Hives (Urticaria): Or something else? Differential Diagnosis

Skin and subcutaneous (L00-L99).

  • Acute urticaria
  • Allergic urticaria
  • Aquagenic urticaria – hives after water contact.
  • Bullous pemphigoid – blistering autoimmune disease of the skin.
  • Cholinergic urticaria – hives caused by sweating or intense exertion.
  • Chronic urticaria – for example, based on allergic contact dermatitis when using acrylate or methacrylate-based nail cosmetics.
  • Idiopathic urticaria – hives, the cause of which is unclear.
  • Contact urticaria
  • Periodic/recurrent urticaria
  • Urticaria due to cold/heat
  • Urticaria bullosa – hives associated with blistering.
  • Urticaria circinata – polycyclic limited foci.
  • Urticaria cum pigmentatione – hives, after which subsides hyperpigmentation occurs.
  • Urticaria e calore (heat urticaria).
  • Urticaria factitia – hives due to mechanical irritation.
  • Urticaria gigantea
  • Urticaria haemorrhagica – associated with hemorrhages.
  • Urticaria mechanica (pressure urticaria)
  • Urticaria pigmentosa – benign generalized proliferation of tissue mast cells.
  • Urticaria porcellanea – whitish edematous wheals.
  • Urticaria profunda – associated with deep edema formation.
  • Urticaria rubra – bright red discoloration of the wheals.
  • Urticaria solaris – urticaria triggered by solar radiation.
  • Urticaria vasculitis – systemic form of hives associated with vascular inflammation.
  • Cellulitis eosinophilic – inflammatory systemic disease; skin involvement with recurrent, itchy or burning, red solid plaques (areal or plate-like substance proliferation of the skin).

Infectious and parasitic diseases (A00-B99).

  • Hepatitis B infection
  • Hepatitis C infection
  • Infections, unspecified:
    • Bacteria (including Helicobacter pylori or, less commonly, Yersinia colonization).
    • Parasites (including Anisakis simplex (nematodes, predominantly found in fish); Toxocara canis (canine roundworm)). → chronic spontaneous urticaria
    • Protozoa (including Leishmania, Plasmodia, Toxoplasma and Trypanosoma) → chronic spontaneous urticaria.
    • Viruses

Musculoskeletal system and connective tissue (M00-M99).

  • Systemic lupus erythematosus (SLE) – autoimmune disease with formation of autoantibodies mainly against antigens of the cell nuclei (so-called antinuclear antibodies, ANA), in some circumstances also against blood cells and other body tissues.
  • Vasculitides, unspecified

Neoplasms – tumor diseases (C00-D48).

  • Chronic lymphocytic leukemia (CLL)
  • Mastocytosis – two main forms: cutaneous mastocytosis (skin mastocytosis) and systemic mastocytosis (whole body mastocytosis); clinical picture of cutaneous mastocytosis: Yellowish-brown spots of varying size (urticaria pigmentosa); in systemic mastocytosis, there are also episodic gastrointestinal complaints (gastrointestinal complaints), (nausea (nausea), burning abdominal pain and diarrhea (diarrhea)), ulcer disease, and gastrointestinal bleeding (gastrointestinal bleeding) and malabsorption (disorder of food absorption); In systemic mastocytosis, there is an accumulation of mast cells (cell type that is involved in, among other things, allergic reactions). Among other things, involved in allergic reactions) in the bone marrow, where they are formed, as well as accumulation in the skin, bones, liver, spleen and gastrointestinal tract (GIT; gastrointestinal tract); mastocytosis is not curable; course usually benign (benign) and life expectancy normal; extremely rare degeneration mast cells (= mast cell leukemia (blood cancer)).

Injuries, poisoning and other consequences of external causes (S00-T98).

  • Angioedema – transient swelling of the subcutaneous tissue of the lip/lid region.
  • IgE-mediated wheat allergy with the clinical picture of chronic urticaria.
  • Insect bites
  • Intolerance reactions to preservatives and / or dyes (pseudoallergies).
  • Food allergies
  • Oral allergy syndrome (OAS) – contact urticaria of the oropharyngeal mucosa (Os = mouth, pharynx = throat) – in older children and adolescents, the most common clinical manifestation of food allergy; clinical presentation: itching or burning of lips, palate, tongue, pharynx, and possibly ears; onset: immediately after contact with the triggering allergen (latency possible up to 2 h after ingestion of the food).
  • Serum sickness – type III hypersensitivity reaction of the immune system (immune complex disease) to a foreign, non-human protein, which is applied, for example, in vaccine sera or serum therapy. In addition, various drugs, such as sulfonamides and penicillins and other antigens can cause serum sickness

Drugs

  • See “Causes” under medications

Other differential diagnoses

  • Food preservatives
  • Food coloring agents