Case history
Case history #1
An 18-month-old boy is brought by his mother to the pediatrician following an apparent adverse reaction to food. His mother relates that the boy developed a hoarse cry; hives on his face, neck, and trunk; lip swelling; and projectile vomiting 3 minutes after taking one bite of a cracker with peanut butter on it. His mother gave him antihistamine syrup immediately afterward. Further questioning reveals that the child has also experienced facial hives and vomiting within 10 minutes of ingesting a scrambled egg at 12 months of age. Medical history is significant for wheezing with viral infections during the first year of life and mild atopic dermatitis controlled with frequent emollient use.
Case history #2
A 2-year-old girl is taken to her pediatrician for evaluation of chronic dry skin with frequent episodes of inflammation at bilateral antecubital creases and posterior popliteal fossae. The pediatrician diagnoses atopic dermatitis and learns that the mother has been applying emollients twice daily but is hesitant to use a topical corticosteroid preparation prescribed by another physician 4 months earlier. The mother is particularly concerned that foods are contributing to the child's rash, and has noticed that the child's atopic dermatitis lesions seem to flare up after eating eggs.
Other presentations
Reactions may be either immunoglobulin (Ig) E-mediated, non-IgE-mediated, or mixed IgE-mediated/non-IgE-mediated reactions. IgE-mediated reactions typically include symptoms such as urticaria, angioedema, vomiting, diarrhea, asthma, or stridor. Non-IgE-mediated reactions are thought to be cell-mediated and may include contact dermatitis, food protein-induced enterocolitis syndrome, dermatitis herpetiformis, celiac disease, or Heiner syndrome (recurrent pneumonia associated with pulmonary infiltrates, hemosiderosis, gastrointestinal blood loss, iron deficiency anemia, and failure to thrive).[2] Mixed IgE-mediated/non-IgE-mediated reactions include atopic dermatitis, eosinophilic esophagitis, and allergic eosinophilic gastroenteritis.[1]
Use of this content is subject to our disclaimer