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==Differentiating Urticaria from other Diseases==
==Differentiating Urticaria from other Diseases==
* Hereditary or acquired deficiency of compliment factor C1
* Hereditary or acquired deficiency of complement factor C1
* Cutaneous [[mastocytosis]]/urticaria pigmentosa  
* Cutaneous [[mastocytosis]]/urticaria pigmentosa  
* [[Malignancy]]
* [[Malignancy]]
* Poison ivy contact dermatitis: The rash that develops from poison ivy, poison oak, and poison sumac contact is 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]]. Urushiol is spread by contact, but can be washed off with a strong grease/oil dissolving detergent and cool water.
* 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]]. Urushiol is spread by contact but can be washed off with a strong grease/oil dissolving detergent and cool water.
* [[Angioedema]]: It is related to urticaria.  In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria.<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>  This swelling 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 is a concern in severe cases because angioedema of the throat can be fatal.
* [[Angioedema]]: It is related to urticaria.  In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria.<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>  This swelling 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 is 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:
**Cold Contact Urticaria
**Schnitzler Syndrome
**Deficiency in Interleukin-1 Receptor Antagonist
**Systemic-Onset Juvenile Idiopathic Arthritis
**Adult-Onset Still’s Disease
*Table below differentiates the aforementioned [[conditions]]:
{| border="3"
|+
! 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| Signs/Symptoms}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Diagnostic feature(s)}}
! style="background: #4479BA; width: 150px;"|{{fontcolor|#FFF| Other features}}
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |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" |
* Early adulthood
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Urticaria|Urticarial]] skin eruption after exposure to cold
*Urticaria and/or [[angioedema]] affects areas only in contact with cold
*Systemic symptoms may be present in case of extensive skin involvement (even [[anaphylaxis]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ice cube test is positive
*
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* 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: #F5F5F5;" align="left" |
*[[Infancy]], but may be delayed until adulthood
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Non-pruritic [[Urticaria|urticarial rash]]
*[[Fever]]
*[[Headache]]
*[[Fatigue]]
*[[Conjunctivitis]]


<br />
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Ice cube test is negative
*
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Cold-induced [[rash]]
*[[Skin biopsy]] shows increased [[Neutrophil|neutrophils]] at the eccrine coils
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Schnitzler Syndrome<ref name="de KoningBodar2007">{{cite journal|last1=de Koning|first1=Heleen D.|last2=Bodar|first2=Evelien J.|last3=van der Meer|first3=Jos W.M.|last4=Simon|first4=Anna|title=Schnitzler Syndrome: Beyond the Case Reports: Review and Follow-Up of 94 Patients with an Emphasis on Prognosis and Treatment|journal=Seminars in Arthritis and Rheumatism|volume=37|issue=3|year=2007|pages=137–148|issn=00490172|doi=10.1016/j.semarthrit.2007.04.001}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Middle age]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Chronic [[Urticaria|urticarial]] rash
*[[Fever]]
*[[Arthralgia]]
*[[Bone pain]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Monoclonal gammopathy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Rash]] is the presenting sign
*[[Neutrophil|Neutrophillic]] infiltrate in [[dermis]]
*[[Dermographism]]
|-
! style="padding: 5px 5px; background: #DCDCDC; " align="left" |Deficiency in Interleukin-1 Receptor Antagonist<ref name="AksentijevichMasters2009">{{cite journal|last1=Aksentijevich|first1=Ivona|last2=Masters|first2=Seth L.|last3=Ferguson|first3=Polly J.|last4=Dancey|first4=Paul|last5=Frenkel|first5=Joost|last6=van Royen-Kerkhoff|first6=Annet|last7=Laxer|first7=Ron|last8=Tedgård|first8=Ulf|last9=Cowen|first9=Edward W.|last10=Pham|first10=Tuyet-Hang|last11=Booty|first11=Matthew|last12=Estes|first12=Jacob D.|last13=Sandler|first13=Netanya G.|last14=Plass|first14=Nicole|last15=Stone|first15=Deborah L.|last16=Turner|first16=Maria L.|last17=Hill|first17=Suvimol|last18=Butman|first18=John A.|last19=Schneider|first19=Rayfel|last20=Babyn|first20=Paul|last21=El-Shanti|first21=Hatem I.|last22=Pope|first22=Elena|last23=Barron|first23=Karyl|last24=Bing|first24=Xinyu|last25=Laurence|first25=Arian|last26=Lee|first26=Chyi-Chia R.|last27=Chapelle|first27=Dawn|last28=Clarke|first28=Gillian I.|last29=Ohson|first29=Kamal|last30=Nicholson|first30=Marc|last31=Gadina|first31=Massimo|last32=Yang|first32=Barbara|last33=Korman|first33=Benjamin D.|last34=Gregersen|first34=Peter K.|last35=van Hagen|first35=P. Martin|last36=Hak|first36=A. Elisabeth|last37=Huizing|first37=Marjan|last38=Rahman|first38=Proton|last39=Douek|first39=Daniel C.|last40=Remmers|first40=Elaine F.|last41=Kastner|first41=Daniel L.|last42=Goldbach-Mansky|first42=Raphaela|title=An Autoinflammatory Disease with Deficiency of the Interleukin-1–Receptor Antagonist|journal=New England Journal of Medicine|volume=360|issue=23|year=2009|pages=2426–2437|issn=0028-4793|doi=10.1056/NEJMoa0807865}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Infancy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Pustular rash]]
*[[Bone pain]]
* Swollen [[joints]]
*[[Aphthous ulcers]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Occurs due to [[mutation]] in IL1RN [[gene]]
*[[Pustular rash]] similar to [[pustular psoriasis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Epidermal]] [[Neutrophil|neutrophilic]] [[pustules]] at [[hair follicles]]
* Pathergy
*[[Hyperkeratosis]] and  acanthosis
* High [[neutrophil]] infiltrate of the [[dermis]]
|-
!style="padding: 5px 5px; background: #DCDCDC; " align="left" |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" |
* 2-16 years of age
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* High [[fever]]
*[[Arthralgia]]
*[[Generalized lymphadenopathy]]
*[[Splenomegaly]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Evanescent [[rash]]
*Bright salmon-pink
* Morbilliform, [[macular]] [[rash]]
*[[Rash]] presents with onset of [[fever]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* 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: #F5F5F5;" align="left" |
* 16-35 years
* May affect all ages
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* High spiking [[fever]]
*[[Joint pain]]
*[[Skin rash]]
*[[Lymphadenopathy]]
*[[Splenomegaly]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Evanescent salmon-colored bumpy [[rash]]
*[[Itch|Pruritic]] [[rash]] on the [[proximal]] limbs and [[trunk]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* More commonly seen among women
* May cause destructive [[arthritis]]
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 21:31, 21 February 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Urticaria from other Diseases

  • Hereditary or acquired deficiency of complement factor C1
  • Cutaneous mastocytosis/urticaria pigmentosa
  • Malignancy
  • 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. Urushiol is spread by contact but can be washed off with a strong grease/oil dissolving detergent and cool water.
  • Angioedema: It is related to urticaria. In angioedema, the swelling occurs in a lower layer of the dermis than it does in urticaria.[1] This swelling 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 is 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:
    • Cold Contact Urticaria
    • Schnitzler Syndrome
    • Deficiency in Interleukin-1 Receptor Antagonist
    • Systemic-Onset Juvenile Idiopathic Arthritis
    • Adult-Onset Still’s Disease
  • Table below differentiates the aforementioned conditions:
Disease name Age of onset Signs/Symptoms Diagnostic feature(s) Other features
Cold Contact Urticaria[2][3]
  • Early adulthood
  • Urticarial skin eruption after exposure to cold
  • Urticaria and/or angioedema affects areas only in contact with cold
  • Systemic symptoms may be present in case of extensive skin involvement (even anaphylaxis)
  • Ice cube test is positive
  • The wheal appears within 5 minutes of cold contact
Familial Cold Autoinflammatory Syndrome[4]
  • Infancy, but may be delayed until adulthood


  • Ice cube test is negative
Schnitzler Syndrome[5]
Deficiency in Interleukin-1 Receptor Antagonist[6]
Systemic-Onset Juvenile Idiopathic Arthritis[7]
  • 2-16 years of age
Adult-Onset Still’s Disease[8]
  • 16-35 years
  • May affect all ages
  • More commonly seen among women
  • May cause destructive arthritis

References

  1. ↑ "Hives (Urticaria and Angioedema)". 2006-03-01. Retrieved 2007-08-24.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ Kastner, D. L. (2005). "Hereditary Periodic Fever Syndromes". Hematology. 2005 (1): 74–81. doi:10.1182/asheducation-2005.1.74. ISSN 1520-4391.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.

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