Auriculotemporal (Frey) Syndrome in Late Childhood: An Unusual Variant Presenting as Gustatory Flushing Mimicking Food Allergy

Abstract

Auriculotemporal or Frey syndrome is characterized mainly by recurrent episodes of facial gustatory flushing and/or sweating, limited to the cutaneous distribution of the auriculotemporal nerve. Although relatively common in adults following injury to the auriculotemporal nerve or parotid disease, the condition has rarely been reported in children. Moreover, in childhood, auriculotemporal syndrome has been described mainly in infancy and early childhood as a sequel of perinatal birth trauma resulting from assisted forceps delivery. We report a 13-year-old girl with a 2-month history of recurrent, painless, preauricular gustatory flushing without sweating, initially suspected to be a food allergy. Detailed inquiry revealed a history of a bicycle accident with mandibular condyle fracture 7 years prior to the onset of symptoms. Our patient demonstrates an unusual presentation of auriculotemporal syndrome in late childhood as gustatory flushing mimicking food allergy. Awareness of this variant is essential for prompt recognition, thus avoiding unnecessary laboratory tests, especially as this condition usually resolves spontaneously.

Management of frey syndrome

“…Frey syndrome may also occur after extirpation of the submandibular gland, mandibular condylar fracture, and obstetric trauma caused by a forceps. [9][10][11] Other nontraumatic causes are sympathectomy, autonomic neuropathy in diabetes mellitus, herpes zoster infection, and metabolic diseases. 12 …”

Frey syndrome in neurofibromatosis 1

“…An earlier case report described localised gustatory flushing and sweating in a child who suffered unilateral facial herpes zoster6 and it has been suggested that this syndrome can be mistaken for food allergy 7. An individual with NF1 is reported to have had unilateral hyperhidrosis involving an upper limb without obvious explanation 8.…”

The flushing patient: Differential diagnosis, workup, and treatment

“…These latter entities are benign and resolve spontaneously. 1,[72][73][74] Autonomic epilepsy, also known as diencephalic epilepsy, is a rare syndrome of paroxysmal and transient autonomic discharges that may present with paroxysmal flushing, tachycardia, and hypertension from catecholamine release, in addition to generalized seizures or loss of consciousness. Other signs may include pilomotor activation, salivation, dilated pupils, and spasms of the sphincters.…”