Differentiating urticaria from other diseases: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Urticaria}} | {{Urticaria}} | ||
{{CMG}} {{AE}}{{Anahita}} | {{CMG}}; {{AE}} {{Anahita}} | ||
==Overview== | ==Overview== | ||
It is critical to differentiate [[urticaria]] from other similar disorders to utilize the best approach for the [[treatment]]. [[Complement deficiency|Hereditary or acquired deficiency of complement factor C1]], [[ | It is critical to differentiate [[urticaria]] from other similar disorders to utilize the best approach for the [[treatment]]. [[Complement deficiency|Hereditary or acquired deficiency of complement factor C1]], cutaneous [[mastocytosis]] such as [[urticaria pigmentosa]], certain [[malignancies]], [[connective tissue diseases]], [[angioedema]] and [[Anaphylaxis causes|exercise‐induced anaphylaxis]] are some of the differential [[diagnosis]] of [[urticaria]]. | ||
==Differentiating Urticaria from other Diseases== | ==Differentiating Urticaria from other Diseases== | ||
*[[Complement deficiency|Hereditary or acquired deficiency of complement factor C1]] | *[[Complement deficiency|Hereditary or acquired deficiency of complement factor C1]] | ||
*[[mast cell tumor|Cutaneous mastocytosis]]/[[urticaria pigmentosa]] | *[[mast cell tumor|Cutaneous mastocytosis]]/[[urticaria pigmentosa]] | ||
*[[Malignancy]] | *[[Malignancy]] | ||
*[[Anaphylaxis causes|Exercise‐induced anaphylaxis]]<ref name="pmid14616095">{{cite journal| author=Zuberbier T| title=Urticaria. | journal=Allergy | year= 2003 | volume= 58 | issue= 12 | pages= 1224-34 | pmid=14616095 | doi=10.1046/j.1398-9995.2003.00327.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616095 }} </ref> | *[[Anaphylaxis causes|Exercise‐induced anaphylaxis]]<ref name="pmid14616095">{{cite journal| author=Zuberbier T| title=Urticaria. | journal=Allergy | year= 2003 | volume= 58 | issue= 12 | pages= 1224-34 | pmid=14616095 | doi=10.1046/j.1398-9995.2003.00327.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14616095 }} </ref> | ||
*[[Connective tissue diseases]] | *[[Connective tissue diseases]] | ||
*[[Photosensitivity|Photosensitive diseases]] | *[[Photosensitivity|Photosensitive diseases]] | ||
*[[Urushiol-induced contact dermatitis|Poison ivy contact dermatitis]]: The [[rash]] that develops from [[Urushiol-induced contact dermatitis|poison ivy, poison oak, and poison sumac contact]] are commonly mistaken for [[urticaria]]. This [[rash]] is caused by contact with [[urushiol]] and results in a form of [[contact dermatitis]] called [[ | *[[Urushiol-induced contact dermatitis|Poison ivy contact dermatitis]]: The [[rash]] that develops from [[Urushiol-induced contact dermatitis|poison ivy, poison oak, and poison sumac contact]] are commonly mistaken for [[urticaria]]. This [[rash]] is caused by contact with [[urushiol]] and results in a form of [[contact dermatitis]] called [[urushiol-induced contact dermatitis]]. | ||
*[[Angioedema]]: | *[[Angioedema]]: | ||
**Although it might be related to [[urticaria]], [[angioedema]] occurs due to swelling of the lower layers of [[dermis]].<ref>{{cite web | url = http://www.webmd.com/allergies/guide/hives-urticaria-angioedema | title = Hives (Urticaria and Angioedema) | date = 2006-03-01 | accessdate = 2007-08-24}}</ref> | **Although it might be related to [[urticaria]], [[angioedema]] occurs due to swelling of the lower layers of [[dermis]].<ref>{{cite web | url = http://www.webmd.com/allergies/guide/hives-urticaria-angioedema | title = Hives (Urticaria and Angioedema) | date = 2006-03-01 | accessdate = 2007-08-24}}</ref> | ||
**[[Edema]] can occur around the [[mouth]], in the [[throat]], in the [[abdomen]], or in other locations. [[Urticaria]] and [[angioedema]] sometimes occur together in response to an [[allergen]] and should be a concern in severe cases because [[angioedema]] of the [[throat]] can be fatal. | **[[Edema]] can occur around the [[mouth]], in the [[throat]], in the [[abdomen]], or in other locations. [[Urticaria]] and [[angioedema]] sometimes occur together in response to an [[allergen]] and should be a concern in severe cases because [[angioedema]] of the [[throat]] can be [[fatal]]. | ||
*A possible [[differential diagnosis]] for diseases that cause [[urticaria]], and [[rash]] include: | *A possible [[differential diagnosis]] for diseases that cause [[urticaria]], and [[rash]] include: | ||
**[[Schnitzler syndrome]] | **[[Schnitzler syndrome]] | ||
**Deficiency in [[Interleukin 1 receptor antagonist|interleukin-1 receptor antagonist]] | **[[Deficiency]] in [[Interleukin 1 receptor antagonist|interleukin-1 receptor antagonist]] | ||
**[[Juvenile idiopathic arthritis]] | **[[Juvenile idiopathic arthritis]] | ||
**[[Adult-onset Still's disease]] | **[[Adult-onset Still's disease]] | ||
**[[virus|Viral]] [[rashes]] | **[[virus|Viral]] [[rashes]] | ||
*Table below differentiates some of the aforementioned [[conditions]]: | *Table below differentiates some of the aforementioned [[conditions]]: | ||
{| border="3" | {| border="3" | ||
|+ | |+ | ||
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Disease name}} | ! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF| Disease name}} | ||
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Age of onset}} | ! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF| Age of onset}} | ||
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF| Signs/Symptoms}} | ! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF| Signs/Symptoms}} | ||
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Diagnostic feature(s)}} | ! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|Diagnostic feature(s)}} | ||
! style="background: #4479BA; width: 150px;"|{{fontcolor|#FFF| Other features}} | ! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF| Other features}} | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[urticaria|Cold Contact Urticaria]]<ref name="SiebenhaarWeller2007">{{cite journal|last1=Siebenhaar|first1=F.|last2=Weller|first2=K.|last3=Mlynek|first3=A.|last4=Magerl|first4=M.|last5=Altrichter|first5=S.|last6=Vieira dos Santos|first6=R.|last7=Maurer|first7=M.|last8=Zuberbier|first8=T.|title=Acquired cold urticaria: clinical picture and update on diagnosis and treatment|journal=Clinical and Experimental Dermatology|volume=32|issue=3|year=2007|pages=241–245|issn=0307-6938|doi=10.1111/j.1365-2230.2007.02376.x}}</ref><ref name="KrauseZuberbier2010">{{cite journal|last1=Krause|first1=Karoline|last2=Zuberbier|first2=Torsten|last3=Maurer|first3=Marcus|title=Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria|journal=Current Allergy and Asthma Reports|volume=10|issue=4|year=2010|pages=243–249|issn=1529-7322|doi=10.1007/s11882-010-0121-3}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[urticaria|Cold Contact Urticaria]]<ref name="SiebenhaarWeller2007">{{cite journal|last1=Siebenhaar|first1=F.|last2=Weller|first2=K.|last3=Mlynek|first3=A.|last4=Magerl|first4=M.|last5=Altrichter|first5=S.|last6=Vieira dos Santos|first6=R.|last7=Maurer|first7=M.|last8=Zuberbier|first8=T.|title=Acquired cold urticaria: clinical picture and update on diagnosis and treatment|journal=Clinical and Experimental Dermatology|volume=32|issue=3|year=2007|pages=241–245|issn=0307-6938|doi=10.1111/j.1365-2230.2007.02376.x}}</ref><ref name="KrauseZuberbier2010">{{cite journal|last1=Krause|first1=Karoline|last2=Zuberbier|first2=Torsten|last3=Maurer|first3=Marcus|title=Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria|journal=Current Allergy and Asthma Reports|volume=10|issue=4|year=2010|pages=243–249|issn=1529-7322|doi=10.1007/s11882-010-0121-3}}</ref> | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Early adulthood | *Early adulthood | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
*[[Urticaria|Urticarial]] [[skin]] eruption after exposure to cold | *[[Urticaria|Urticarial]] [[skin]] eruption after exposure to cold | ||
| Line 39: | Line 41: | ||
*Systemic [[symptoms]] may be present in case of extensive [[skin]] involvement (such as [[anaphylaxis]]) | *Systemic [[symptoms]] may be present in case of extensive [[skin]] involvement (such as [[anaphylaxis]]) | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Ice cube test is positive | *Ice cube test is positive | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* The [[wheal]] appears within 5 minutes of cold contact | *The [[wheal]] appears within 5 minutes of cold contact | ||
|- | |- | ||
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Cryopyrin-associated periodic syndrome|Familial Cold Autoinflammatory Syndrome]]<ref name="Kastner2005">{{cite journal|last1=Kastner|first1=D. L.|title=Hereditary Periodic Fever Syndromes|journal=Hematology|volume=2005|issue=1|year=2005|pages=74–81|issn=1520-4391|doi=10.1182/asheducation-2005.1.74}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Cryopyrin-associated periodic syndrome|Familial Cold Autoinflammatory Syndrome]]<ref name="Kastner2005">{{cite journal|last1=Kastner|first1=D. L.|title=Hereditary Periodic Fever Syndromes|journal=Hematology|volume=2005|issue=1|year=2005|pages=74–81|issn=1520-4391|doi=10.1182/asheducation-2005.1.74}}</ref> | ||
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*[[Infancy]], but may be delayed until adulthood | *[[Infancy]], but may be delayed until adulthood | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Non-[[itch|pruritic]] [[Urticaria|urticarial rash]] | *Non-[[itch|pruritic]] [[Urticaria|urticarial rash]] | ||
*[[Fever]] | *[[Fever]] | ||
*[[Headache]] | *[[Headache]] | ||
| Line 82: | Line 84: | ||
*[[Pustular rash]] | *[[Pustular rash]] | ||
*[[Bone pain]] | *[[Bone pain]] | ||
* Swollen [[joints]] | *Swollen [[joints]] | ||
*[[Aphthous ulcers]] | *[[Aphthous ulcers]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Occurs due to [[mutation]] in [[Interleukin 1 receptor antagonist|IL1RN]] [[gene]] | *Occurs due to [[mutation]] in [[Interleukin 1 receptor antagonist|IL1RN]] [[gene]] | ||
*[[Pustular rash]] similar to [[pustular psoriasis]] | *[[Pustular rash]] similar to [[pustular psoriasis]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
*[[Epidermal]] [[Neutrophil|neutrophilic]] [[pustules]] at [[hair follicles]] | *[[Epidermal]] [[Neutrophil|neutrophilic]] [[pustules]] at [[hair follicles]] | ||
*[[Pathergy test|Pathergy]] | *[[Pathergy test|Pathergy]] | ||
*[[Hyperkeratosis]] and acanthosis | *[[Hyperkeratosis]] and acanthosis | ||
* High [[neutrophil]] infiltrate of the [[dermis]] | *High [[neutrophil]] infiltrate of the [[dermis]] | ||
|- | |- | ||
!style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Juvenile idiopathic arthritis|Systemic-Onset Juvenile Idiopathic Arthritis]]<ref name="GurionLehman2012">{{cite journal|last1=Gurion|first1=R.|last2=Lehman|first2=T. J. A.|last3=Moorthy|first3=L. N.|title=Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment|journal=International Journal of Inflammation|volume=2012|year=2012|pages=1–16|issn=2090-8040|doi=10.1155/2012/271569}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Juvenile idiopathic arthritis|Systemic-Onset Juvenile Idiopathic Arthritis]]<ref name="GurionLehman2012">{{cite journal|last1=Gurion|first1=R.|last2=Lehman|first2=T. J. A.|last3=Moorthy|first3=L. N.|title=Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment|journal=International Journal of Inflammation|volume=2012|year=2012|pages=1–16|issn=2090-8040|doi=10.1155/2012/271569}}</ref> | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* 2-16 years of age | *2-16 years of age | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* High [[fever]] | *High [[fever]] | ||
*[[Arthralgia]] | *[[Arthralgia]] | ||
*[[Generalized lymphadenopathy]] | *[[Generalized lymphadenopathy]] | ||
*[[Splenomegaly]] | *[[Splenomegaly]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Evanescent [[rash]] | *Evanescent [[rash]] | ||
*Bright salmon-pink | *Bright salmon-pink | ||
* Morbilliform, [[macular]] [[rash]] | *Morbilliform, [[macular]] [[rash]] | ||
*[[Rash]] presents with onset of [[fever]] | *[[Rash]] presents with onset of [[fever]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* May cause [[amyloidosis]] | *May cause [[amyloidosis]] | ||
|- | |- | ||
!style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Adult-Onset Still’s Disease]]<ref name="Efthimiou2006">{{cite journal|last1=Efthimiou|first1=P|title=Diagnosis and management of adult onset Still's disease|journal=Annals of the Rheumatic Diseases|volume=65|issue=5|year=2006|pages=564–572|issn=0003-4967|doi=10.1136/ard.2005.042143}}</ref> | ! style="padding: 5px 5px; background: #DCDCDC; " align="left" |[[Adult-Onset Still’s Disease]]<ref name="Efthimiou2006">{{cite journal|last1=Efthimiou|first1=P|title=Diagnosis and management of adult onset Still's disease|journal=Annals of the Rheumatic Diseases|volume=65|issue=5|year=2006|pages=564–572|issn=0003-4967|doi=10.1136/ard.2005.042143}}</ref> | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* 16-35 years | *16-35 years | ||
* May affect all ages | *May affect all ages | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* High spiking [[fever]] | *High spiking [[fever]] | ||
*[[Joint pain]] | *[[Joint pain]] | ||
*[[Skin rash]] | *[[Skin rash]] | ||
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*[[Splenomegaly]] | *[[Splenomegaly]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* Evanescent salmon-colored bumpy [[rash]] | *Evanescent salmon-colored bumpy [[rash]] | ||
*[[Itch|Pruritic]] [[rash]] on the [[proximal]] [[Limb (anatomy)|limbs]] and [[trunk]] | *[[Itch|Pruritic]] [[rash]] on the [[proximal]] [[Limb (anatomy)|limbs]] and [[trunk]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | | style="padding: 5px 5px; background: #F5F5F5;" align="left" | | ||
* More commonly seen among women | *More commonly seen among women | ||
* May cause destructive [[arthritis]] | *May cause destructive [[arthritis]] | ||
|} | |} | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Allergology]] | [[Category:Allergology]] | ||
| Line 138: | Line 139: | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 15:32, 28 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
It is critical to differentiate urticaria from other similar disorders to utilize the best approach for the treatment. Hereditary or acquired deficiency of complement factor C1, cutaneous mastocytosis such as urticaria pigmentosa, certain malignancies, connective tissue diseases, angioedema and exercise‐induced anaphylaxis are some of the differential diagnosis of urticaria.
Differentiating Urticaria from other Diseases
- Hereditary or acquired deficiency of complement factor C1
- Cutaneous mastocytosis/urticaria pigmentosa
- Malignancy
- Exercise‐induced anaphylaxis[1]
- Connective tissue diseases
- Photosensitive diseases
- Poison ivy contact dermatitis: The rash that develops from poison ivy, poison oak, and poison sumac contact are commonly mistaken for urticaria. This rash is caused by contact with urushiol and results in a form of contact dermatitis called urushiol-induced contact dermatitis.
- Angioedema:
- Although it might be related to urticaria, angioedema occurs due to swelling of the lower layers of dermis.[2]
- Edema can occur around the mouth, in the throat, in the abdomen, or in other locations. Urticaria and angioedema sometimes occur together in response to an allergen and should be a concern in severe cases because angioedema of the throat can be fatal.
- A possible differential diagnosis for diseases that cause urticaria, and rash include:
- Table below differentiates some of the aforementioned conditions:
| Disease name | Age of onset | Signs/Symptoms | Diagnostic feature(s) | Other features |
|---|---|---|---|---|
| Cold Contact Urticaria[3][4] |
|
|
|
|
| Familial Cold Autoinflammatory Syndrome[5] |
|
|
|
|
| Schnitzler syndrome[6] |
|
| ||
| Deficiency in Interleukin-1 Receptor Antagonist[7] |
|
|
| |
| Systemic-Onset Juvenile Idiopathic Arthritis[8] |
|
| ||
| Adult-Onset Still’s Disease[9] |
|
|
|
References
- ↑ Zuberbier T (2003). "Urticaria". Allergy. 58 (12): 1224–34. doi:10.1046/j.1398-9995.2003.00327.x. PMID 14616095.
- ↑ "Hives (Urticaria and Angioedema)". 2006-03-01. Retrieved 2007-08-24.
- ↑ Siebenhaar, F.; Weller, K.; Mlynek, A.; Magerl, M.; Altrichter, S.; Vieira dos Santos, R.; Maurer, M.; Zuberbier, T. (2007). "Acquired cold urticaria: clinical picture and update on diagnosis and treatment". Clinical and Experimental Dermatology. 32 (3): 241–245. doi:10.1111/j.1365-2230.2007.02376.x. ISSN 0307-6938.
- ↑ Krause, Karoline; Zuberbier, Torsten; Maurer, Marcus (2010). "Modern Approaches to the Diagnosis and Treatment of Cold Contact Urticaria". Current Allergy and Asthma Reports. 10 (4): 243–249. doi:10.1007/s11882-010-0121-3. ISSN 1529-7322.
- ↑ Kastner, D. L. (2005). "Hereditary Periodic Fever Syndromes". Hematology. 2005 (1): 74–81. doi:10.1182/asheducation-2005.1.74. ISSN 1520-4391.
- ↑ de Koning, Heleen D.; Bodar, Evelien J.; van der Meer, Jos W.M.; Simon, Anna (2007). "Schnitzler Syndrome: Beyond the Case Reports: Review and Follow-Up of 94 Patients with an Emphasis on Prognosis and Treatment". Seminars in Arthritis and Rheumatism. 37 (3): 137–148. doi:10.1016/j.semarthrit.2007.04.001. ISSN 0049-0172.
- ↑ Aksentijevich, Ivona; Masters, Seth L.; Ferguson, Polly J.; Dancey, Paul; Frenkel, Joost; van Royen-Kerkhoff, Annet; Laxer, Ron; Tedgård, Ulf; Cowen, Edward W.; Pham, Tuyet-Hang; Booty, Matthew; Estes, Jacob D.; Sandler, Netanya G.; Plass, Nicole; Stone, Deborah L.; Turner, Maria L.; Hill, Suvimol; Butman, John A.; Schneider, Rayfel; Babyn, Paul; El-Shanti, Hatem I.; Pope, Elena; Barron, Karyl; Bing, Xinyu; Laurence, Arian; Lee, Chyi-Chia R.; Chapelle, Dawn; Clarke, Gillian I.; Ohson, Kamal; Nicholson, Marc; Gadina, Massimo; Yang, Barbara; Korman, Benjamin D.; Gregersen, Peter K.; van Hagen, P. Martin; Hak, A. Elisabeth; Huizing, Marjan; Rahman, Proton; Douek, Daniel C.; Remmers, Elaine F.; Kastner, Daniel L.; Goldbach-Mansky, Raphaela (2009). "An Autoinflammatory Disease with Deficiency of the Interleukin-1–Receptor Antagonist". New England Journal of Medicine. 360 (23): 2426–2437. doi:10.1056/NEJMoa0807865. ISSN 0028-4793.
- ↑ Gurion, R.; Lehman, T. J. A.; Moorthy, L. N. (2012). "Systemic Arthritis in Children: A Review of Clinical Presentation and Treatment". International Journal of Inflammation. 2012: 1–16. doi:10.1155/2012/271569. ISSN 2090-8040.
- ↑ Efthimiou, P (2006). "Diagnosis and management of adult onset Still's disease". Annals of the Rheumatic Diseases. 65 (5): 564–572. doi:10.1136/ard.2005.042143. ISSN 0003-4967.