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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes swelling of lips and tongue followed by breathing difficulty?

My daughter has been having unusul attacks that mimic an allergic reaction. Kates lips swell, ONLY the front of tongue swell. Kate can catch her breath. Eyes swell. When the EPi is given her blood pressure is high, and heart rate has gone as high as 216. The ER continues to intubate her. Kate has has 8 intubation since 03/2013, the last 01/07/2014. The mystery is that her oxygen is 100 percent.
Wed, 15 Apr 2015
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Allergist and Immunologist 's  Response

Thank you for asking at HCM.

I went through your daughter's history and would like to make suggestions for her as follows:

1. I would like to know more about her like her age, whether she has associated urticaria (hives, rash, itching, etc), whether any correlation with any foods or drugs, whether any digestion related complaints, whether she has any known allergies, whether she has any other disorders, etc.

At present, from your provided details, I would suggest her as follows:

2. I would first think of recurrent angioedema or anaphylaxis (more details are required to differentiate the two), common causes could be allergies (may be to foods, drugs or food additives like coloring agents, flavoring agents, etc) or non-allergic causes like intestinal parasites, physical causes like exposure to hot/cold temperature/water, etc etc. Detailed history is required to identify the cause.

3. If she has anaphylaxis, I would suggest you to have a autoinjector epinephrine handy at home. This is more important as she has always had 8 intubations so far. Early administration of epinephrine can prevent more serious or fatal reaction.

4. If she has recurrent angioedema, I usually prescribe my such patients daily antihistamines like cetirizine or levocetirizine for 4-6 weeks, which can prevent some episodes.

5. For diagnosis, I usually suggest my patients investigations like CBC with ESR, CRP, stool and urine examination, serum total IgE, etc. To identify allergy, I would suggest specific testing for allergies.

6. I would like to mention here is that even if you give drug (like epinephrine) at home, it is necessary to take her to hospital immediately after development of such reaction. Please do not delay to call emergency services as both anaphylaxis and angioedema (when affects larynx) are dangerous conditions.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask at HCM.

Wish your daughter the best of the health ahead.

Thank you & Regards.
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