Table 2.
Possible alternative diagnoses associated with the symptoms considered as clinical criteria for cutaneous MCAS [125].
| Flushing | fever, emotion, exercise, temperature changes, foods (spicy, fish—scombroid poisoning) or beverages (alcohol ingestion), medications (e.g., calcium channel blockers, nicotinic acid, disulfiram combined with alcohol) rosacea, climacteric flushing, carcinoid syndrome, pheochromocytoma, mastocytosis, anaphylaxis, thyroid—medullary carcinoma, VIPoma, renal cell carcinoma, neuro-psychiatric (anxiety disorders, Parkinson’s, multiple sclerosis, migraine, trigeminal nerve damage, Frey syndrome, Horner syndrome, Streeten syndrome, autonomic epilepsy, orthostatic hypotension), sarcoid, dumping syndrome, arsenic intoxication, basophilic granulocytic leukemia, malignant histiocytoma, idiopathic flushing |
| Pruritus | xerosis, scabies, noncutaneous causes (e.g., cholestatic/non-cholestatic hepatobiliary diseases, hyperthyroidism, uremic pruritus, myeloproliferative disorders such as Hodgkin/non-Hodgkin lymphoma, lymphocytic leukemia, polycythemia vera ± aquagenic pruritus, essential thrombocytosis, diabetes), psychogenic (depression, anxiety, obsessive-compulsive disorder, somatic symptom disorders, psychosis, substance use), subclinical mastocytosis, drug induced—either directly or via cholestasis (e.g., morphine-based analgesics, angiotensin-converting enzyme inhibitors, selective serotonin re-uptake inhibitors, nonsteroidal anti-inflammatory drugs can induce chronic pruritus without associated cutaneous lesions); for localized pruritus: spinal nerve compressions, notalgia paresthetica, small fiber neuropathy, parasitoses (e.g., enterobiasis) |
| Urticarial lesions | acute/chronic urticaria, urticarial vasculitis, urticarial dermatitis, urticaria multiforme, drug and viral exanthems, autoinflammatory syndromes (cryopyrin-associated periodic syndromes, Schnitzler syndrome, adult-onset Still disease, Gleich syndrome, neutrophilic urticarial dermatosis), hypereosinophilic syndromes, autoimmune progesterone dermatitis, polymorphic light eruption |
| Angioedema | bradykinin-mediated angioedema, hereditary angioedema, granulomatous cheilitis at an initial stage, eosinophilic cellulitis (Wells syndrome), allergic contact dermatitis (e.g., to hair dye), photoallergy |