Allergy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Overview

Allergy must be differentiated from other diseases that cause Dermatological (Urticaria, pruritus, flushing, Angioedema), Respiratory (Rhinorrhea,chest tightness,Wheezing, Dyspnoea, Sneezing, Shortness of breath) Mucosal (Mucosal swelling affecting nose, lips, tongue, larynx, pharynx, conjunctiva, GIT) Ocular (Periorbital edema, Conjunctival Congesion, Itching), Systemic (Hypotension). Allergy can be differentiated according to the type of allergy.


Differentiating allergy from other Diseases

Allergy must be differentiated from other diseases that cause Dermatological (Urticaria, pruritus, flushing, Angioedema), Respiratory (Rhinorrhea,chest tightness,Wheezing, Dyspnoea, Sneezing, Shortness of breath) Mucosal (Mucosal swelling affecting nose, lips, tongue, larynx, pharynx, conjunctiva, GIT) Ocular (Periorbital edema, Conjunctival Congesion, Itching), Systemic (Hypotension). Allergy can be differentiated according to the types of allergy.

Differentiating Allergy from other diseases on the basis of Dermatological, Respiratory, Mucosal, Ocular, Systemic Manifestations

On the basis Dermatological, Respiratory, Mucosal, Ocular, Systemic Manifestations, Allergy must be differentiated according to the types of allergy.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Abdominal Pain Diarrhea/ Nausea/Vomiting Dysphagia/Chest Pain Bloating/Flatulence Regurgitation/Reflux Urticaria/Angioedema / Mucosal Swelling/ Oral Ulcer Dyspnea/ Rhinorrhea /Sneezing /Nasal congesion Pruritus/Flushing/Conjunctival or OcularIrritation Gastrointestinal Dermatological Respiratory Mucosal Ocular Systemic and Other Complete blood count and Complete metabolic panel Specific Laboratory test Hydrogen/Fructose breath Test, lactose intolerance test Toxin or Others Stool analysis Or Urine Analysis Ultrasonography and Endoscopy Colonoscopy, Sigmoidoscopy or Bronchoscopy Barium Enema and X-ray CT MRI
Enzyme deficiencies and Malabsorption +(Diffuse Mild abdominal pain) +(Steatorrhea/Osmotic Diarrhea) - + - - - - Abdominal distention, Mild tenderness -/+, Osmotic diarrhea Hepatomegaly -/+, Ascites -/+ Koilonychia, Edema, Dermatitis, Easy Bruisability, ecchymoses, Follicular Hyperkeratosis, Pale mucosa Tachypnea -/+ Glossitis/Cheilosis/Stomatitis Keratitis, Xeropthalmia, Night blindness, weight loss, Failure to thrive, Fatigue , Generalized and muscle weakness, Arthralgia, Bone fracture, rickets/osteomalacia, Paresthesia, Ataxia Iron deficiency anemia, Anemia of chronic disease, Increased ESR, Electrolyte imbalance, Serum Pr/globulin, - + in lactose and fructose intolerance -/ Autoantibodies(ANA in Connective tissue disease, Antimitochondrial Ab in PBC), CFTR mutation in CF, Immunoglobulins in Immunodeficiency, HIV-ELISA/Western blot in HIV, 5-HIA in Carcinoid, Gastrin in Zollinger Ellison syndrome, TSH in Dysfunctional thyroid gland Stool analysis: Decreased pH, Increased Fecal Fat, Increased electrolyte, Increased osmotic gap, stool WBC, Calprotectin USG rule out ascites, lymphadenopathy, hepatobiliiary disease, lymphangiectasia, gastrinoma, somatostatinoma - - to rule out pancreatic cause of malabsorption, malignancy - Hydrogen breath test for Carbohydrate intolerance, Antimitochondrial Ab in PBC, CFTR mutation in CF, Immunoglobulins in Immunodeficiency, HIV-ELISA/Western blot in HIV, 5-HIA in Carcinoid, Gastrin in Zollinger Ellison syndrome -
Inflammatory Bowel Disease +(Right LQ pain in Crohn's Disease, Colicky abdominal or rectal pain in UC) + (Bloody diarrhea or Mucus or pus in stool) - + - + - - Abdominal distention, RUQ or LLQ or rectal tenderness -/+, Bloody diarrhea Hepatomegaly -/+, Ascites -/+ Pyoderma gangrenosum, Erythema nodosum - Aphthous Stomatitis Uveitis, Episcleritis, scleritis Weight loss, Ankylosing spondylitis, Sacroiliitis, Arthralgia, Osteoporosis, Primary biliary cholangitis, Nephrolithiasis Anemia of chronic disease, Increased ESR, Electrolyte imbalance, Serum Pr/globulin, Ferritin, CRP, Hypoalbuminemia,low B12 - - - Saccharomyces cerevisiae Ab, P-ANCA Stool culture is performed to rule out infectious cause Small bowel thickening Aphthous ulcer, erythematous GI mucosa, erosions, spontaneous bleeding, fistula or stricture Aphthous ulcers, cobblestoning, Skip lesion present in CD, edematous friable mucosa , erosions, paleness, granular mucosa are shown in UC Thickened small bowel, or fistula To rule out complication of Inflammatory bowel disease Endoscopy with Ilieocolonoscopy -
Celiac Disease +/-, cramping + - + + Gingivitis/Stomatitis/Cheilosis - - Tenderness, Loose watery Diarrhea, Nausea, Vomiting, enamel erosion, aphthous ulcer, hyposplenism, constipation, acid reflux Dermatitis herpetiformis, acne, eczema, seborrheic dermatitis, brittle nails Asthma, tachypnea, wheezing-/+ Gingivitis/Stomatitis/Cheilosis - Fatigue, weight loss, arthralgia, arthritis, muscle cramping, peripheral neuropathy, headche, dizziness, ataxia, menstrual abnormalities IDA, Anemia of chronic disease, Increased ESR, Electrolyte imbalance, Serum Pr/globulin, Ferritin, CRP, Hypoalbuminemia, low vitamin B12, low vitamin D + - DNA PCR, HLA Haplotypes, IgA or IgG deaminated gliadin peptide Ab - Refractory Celiac disease IgA or IgG anti TTG, HLA-DQ2/DQ8
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis
Acute Infectious rhinitis
Irritant rhinitis
Acute Rhinosinusitis
Hormonal Rhinitis
Vasomotor rhinitis
IgE mediated (Carcinoid Syndrome, Mastocytosis)
Non-IgE mediated (Kawasaki disease, Acute Viral or streptococcal infection, Acute graft-versus host disease, Hereditary angioedema)
COPD Spirometry
Allergic bronchopulmonary aspergillosis
Bronchiectasis
OSA
Chrug-strauss syndrome
Anxiety
Foreign Body in respiratory tract
Seborrheic dermatitis
Psoriasis
Contact dermatitis
Scabies
Nutrient deficiency ( Zinc, Vitamin B3, Vitamin B6)
Hyper IgE syndrome
Wiskott-Aldrich syndrome
IPEX syndrome
Brutons Agammaglobulinemia

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