425 Possible Prenatal Sensitization: "The Case of the Hidden Cake"

BACKGROUND: To discuss the clinical case of an infant with food allergy and probably sensitization during pregnancy and/or breast-feeding. METHODS: Case report with clinical description of signs and symptoms, pictures from his skin prick tests and correlation with in vitro studies (Total IgE and specific IgE to casein, soy and egg). RESULTS: 7 month old boy with history of gastroesophageal reflux since 2 months old; product of the first pregnancy of a young mother with history of asthma during childhood, obtained by cesarean section. He received maternal human milk combined with normal infant formulae since birth to 5 months of age when he started other foods. He presented skin perioral rash with the ingestion of apple and sometimes with infant formulae and gastroenterologist changed to extense hydrolized formulae but the parents decided to give partial hydrolized formulae because of cost and taste. In his white blood cell count marked eosinophilia was noted (700/mL), elevation of total IgE (170 UI/mL; normal ≤ 15 UI/mL) and specific IgE (chemiluminiscence by immunoCap system) positive to Egg white (>300) (Class IV), Egg yolk (110) (Class III), Soy (260) (Class III) and Casein (21) (Class II). Skin prick tests reported (papules): negative saline control = 0 mm, positive histamine control = 5 mm, Soy = 4 mm, Cow's Milk = 12 mm, Egg = 34 mm. The boy had received cow's milk in infant formulae, soy in cookies given since 5 months of age and egg in cakes eaten by the mother in great amounts during pregnancy and breast-feeding. CONCLUSIONS: Recomendations to avoid soy, egg and cows milk products were given to the parents, changing to an extense hydrolized formulae with good clinical results. The present case suggests that sensitization during pregnancy and breast-feeding to several foods can be present in high risk infants.