Background: Ingestion is the principal route for food allergens, yet some highly sensitive patients may develop severe symptoms upon skin contact.
Case report: We describe five cases of severe food allergic reactions through skin contact, including inhalation in one.
Methods: The cases were referred to a university allergy clinic, and evaluation comprised detailed medical history, physical examination, skin testing, serum total and specific IgE, and selected challenges.
Results: These cases were found to have a strong family history of allergy, early age of onset, very high total serum IgE level, and strong reactivity to foods by skin prick testing or RAST. Interestingly, reactions occurred while all five children were being breast-fed (exclusively in four and mixed in one).
Conclusions: Severe food allergic reactions can occur from exposure to minute quantities of allergen by skin contact or inhalation. Food allergy by a noningestant route should be considered in patients with the above characteristics.