title: Severe reaction in a child with asymptomatic codfish allergy: food challenge reactivating recurrent pancreatitis.
abstract: An 8-year-old child during the first year of life manifested severe atopic dermatitis and chronic diarrhea with mucorrhea and rectal bleeding; a fish-free diet was started based on weakly positive skin-prick tests to codfish extract. At the age of 4 years the child began to suffer of recurrent pancreatitis. When he came to our attention for the evaluation of his fish allergy, he was asymptomatic; a weak reactivity to codfish was observed (SPTs: cod, 4 mm, sIgE ImmunoCAP: cod, 1.30 kU/l). The food challenge test with cod was negative. When the child ate cod again, within 5 minutes, developed anaphylactic reaction and complained of abdominal pain compatible with pancreatitis (enzyme serum levels risen and parenchymal oedema at ultrasonography), that resolved within 7 days after specific therapy. This case raises two issues: the elimination diet in asymptomatic food allergy on the basis only of SPT and the ethicality of food challenge in gastrointestinal chronic disease.
authors.affiliation: Department of Paediatric Medicine-Allergy Unit, I.R.C.C.S. Children's Hospital Bambino Gesù, Rome, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Pellegrino
authors.forename: Leila Emma
authors.initials: LE
authors.lastname: D'Urbano
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Artesani
authors.forename: Carla
authors.initials: C
authors.lastname: Riccardi
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancini
authors.forename: Sergio
authors.initials: S
authors.lastname: Bella
authors.forename: Federico
authors.initials: F
authors.lastname: Alghisi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cavagni
mesh_terms: D000818:Animals; D002648:Child; D003937:Diagnosis, Differential; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D048389:Gadus morhua / Q000276:immunology*; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D012008:Recurrence