Mold Allergy Differential Diagnoses
- Author: Shih-Wen Huang, MD; Chief Editor: Harumi Jyonouchi, MD more...
Allergic rhinitis and allergic conjunctivitis
Consider the following:
Viral infectious rhinitis
Nasal congestion as a complication of pregnancy
Rhinitis medicamentosa (rebound vasodilation due to drugs such as Neo-Synephrine, terbutaline, and reserpine)
In children, the presence of congenital choanal atresia or a foreign body should be considered. The presence of nasal polyps should be carefully excluded.
Differential diagnoses for allergic conjunctivitis include but are not limited to infectious conjunctivitis (viral and bacterial) and vernal conjunctivitis.
For patients with wheezing, after a carefully obtained history, the following conditions must be excluded:
Medical conditions involving the lung that manifest with symptoms suggestive of asthma
Syndromes characterized by abnormal breathing in which the lungs are structurally normal
Cases of local airway obstruction that manifest with wheezing that is audible to the patient or can be heard on examination
For those with cough without wheezing, the following conditions must be excluded:
Cardiac failure with acute pulmonary edema
Cardiac failure secondary to myocardial infarction
For children with wheezing or cough, asthma needs to be differentiated from the following conditions:
Hypersensitivity vasculitis - Allergic bronchopulmonary aspergillosis (ABPA), hypersensitive pneumonia, periarteritis nodosa
Other - Foreign-body aspiration, pulmonary thromboembolism, psychogenic cough, sarcoidosis, bronchopulmonary dysplasia
Allergic fungal sinusitis
Differential diagnoses include conditions that lead to chronic sinus diseases, including the following:
Aspirin hypersensitivity with nasal polyp
Anatomic defect with small ostium of sinus
Poorly treated sinusitis
Poor response to prolonged antibiotic treatment should raise the suspicion for allergic fungal sinusitis (AFS), and a workup for the disease should be initiated.
Allergic bronchopulmonary aspergillosis and allergic bronchopulmonary mycosis
The following conditions and findings must be excluded for diagnosis:
Asthma not associated with mold allergy
Chest radiographic infiltrate (eg, atelectasis, mucoid impactions, middle-lobe syndrome)
Bronchiectasis caused by other diseases
Other forms of hypersensitivity pneumonitis
Extrinsic allergic alveolitis
Individuals who are exposed to mycotoxin in an atmosphere with molds may develop symptoms of respiratory illness now defined as organic dust toxic syndrome. The disease is due to toxicity, not hypersensitivity. Another condition that must be excluded is nitrogen oxide pneumonitis, which is reported in individuals working in silos.
Other diseases that should be excluded include the following:
Cryptogenic fibrosing alveolitis
Metastatic cancer of the lung
Any infection, inflammation, or drug reaction leading to a fibrotic process of the lung also should be considered as differential diagnosis.
Worth re-emphasis is that mold-exposed patients can present with various immunoglobulin E (IgE)-mediated and non-IgE-mediated symptoms. Mycotoxins, irritation by spores, or metabolites may be culprits in non-IgE–mediated presentations; environmental assays have not been perfected. Symptoms attributable to the toxic effects of molds and not attributable to IgE or other immune mechanisms need further evaluation regarding their pathogenesis. However, immune, rather than toxic, responses seemed to be the major causes of symptoms in most studies.
Parainfluenza Virus Infections
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