Frey Syndrome

Episodic right-sided facial flushing was noted in a 2-month-old girl born at full term via forceps-assisted vaginal delivery. The erythema appeared within minutes of latching onto her mother’s breast and resolved within 5 to 10 minutes after breastfeeding. The episodes of flushing had begun a week before the clinic visit; there were no collateral symptoms of anaphylaxis. Because food allergy was suspected, the mother had eliminated all dairy products from her diet.

This transient, unilateral (occasionally bilateral) facial flushing is known as Frey syndrome or auriculotemporal nerve syndrome. Gustatory flushing is an abnormal neurological and vascular response triggered by prandial intake. The erythema typically appears in the distribution of the auriculotemporal nerve, which carries sensory input from both skin and sympathetic fibers enervating salivary glands and blood vessels. If this nerve is injured, regenerating nerve fibers may be misdirected and activate superficial blood vessels instead of salivary glands.

Frey syndrome typically presents in the first few years of life. In some cases, the flushing may be noted as early as 2 to 4 months after birth. In about half of published reports, affected infants have a history of birth trauma or forceps-assisted delivery. In children, the condition is generally harmless and frequently resolves within a few years.

FOR MORE INFORMATION:
* Karunananthan CG, Kim HL, Kim JH. An unusual case of bilateral auriculotemporal syndrome presenting to an allergist. Ann Allergy Asthma Immunol. 2002;89:104-105.
* Sicherer SH, Sampson HA. Auriculotemporal syndrome: a masquerader of food allergy. J Allergy Clin Immunol. 1996;97:851-852.