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ASK DR. H.

July 7, 2009

Swelling in the mouth caused by allergic reaction ASK DR. H. MITCHELL HECHT

Q: I am a 77- year-old woman who developed swelling of the soft tissues inside my mouth and lips with a loss of taste after quitting smoking. Could that have caused it?

A: The swelling sounds like a case of “angioedema.” It’s a swelling similar to hives, but unlike hives, the swelling of angioedema occurs below the surface rather than above it. I’m not sure what caused your angioedema event, but it would be more likely caused by an allergic reaction to something you ate or ingested, rather than by the cessation of cigarettes or anything else.

There are a number of things that are known to cause angioedema: animal dander; medication reaction (e.g., penicillin, sulfa and ACE inhibitor blood pressure drugs); certain foods; insect bites; pollen; acute viral illnesses; leukemia; lupus; and exposure to extreme sun, cold or heat. That said, often the cause of angioedema is never found.

The good news is that as long as the swelling doesn’t involve your airway, you’ll be fine within a few days. For moderate symptoms, after a few days of antihistamines and a short course of steroids, it’s “all’s well that ends swell.” For more severe symptoms that involve the airway, a shot of epinephrine (adrenaline) may be needed. Any time angioedema causes shortness of breath or difficulty swallowing, immediately go to the hospital or call 911.

Q: I developed “Stevens-Johnson Syndrome” after receiving hydrochlorothiazide for my blood pressure. I ended up with a severe allergic rash with blisters all over my body and inside my mouth. Could you write something about this to educate me and others about this terrible condition?

A: You developed a severe allergic reaction, most likely from sulfa part of the water pill. What’s different about your rash from a usual drug allergy is that there’s severe rash, skin blistering and breakdown, fever, swelling of eyelids, flu-like symptoms and blisters of the mouth, eyes, nose and genital area.

Almost any medication that can cause an allergic reaction can cause it. That includes antibiotics like penicillin and sulfa drugs, anti-seizure medications like Tegretol, and anti-inflammatory medications like aspirin and ibuprofen (Motrin, Advil) and Aleve.

Lots of IV fluids, high calorie formulas and pain meds are used in treatment. Antibiotics may be given to prevent wound infection.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. — A.G., Lexington, S.C. —L.L., Marietta, Ga.

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