A 68-year-old black woman presented to the emergency department with the chief complaint of facial, labial, and tongue swelling (Figure). Her symptoms had been worsening over the past few hours. About 4 months ago, she had had a similar episode, and the symptoms resolved spontaneously. The patient and her family reported no known insect bites or stings, no recent changes in her diet, and no family history of similar symptoms. The patient had no urticarial lesions. She said she was allergic to “sulfa” but had not started any new medicines lately. Her hypertension and diabetes were controlled with oral medications, although she could not recall their names. Laboratory studies were unremarkable.

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