Bananas, Bread and Tuna Turned a Baby’s Face Red on Both Sides, and Allergy Was Not the Culprit

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The pattern looked like a food allergy. It was not. Allergists at Kanagawa Children’s Medical Center in Yokohama diagnosed bilateral infantile Frey syndrome, a nerve-related condition that makes the face flush in response to eating, and described the case in a report in Pediatric Investigation published on April 24, 2026.

The case stands out because the boy broke two of the usual patterns doctors rely on to recognize the condition in children. His flushing appeared on both sides of the face, and he had no history of a forceps delivery.

The boy’s symptoms began at 6 months of age, after his parents started him on solid foods. By the time he was evaluated at 10 months, the episodes followed a consistent pattern: redness over both temples and the lower eyelids, starting within minutes of eating and lasting 30 to 45 minutes.

Several details pointed away from an allergic reaction. The flushing occurred whether or not the food touched his skin, and it spared the area around the mouth, where contact rashes from food usually show up. He had no itching, hives, swelling, breathing trouble or stomach symptoms during the episodes.

An oral antihistamine prescribed at another clinic did not reduce how often the flushing happened, how far it spread or how long it lasted. The authors noted that the parents’ concern about a food allergy initially raised the possibility of restricting his diet.

The allergy team performed prick-to-prick skin testing, in which a needle is pressed into the suspected food and then into the skin. Every food tested negative, while the histamine control produced the expected response, showing the test itself was working.

The doctors based the diagnosis on the reproducible, clearly localized flushing. They did not perform the Minor starch-iodine test, which uses iodine and starch to reveal where the skin sweats.

Frey syndrome, also called auriculotemporal syndrome, is known for gustatory sweating, meaning sweating triggered by eating. The National Organization for Rare Disorders explains that damaged nerve fibers near the parotid salivary gland can regrow along the wrong path and connect to sweat glands in the skin instead of the salivary gland. In adults, the most commonly reported cause is surgery to remove the parotid gland.

In children, the usual suspect is birth. A 2022 systematic review in the European Journal of Pediatrics pooled 121 published cases of Frey syndrome not tied to surgery or diabetes. Among the 85 cases with an identified cause, 52% followed forceps-assisted delivery. Only 17% of all cases involved both sides of the face.

The Japanese boy fit neither pattern. He was born at term by cesarean section because of umbilical cord entanglement, with no instrumental delivery, facial injury or surgery. The authors wrote that bilateral cases reportedly make up 17% to 27% of pediatric Frey syndrome and that “In bilateral Frey syndrome, a history of ATN damage is rare,” referring to the auriculotemporal nerve. Such cases are usually considered idiopathic, meaning without a known cause, though familial cases have been reported. The authors concluded that their patient’s presentation appeared more consistent with an idiopathic or possibly congenital mechanism.

Instead of removing foods, the medical team counseled and reassured the family, and the boy kept eating the foods that set off his flushing.

The episodes faded steadily. At 14 months of age, flushing occurred about once a week. By 19 months, it was limited to a smaller area, mainly the lower eyelids, and fewer foods caused it.

At the last reported follow-up, when he was 24 months old, only tomatoes and tomato sauce consistently produced the redness, and episodes lasted about five minutes. The authors described that change as “suggesting ongoing spontaneous regression.”

Frey syndrome is uncommon in children, but it can easily be mistaken for something more familiar. The 2022 review called the condition underrecognized, noted that in childhood it is often wrongly attributed to food allergy, and found that 45% of patients waited 12 months or more for a diagnosis.

The Japanese authors cited earlier data showing that only 20% of children received a definitive diagnosis at their first visit, while 21% were placed on inappropriate dietary restrictions. Their case “highlights the importance of recognizing pediatric Frey syndrome to avoid unnecessary dietary restrictions, undue concerns about anaphylaxis, and excessive allergy investigations,” they wrote.

The report follows a February 2026 case report from Canada in Allergy, Asthma & Clinical Immunology, in which an 8-month-old boy labeled allergic to milk, soy, peanut, wheat and egg turned out to have one-sided flushing and sweating of the right cheek. In that case, doctors used supervised food challenges to help confirm the diagnosis.

Allergy tests have limits on their own. Food allergy guidelines sponsored by the National Institute of Allergy and Infectious Diseases state that a skin prick test, used alone, cannot be considered diagnostic, as summarized by the American Academy of Family Physicians. In this case, the negative results mattered alongside the history: a reaction limited to the same patches of skin, with no hives or other body-wide symptoms.

This is a single case report, and the diagnosis rested on clinical judgment rather than a supervised food challenge or sweat test. It does not mean that facial redness during meals is usually harmless. Children who develop hives, swelling, vomiting, wheezing or trouble breathing after eating need prompt medical attention, and parents who suspect a food allergy should talk with a pediatrician or allergist before cutting foods from a baby’s diet.

A boy in Japan developed redness over both temples and lower eyelids within minutes of eating many common foods, starting at 6 months old. Skin prick tests were negative, and doctors diagnosed bilateral infantile Frey syndrome.

Most reported pediatric cases affect one side of the face and are linked to instrumental delivery, most often forceps. This child had flushing on both sides and was born by cesarean section with no birth injury.

How can Frey syndrome be told apart from a food allergy?

Frey syndrome causes flushing, sometimes with sweating, in the same well-defined facial area each time, without hives, itching, swelling, breathing problems, or stomach symptoms. Allergy tests are typically negative. A clinician should make that assessment.

In this case, the episodes became shorter, smaller, and less frequent over 14 months of follow-up, until only tomatoes triggered them. The authors noted that most reported children improve or recover on their own, but data on the condition remain limited.

Should parents remove foods that cause facial redness?

Not without medical advice. The authors cited data showing that about 21% of children with the condition were placed on inappropriate diets. Parents should consult a pediatrician or allergist before restricting foods.

When is facial redness after eating an emergency?

Redness accompanied by hives, swelling of the lips or face, vomiting, wheezing or difficulty breathing can signal a serious allergic reaction and needs immediate medical care.