Pediatric Angioedema Differential Diagnoses

  • Author: Shih-Wen Huang, MD; Chief Editor: Harumi Jyonouchi, MD   more...
 
Updated: Jan 6, 2012
 
 

Diagnostic Considerations

A variety of other diagnostic possibilities should also be considered in children with possible angioedema.

For other discussions on angioedema, see the overview topics Acquired Angioedema and Hereditary Angioedema.

Cellulitis

Usually, this is caused by gram-positive bacterial infection. Pain and fever are common.

Erysipelas

This is caused by group A beta streptococci. Tenderness, fever, and redness are common.

Lymphedema

Chronic thickening of tissues occurs in lymphedema. This contrasts with the acute stretching of tissue observed in angioedema.

Collagen vascular disorders

Patients with systemic lupus erythematosus (SLE) or other collagen vascular disorders should have a history of systemic illness, indicating the presence of vasculitis. Laboratory findings reflect features of chronic inflammatory conditions.

Acute contact dermatitis

In acute contact dermatitis, the patient has a history of contact with sensitizing agents. The rash is always accompanied by intense pruritus.

Idiopathic scrotal edema in children

The etiology of this disorder is unknown, but swelling is limited to the scrotal area. Rarely, it causes systemic symptoms.

Rosenthal-Melkersson syndrome

In this rare neurologic disorder, recurrent facial edema, recurrent peripheral facial nerve palsy, and remarkable fissuring of the tongue are characteristic. Onset is in childhood or early adolescence.

Laryngeal swelling due to anaphylaxis

Most patients have a history of intense allergic diathesis. The anaphylaxis may be caused by ingestion of food, drugs, insect sting, or latex allergy. Idiopathic anaphylaxis, which is rare in children, may occasionally cause difficulty in the differential diagnosis.

Surgical abdomen

Severe pain caused by hereditary angioedema can be difficult to distinguish from conditions leading to surgical abdomen. The latter include intestinal obstruction and appendicitis. In addition, Crohn disease may cause chronic pain and diarrhea. History and physical examination should be helpful to distinguish those conditions with the aid of imaging studies.

Differential Diagnoses

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Contributor Information and Disclosures
Author

Shih-Wen Huang, MD  Professor Emeritus of Pulmonology and Allergy, Department of Pediatrics, University of Florida College of Medicine

Shih-Wen Huang, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology

Disclosure: Nothing to disclose.

Chief Editor

Harumi Jyonouchi, MD  Associate Professor, Division of Pulmonary, Allergy/Immunology, and Infectious Diseases, Department of Pediatrics, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Harumi Jyonouchi, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American Association of Immunologists, American Medical Association, Clinical Immunology Society, New York Academy of Sciences, Society for Experimental Biology and Medicine, Society for Mucosal Immunology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

C Lucy Park MD, Head, Division of Allergy, Immunology, and Pulmonology, Associate Professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine

C Lucy Park is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Medical Association, Chicago Medical Society, Clinical Immunology Society, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Agostoni A, Aygoren-Pursun E, Binkley KE, et al. Hereditary and acquired angioedema: problems and progress: proceedings of the third C1 esterase inhibitor deficiency workshop and beyond. J Allergy Clin Immunol. Sep 2004;114(3 Suppl):S51-131. [Medline].

  2. Patel NN, Patel DN. Hereditary angioedema with normal C1 inhibitor. Am J Med. Nov 2008;121(11):949-51. [Medline].

  3. Visy B, Fust G, Varga L, et al. Sex hormones in hereditary angioneurotic oedema. Clin Endocrinol (Oxf). Apr 2004;60(4):508-15. [Medline].

  4. Cichon S, Martin L, Hennies HC, Muller F, Van Driessche K, Karpushova A. Increased activity of coagulation factor XII (Hageman factor) causes hereditary angioedema type III. Am J Hum Genet. Dec 2006;79(6):1098-104. [Medline].

  5. Prieto A, Tornero P, Rubio M, Fernandez-Cruz E, Rodriguez-Sainz C. Missense mutation Thr309Lys in the coagulation factor XII gene in a Spanish family with hereditary angioedema type III. Allergy. Feb 2009;64(2):284-6. [Medline].

  6. Duan QL, Binkley K, Rouleau GA. Genetic analysis of Factor XII and bradykinin catabolic enzymes in a family with estrogen-dependent inherited angioedema. J Allergy Clin Immunol. Jan 27 2009;[Medline].

  7. Farkas H. Pediatric hereditary angioedema due to C1-inhibitor deficiency. Allergy Asthma Clin Immunol. Jul 28 2010;6(1):18. [Medline]. [Full Text].

  8. [Guideline] Bowen T, Cicardi M, Farkas H, Bork K, Longhurst HJ, Zuraw B, et al. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema. Allergy Asthma Clin Immunol. Jul 28 2010;6(1):24. [Medline]. [Full Text].

  9. Bork K. Diagnosis and treatment of hereditary angioedema with normal C1 inhibitor. Allergy Asthma Clin Immunol. Jul 28 2010;6(1):15. [Medline]. [Full Text].

  10. Huang SW. Results of an on-line survey of patients with hereditary angioedema. Allergy Asthma Proc. Mar-Apr 2004;25(2):127-31. [Medline].

  11. Perricone C, Agmon-Levin N, Shoenfeld N, de Carolis C, Guarino MD, Gigliucci G, et al. Evidence of impaired sense of smell in hereditary angioedema. Allergy. Jul 22 2010;[Medline].

  12. Cugno M, Zanichelli A, Bellatorre AG, Griffini S, Cicardi M. Plasma biomarkers of acute attacks in patients with angioedema due to C1-inhibitor deficiency. Allergy. Feb 2009;64(2):254-7. [Medline].

  13. Epstein TG, Bernstein JA. Current and emerging management options for hereditary angioedema in the US. Drugs. 2008;68(18):2561-73. [Medline].

  14. Reshef A, Leibovich I, Goren A. Hereditary angioedema: new hopes for an orphan disease. Isr Med Assoc J. Dec 2008;10(12):850-5. [Medline].

  15. Bernstein JA, Ritchie B, Levy RJ, Wasserman RL, Bewtra AK, Hurewitz DS, et al. Population pharmacokinetics of plasma-derived C1 esterase inhibitor concentrate used to treat acute hereditary angioedema attacks. Ann Allergy Asthma Immunol. Aug 2010;105(2):149-54. [Medline].

  16. Cicardi M et al. Ecallantide for the treatment of acute attacks in hereditary angioedema. N Engl J Med. Aug 2010;363:523-31.

  17. Cicardi M, Banerji A, Bracho F, Malbrán A, Rosenkranz B, Riedl M, et al. Icatibant, a new bradykinin-receptor antagonist, in hereditary angioedema. N Engl J Med. Aug 5 2010;363(6):532-41. [Medline]. [Full Text].

  18. Lumry WR, et al. Results from FAST-3: A phase III randomized, double-blind, placebo-controlled, multicenter study of subcutaneous icatibant in patients with acute hereditary angioedema (HAE) attacks. American Academy of Allergy, Asthma, & Immunology Meeting. March 22, 2011; Abstract L2.

  19. Zuraw BL et al. Nanofiltered C1 inhibitor concentrate for treatment of hereditary angioedema. N Engl J Med. Aug 2010;363:513-22.

  20. Birjmohun RS, Kees Hovingh G, Stroes ES, et al. Effects of short-term and long-term danazol treatment on lipoproteins, coagulation, and progression of atherosclerosis: two clinical trials in healthy volunteers and patients with hereditary angioedema. Clin Ther. Dec 2008;30(12):2314-23. [Medline].

  21. Zanichelli A, Badini M, Nataloni I, Montano N, Cicardi M. Treatment of acquired angioedema with icatibant: a case report. Intern Emerg Med. Aug 3 2010;[Medline].

  22. Herrmann G, Schneider L, Krieg T. Efficacy of danazol treatment in a patient with the new variant of hereditary angio-oedema (HAE III). Br J Dermatol. Jan 2004;150(1):157-8. [Medline].

  23. [Guideline] Grattan CE, Humphreys F. Guidelines for evaluation and management of urticaria in adults and children. Br J Dermatol. Dec 2007;157(6):1116-23. [Medline].

  24. Morgan BP. Hereditary angioedema - therapies old and new (Editorial). N Engl J Med. Aug 2010;363:581-583.

 
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The mechanism of angioedema resulting from C1-esterase inhibitor deficiency.
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