heart or thyroid problems: gradual, often pitting, both sides

What to do right now

1. Check breathing and swallowing. Any throat tightness, voice change, drooling or breathlessness means call emergency services.
2. Use epinephrine if you have been prescribed an auto-injector and there are signs of anaphylaxis.
3. Stop the trigger if obvious, and do not take the next dose of a suspected medicine, but ask a doctor before stopping an essential medicine.
4. Take a non-drowsy antihistamine such as cetirizine or loratadine for swelling with hives, following the label dose.
5. Apply cool compresses to swollen areas.
6. Take photos of the swelling to show your doctor later.

Antihistamines do not work for ACE-inhibitor or hereditary angioedema. These need medical care.

How doctors assess angioedema

A doctor will ask about foods, medicines, stings, timing, hives, family history and previous episodes. They may arrange:

• allergy skin-prick or blood tests if an allergy is suspected
• C4 and C1-inhibitor level and function tests for swelling without hives
• blood tests for thyroid and other causes in chronic hives

See the angioedema condition page for the full explanation of types, tests and long-term treatment.

Frequently asked questions

What are the symptoms of angioedema?

Angioedema causes sudden, puffy swelling under the skin, usually of the lips, eyelids, tongue, face, hands, feet or genitals. The swelling feels tight or burning rather than itchy, is often on one side, and lasts 1 to 3 days. Hives may appear elsewhere.

When is angioedema an emergency?

When it affects the tongue, throat or voice box, causing hoarseness, drooling, noisy breathing, or trouble breathing or swallowing. Swelling with dizziness, fainting or vomiting may be anaphylaxis. Call 911 or your local emergency number and use epinephrine if prescribed.

How long does angioedema last?

Allergic angioedema usually settles within 24 to 48 hours. Swelling caused by ACE inhibitors or hereditary angioedema can last 2 to 5 days. Swelling that persists beyond this, or keeps coming back, needs medical assessment.

Can blood pressure pills cause lip swelling?

Yes. ACE inhibitors such as lisinopril and ramipril can cause angioedema of the lips, tongue and throat, sometimes years after starting them. It does not respond to antihistamines and can be dangerous. Seek urgent care and do not take the medicine again unless a doctor says so.

What can I take for angioedema at home?

For mild swelling with hives after a known allergen, a non-drowsy antihistamine and cool compresses often help. Do not rely on home treatment for throat swelling, breathing trouble or swelling without hives. Those need urgent medical care.