Angioedema of the tongue secondary to glossitis due to toothpaste

Author: V. Dimov, M.D., Allergist/Immunologist, Cleveland Clinic
Reviewer: S. Randhawa, M.D., Allergist/Immunologist and Assistant Professor at NSU

A 20-year-old male presented to the allergy clinic with a complaint of a swollen tongue one day after he used a toothpaste with cinnamon flavor. The toothpaste - Colgate Cinnamon - caused burning sensation in the mouth and he noted swelling of the tongue the next day. The swelling was present for 2 days. He had used the same toothpaste before but only for a few seconds before rinsing and spitting it out.

No shortness of breath or systemic symptoms. No hives. No connection to any foods. No new medications. No family history of HAE.

What is the most likely diagnosis?

Angioedema of the tongue secondary to glossitis due to toothpaste containing cinnamal (flavouring of cinnamon).

The cause of the above reaction is either:

- Irritant contact reaction to the toothpaste, for example, cinnamal – flavouring derived from cinnamon
- allergic reaction to cinnamal – flavouring derived from cinnamon (Hexyl cinnamaldehyde).

Glossitis is inflammation of the tongue. Glossitis is often a symptom of other conditions, such as:

- Allergic reactions to oralcare products, foods, or medicine
- Dry mouth due to Sjogren syndrome
- Infection from bacteria, yeast or viruses (including oral herpes)
- Injury (such as from burns, rough teeth, or bad-fitting dentures
- Skin conditions that affect the mouth
- Irritants such as tobacco, alcohol, hot foods, spices, or other irritants

What management would you recommend?

Regarding angioedema of the tongue, avoidance is recommended of toothpastes that contain cinnamal – flavouring derived from cinnamon.

If there is another, unprovoked episode of angioedema, then the following workup may be indicated: CBCD, CMP, ESR, CRP, IgG, IgA, IgM, SPEP, thyroid function tests (TSH and T4), thyroid antibodies, Helicobacter pylori IgG, total IgE, ANA, RF, vitamin D level, and specific workup for angioedema including C4, C1 esterase inhibitor and CH50.

What is cinnamal?

Hexyl cinnamaldehyde (hexyl cinnamal) is a common additive in perfume and cosmetic industry as aroma substance. It is found naturally in the essential oil of chamomile. Hexyl cinnamaldehyde is an allergen and an irritant in concentrations higher than recommended.

Final diagnosis

Angioedema of the tongue secondary to glossitis due to toothpaste containing cinnamal (flavouring of cinnamon).

References

Glossitis: MedlinePlus Medical Encyclopedia http://buff.ly/1DgkwA5
Toothpaste Allergy Diagnosis and Management: JCAD | The Journal of Clinical and Aesthetic Dermatology http://buff.ly/1DgkSXg
Contact reactions to toothpaste and other oral hygiene products. DermNet NZ http://buff.ly/1BK6FQH

Published: 02/26/2009
Updated: 09/12/2014