Urticaria and fever
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Urticaria and Fever: Clinical Associations and Differential Diagnosis
Acute Urticaria and Fever: Common Triggers and Presentations
Acute urticaria often presents with transient, itchy wheals and can be triggered by infections, medications, or food allergies, especially in children. Fever may accompany urticaria, particularly when the underlying cause is an infection or a systemic inflammatory response. In some cases, urticaria and fever appear together without clear respiratory or gastrointestinal symptoms, and laboratory findings may show mild changes such as leukopenia or lymphocytopenia, but often resolve with standard treatments like antihistamines and steroids 16.
Urticaria Following Febrile Illnesses
It is not uncommon for urticaria to develop after specific fevers, such as pneumonia or influenza. The rash typically appears within a few days after the fever subsides, but can also occur weeks later. These episodes may be brief or persistent, and sometimes coincide with mild fever and joint pain. This pattern suggests a post-infectious hypersensitivity reaction .
Chronic Urticaria, Fever, and Underlying Systemic Diseases
Chronic urticaria (CU) can be associated with non-skin symptoms like recurrent unexplained fever, joint pain, and malaise. These symptoms may indicate an underlying systemic or autoinflammatory disorder, such as urticarial vasculitis or Familial Mediterranean Fever (FMF). Genetic mutations, such as those in the MEFV gene, have been linked to chronic urticaria with fever and joint symptoms, highlighting the importance of considering genetic and autoimmune causes in persistent or atypical cases 45.
Urticaria Mimickers in the Context of Fever
Several conditions can mimic urticaria in children, especially when fever and other systemic symptoms are present. These include urticaria multiforme, serum sickness-like reactions, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, systemic onset juvenile idiopathic arthritis, cryopyrin-associated periodic syndromes, and urticarial vasculitis. Accurate diagnosis is crucial to avoid unnecessary investigations for self-limited conditions and to identify serious multisystem inflammatory diseases 68.
Viral Infections and Urticaria
Viral infections are a recognized cause of acute urticaria. For example, dengue fever can present with acute urticaria, likely due to viral-induced mast cell activation. Such cases typically respond well to antihistamines and resolve without recurrence . Other viral illnesses, such as influenza, have also been associated with urticaria, either during or after the febrile phase 27.
Diagnostic Considerations for Urticaria with Fever
When urticaria is accompanied by fever, especially if the rash is non-itchy, persistent, or associated with joint pain or other systemic symptoms, clinicians should consider alternative diagnoses beyond simple allergic reactions. These include vasculitis, autoimmune bullous diseases, drug reactions, and autoinflammatory syndromes. Histological and serological evaluations may be necessary to distinguish these conditions from typical urticaria 458.
Conclusion
Urticaria with fever can result from a range of causes, from common infections and hypersensitivity reactions to rare systemic and autoinflammatory diseases. Recognizing the clinical context, associated symptoms, and response to standard treatments is essential for accurate diagnosis and management. In persistent or atypical cases, further investigation for underlying systemic or genetic conditions is warranted to guide appropriate therapy and improve patient outcomes 1245678.
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