Frey’s syndrome as a differential diagnosis for food allergy: a case report

Case report A 5-year-old girl presented to her GP with a history of an erythematous rash that appeared on her left cheek associated with eating certain foods including strawberries, apples, and sweets. The rash would appear immediately on mastication and would entirely disappear within 30 minutes of ingestion. Her medical history was unremarkable apart from a road traffic accident at 3 years of age when she suffered facial and chest trauma leading to a mandibular fracture and right lower lobe collapse. The patient required intubation and ventilation for 9 days on the paediatric intensive care unit and underwent maxillofacial surgery for the mandibular fracture. Physical examination revealed a well-grown child with no systemic abnormalities or eczema. Within a few seconds of eating candy a facial flushing appeared on her left cheek, stretching from her the temporal region to the corner of her mouth. This faded within a few minutes as demonstrated in Figure 1. There was no associated lip or tongue swelling or difficulty in breathing. The patient was referred for skin prick testing which was performed on an extended panel and was negative. She was reviewed by a consultant paediatrician who made a diagnosis of Frey’s syndrome and counselled the family with regard to the non-allergic pathogenesis of this condition.