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.

• Food Allergy is differentiated from enzyme deficiencies like lactose intolerance, fructose intolerance, Celiac Disease, Toxic reactions, Irritable bowel syndrome, Tyramine or caffeine toxicity, Gustatory Rhinitis.

Diseases		Clinical manifestations																	Para-clinical findings																	Gold standard	Additional findings
		Symptoms						Physical examination
														Lab Findings			Imaging							Histopathology
		Abdominal Pain	Diarrhea/ Nausea/Vomiting	Dysphagia	Bloating/Flatulence	Regurgitation/Reflux	Urticaria/Oral Ulcer	Dyspnea	Pruritus/Flushing	Gastrointestinal	Dermatological	Respiratory	Mucosal	Ocular	Systemic and Other	Complete blood count and Complete metabolic panel	IgA or IgG anti TTG, HLA-DQ2/DQ8	Hydrogen/Fructose breath Test, lactose intolerance test	Toxin or Others	Stool analysis	Ultrasonography and Endoscopy	Colonoscopy and Sigmoidoscopy	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, %HIA in Carcinoid, Gastrin in Zollinger Ellison syndrome, TSH in Dysfunctional thyroid gland	Decreased pH, Fecal Fat, Increased electrolyte, Increased osmotic gap, stool WBC, Calprotectin	to rule out ascites, lymphadenopathy, hepatobiliiary disease, lymphangiectasia, gastrinoma, somatostatinoma	-	-	to rule out pancreatic cause of malabsorption, malignancy	-
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)	+	-	+	-	-
Celiac Disease
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis

Diseases		Clinical manifestations																	Para-clinical findings																	Gold standard	Additional findings
		Symptoms						Physical examination
														Lab Findings			Imaging							Histopathology
		Abdominal Pain	Diarrhea/ Nausea/Vomiting	Dysphagia	Bloating/Flatulence	Regurgitation/Reflux	Urticaria/Oral Ulcer	Dyspnea	Pruritus/Flushing	Gastrointestinal	Dermatological	Respiratory	Mucosal	Ocular	Systemic and Other	Complete metabolic panel	IgA or IgG anti TTG, HLA-DQ2/DQ8	Hydrogen/Fructose breath Test, lactose intolerance test	Toxin	Stool analysis	Endoscopy	Colonoscopy and Sigmoidoscopy	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/Icteric mucosa	Tachypnea -/+	Glossitis/Cheilosis/Stomatitis	Keratitis, Xeropthalmia, Night blindness,	weight loss, Failure to thrive, Fatigue , Generalized and muscle weakness, Bone fracture, rickets/osteomalacia, Paresthesia, Ataxia
Inflammatory Bowel Disease
Celiac Disease
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis

Diseases		Clinical manifestations																	Para-clinical findings																	Gold standard	Additional findings
		Symptoms						Physical examination
														Lab Findings			Imaging							Histopathology
		Abdominal Pain	Diarrhea/ Nausea/Vomiting	Dysphagia	Bloating/Flatulence	Regurgitation/Reflux	Urticaria/Oral Ulcer	Dyspnea	Pruritus/Flushing	Gastrointestinal	Dermatological	Respiratory	Mucosal	Ocular	Systemic and Other	Complete metabolic panel	IgA or IgG anti TTG, HLA-DQ2/DQ8	Hydrogen/Fructose breath Test, lactose intolerance test	Toxin	Stool analysis	Endoscopy	Colonoscopy and Sigmoidoscopy	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/Icteric mucosa	Tachypnea -/+	Glossitis/Cheilosis/Stomatitis	Keratitis, Xeropthalmia, Night blindness,	weight loss, Failure to thrive, Fatigue , Generalized and muscle weakness, Bone fracture, rickets/osteomalacia, Paresthesia, Ataxia
Inflammatory Bowel Disease
Celiac Disease
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis

Diseases		Clinical manifestations																	Para-clinical findings																	Gold standard	Additional findings
		Symptoms						Physical examination
														Lab Findings			Imaging							Histopathology
		Abdominal Pain	Diarrhea/ Nausea/Vomiting	Dysphagia	Bloating/Flatulence	Regurgitation/Reflux	Urticaria/Oral Ulcer	Dyspnea	Pruritus/Flushing	Gastrointestinal	Dermatological	Respiratory	Mucosal	Ocular	Systemic and Other	Complete metabolic panel	IgA or IgG anti TTG, HLA-DQ2/DQ8	Hydrogen/Fructose breath Test, lactose intolerance test	Toxin	Stool analysis	Endoscopy	Colonoscopy and Sigmoidoscopy	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/Icteric mucosa	Tachypnea -/+	Glossitis/Cheilosis/Stomatitis	Keratitis, Xeropthalmia, Night blindness,	weight loss, Failure to thrive, Fatigue , Generalized and muscle weakness, Bone fracture, rickets/osteomalacia, Paresthesia, Ataxia
Inflammatory Bowel Disease
Celiac Disease
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis

Diseases		Clinical manifestations																	Para-clinical findings																	Gold standard	Additional findings
		Symptoms						Physical examination
														Lab Findings			Imaging							Histopathology
		Abdominal Pain	Diarrhea/ Nausea/Vomiting	Dysphagia	Bloating/Flatulence	Regurgitation/Reflux	Urticaria/Oral Ulcer	Dyspnea	Pruritus/Flushing	Gastrointestinal	Dermatological	Respiratory	Mucosal	Ocular	Systemic and Other	Complete metabolic panel	IgA or IgG anti TTG, HLA-DQ2/DQ8	Hydrogen/Fructose breath Test, lactose intolerance test	Toxin	Stool analysis	Endoscopy	Colonoscopy and Sigmoidoscopy	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/Icteric mucosa	Tachypnea -/+	Glossitis/Cheilosis/Stomatitis	Keratitis, Xeropthalmia, Night blindness,	weight loss, Failure to thrive, Fatigue , Generalized and muscle weakness, Bone fracture, rickets/osteomalacia, Paresthesia, Ataxia
Inflammatory Bowel Disease
Celiac Disease
Toxic reactions
Irritable bowel syndrome
Tyramine or caffeine toxicity
Gustatory Rhinitis

References

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]