Gustatory Hyperhidrosis

Abstract

A healthy man in his 40s was referred to the allergy outpatient clinic with a suspected vinegar allergy. He had a 4-year history of facial flushing and excessive sweating after smelling or consuming vinegar, vinegar-containing products, and spicy food. Sweating and hyperemia occurred within minutes on his entire face and scalp and lasted for 20 to 30 minutes. These symptoms were perceived as debilitating and interfered with his social activities. There were no oral allergy symptoms, rhinoconjunctivitis, urticaria, or angioedema. He had no hyperhidrosis elsewhere on the body and no history of prior trauma or surgery. After consulting numerous specialists, no underlying neurological, hematological, endocrine, or otolaryngologic cause was found. Skin prick testing results to food allergens were also negative. We conducted a provocation test and placed a cup of vinegar 1.5 m away from the patient (Figure , A). Within a few minutes, his entire face and scalp became flushed and hyperhidrotic (Figure , B), while the remaining body did not show any signs. The iodine-starch test confirmed our findings. A diagnosis of gustatory hyperhidrosis was made.Gustatory hyperhidrosis is a form of focal hyperhidrosis that presents with facial flushing and excessive sweating of the forehead, face, and scalp after smelling or ingesting certain food products, such as sour or spicy foods, coffee, and chocolate. 1 It is typically secondary to damaged parasympathetic nerves in the parotid region with aberrant regeneration to nearby denervated sweat glands and facial skin vessels that are followed by localized sweating and vasodilation. This condition, also known as Frey syndrome, most often follows parotidectomy, neck dissection, facelifts procedures, radiation therapy, or facial trauma. Gustatory hyperhidrosis can also be caused by autonomic neuropathy, as in diabetes, and although most often unilateral can also occur bilateral. [1][2][3][4] The latter scenario is difficult to differentiate from idiopathic disease, a rare cause, which was the case in this patient. Gustatory hyperhidrosis may substantially affect quality of life. 1 Treatment options include injections with botulin toxin A, topical glycopyrrolate, aluminum chloride, oxybutynin, oral anticholinergics, and thoracic sympathectomy. [1][2][3][4] The patient was unsuccessfully treated with oxybutynin. He declined further treatment options.

Postprandial facial rash in an infant

“…1,4,7 It also has been recognized in patients with diabetes or following facial trauma. 1,2,8,9 Forceps delivery is a common cause of Frey syndrome in children. 1,2 Frey syndrome is thought to be caused by damage to the parasympathetic fibers of the auriculotemporal nerve in the parotid region with subsequent aberrant reinnervation to sweat glands and vessels of the overlying skin.…”

“…1,2 Frey syndrome is thought to be caused by damage to the parasympathetic fibers of the auriculotemporal nerve in the parotid region with subsequent aberrant reinnervation to sweat glands and vessels of the overlying skin. 4,5,7,8,10 Patients with Frey syndrome develop sweating or flushing in the preauricular area with salivation. 5,6 Warmth or discomfort also can be present, although sweating, warmth, and discomfort are uncommon in children.…”

“…1,3 Symptoms are most often unilateral, but can be bilateral. 8 In children, Frey syndrome commonly is diagnosed after solid foods are introduced. It often is misdiagnosed as a food allergy, leading to unnecessary testing and treatment.…”

“…Frey syndrome is a common postoperative complication of parotid gland surgery in adults 1,4,7. It also has been recognized in patients with diabetes or following facial trauma 1,2,8,9. Forceps delivery is a common cause of Frey syndrome in children 1,2.…”

“…The symptoms generally occur within a few seconds of eating, especially with consumption of acidic, sour, or spicy foods, and typically last 20 to 60 minutes 1,3. Symptoms are most often unilateral, but can be bilateral 8. In children, Frey syndrome commonly is diagnosed after solid foods are introduced.…”