Recurrent rash associated with food ingestion in a 5-year-old child

Abstract

HISTORY OF THE PRESENT ILLNESS A 5-year-old male was referred to our institution for evaluation of food allergy. He was well until 4 months of age when he began to develop an erythematous, unilateral facial flushing-type rash. It seemed to appear after the introduction of solid foods and did not follow ingestion of liquids. The rash occurs within minutes of eating a variety of seemingly unrelated foods such as candy (Skittles and Starburst; Mars, Hackettstown, NJ), fruits, vegetables (broccoli), popcorn, pretzels, and tomato sauce. The rash resolves spontaneously and gradually after several minutes, but may last up to 90 minutes. The erythema varies in intensity but can be strikingly bright and prominent, extending from the lower edge of the right side of the lip to just anterior to the tragus of the ear. The rash is warm, macular, and not well demarcated. There is no associated swelling, pruritus, sweating, or pain. He denies systemic symptoms such as nausea, vomiting, cough, wheezing, chest or throat tightness, shortness of breath, and tongue or lip swelling. The skin appears normal after resolution of the rash. Daily doses of cetirizine 5 to 10 mg did not prevent the rash from occurring. On a single occasion he developed facial urticaria with mild lip and tongue swelling after eating kiwi fruit, which he has since avoided.