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.

Angioedema with eosinophilia

A total of 11 patients were reported from Japan. They were reported selectively in young females. The common features are angioedema with eosinophilia (eosinophil count of 7,839 +/- 6,008). Serum C-reactive protein and immunoglobulin E levels remained normal. They improved within 8 weeks, even without corticosteroid therapy.^[18]

Differential Diagnoses

Acute Urticaria
Cholinergic Urticaria
Chronic Urticaria
Contact Urticaria Syndrome
Cutaneous Manifestations of Cholesterol Embolism
Dermographism Urticaria
Pressure Urticaria
Solar Urticaria
Urticarial Vasculitis

Workup

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