title: Neonatal parenteral nutrition hypersensitivity: a case report implicating bisulfite sensitivity in a newborn infant.
abstract: This report describes a case of parenteral nutrition hypersensitivity in a 37 weeks' gestation infant with congenital diaphragmatic hernia complicated by bowel necrosis and functional short bowel syndrome. The patient developed a rash with subsequent urticaria beginning on the 50th day of life. The reactions were confirmed with a positive rechallenge. After the amino acid solution was replaced with a non-bisulfite-containing product, the infant was able to continue to receive nutrition support through parenteral nutrition without recurrence of symptoms. It is speculated that the bisulfite additive in the amino acid solution may have interacted with the lipid emulsion to sensitize the patient.
authors.affiliation: Legacy Emanuel Children's Hospital, Portland, Oregon, USA. bob@nwnewborn.com
authors.forename: Robert K
authors.initials: RK
authors.lastname: Huston
authors.forename: Louise M
authors.initials: LM
authors.lastname: Baxter
authors.forename: Paige B
authors.initials: PB
authors.lastname: Larrabee
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage; D003106:Colon / Q000473:pathology; D004044:Dietary Proteins / Q000008:administration & dosage; D005076:Exanthema / Q000209:etiology; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D008055:Lipids / Q000737:chemistry; D009336:Necrosis / Q000150:complications; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012778:Short Bowel Syndrome / Q000150:complications / Q000628:therapy; D013447:Sulfites / Q000009:adverse effects* / Q000737:chemistry; D014581:Urticaria / Q000209:etiology*
chemical_list: D000596:Amino Acids; D004044:Dietary Proteins; D008055:Lipids; D013447:Sulfites; C042345:hydrogen sulfite