Allergy Capital

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Auriculotemporal Syndrome

Auriculotemporal syndrome (Frey's syndrome, gustatory flushing syndrome) results in facial flushing and sweating after eating. Commonly mistaken for food allergy, it is a harmless condition mainly affecting young children.

What is auriculotemporal syndrome?
Some "reactions" after eating food can be mistaken for food allergy and be the source of some anxiety. Auriculotemporal syndrome, Frey's syndrome and gustatory flushing syndrome are all terms used to describe an uncommon condition typically affecting young children after eating.

Symptoms
Within minutes of eating highly flavoured food (e.g. spicey food, tomatoes, flavoured snacks, lollies/confectionary, tangy or sour foods), a transient flushing and sweating of the face is seen. Usually only one side is involved, although both sides of the face are occasionally affected. Flushing is normally seen in a line between the edge of the mouth and ears, disappearing within 1-2 minutes.

Auriculotemporal syndrome is not due to food allergy
Unlike allergic reactions, there is no itch or swelling or rash elsewhere on the body, and no associated features like stomach upset or difficulty breathing. Furthermore, similar reactions can be triggered by a number of very different foods. The common feature is that they are all highly flavoured.

Who is affected?
Typically affecting babies, infants or young children, some (but not all) affected children have undergone forceps delivery. It is sometimes observed in adults who have suffered a head injury, infection or damage to one of the facial (auriculotemporal) nerves after surgery.

What is happening?
The auriculotemporal nerve supplies salivary and sweat glands as well as bloods vessels in the face. When eating highly flavoured food, the nerves stimulate the flow of saliva to aid digestion. After injury, it is thought that these nerve impulses are "misdirected" to stimulate skin blood vessels and sweat glands rather than salivary flow. The result is facial redness and sweating.

Syndromes resembling auriculotemporal syndrome
Gustatory rhinitis describes a condition with similar symptoms of runny nose ("rhinitis"), watery eyes, sweating and facial flushing after consumption of spicy or irritating foods. Dermographism (a type of hives or urticaria triggered by rubbing) can also cause facial redness. It is typically triggered by a child's face being cleaned with a washer to remove residual food after eating. It may or may not be itchy.

How is auriculotemporal syndrome treated?
This is a harmless condition that usually disappears with time in children and requires no treatment. Various medications and other treatments (such as surgery to the nerve) have been attempted, with little success and sometimes side-effects.

References

• Simpson, W. (1968). "Auriculotemporal syndrome after injection into the temporomandibular joint: report of case." J Oral Surg 26(9): 602-3.
• Martis, C. and S. Athanassiades (1969). "Auriculotemporal syndrome (Frey's syndrome), secondary to fracture of the mandibular condyle." Plast Reconstr Surg 44(6): 603-4.
• Balfour, H. H., Jr. and J. E. Bloom (1970). "The auriculotemporal syndrome beginning in infancy." J Pediatr 77(5): 872-4.
• Gordon, A. B. and R. V. Fiddian (1976). "Frey's syndrome after parotid surgery." Am J Surg 132(1): 54-8.
• Schmidseder, R. and H. Scheunemann (1977). "Nerve injury in fractures of the condylar neck." J Maxillofac Surg 5(3): 186-90.
• Davis, R. S. and R. C. Strunk (1981). "Auriculotemporal syndrome in childhood." Am J Dis Child 135(9): 832-3.
• Drummond, P. D., G. M. Boyce, et al. (1987). "Postherpetic gustatory flushing and sweating." Ann Neurol 21(6): 559-63.
• Beck, S. A., A. W. Burks, et al. (1989). "Auriculotemporal syndrome seen clinically as food allergy." Pediatrics 83(4): 601-3.
• De Benedittis, G. (1990). "Auriculotemporal syndrome (Frey's syndrome) presenting as tic douloureux. Report of two cases." J Neurosurg 72(6): 955-8.
• Johnson, I. J. and J. P. Birchall (1995). "Bilatral auriculotemporal syndrome in childhood." Int J Pediatr Otorhinolaryngol 32(1): 83-6.
• Sicherer, S. H. and H. A. Sampson (1996). "Auriculotemporal syndrome: a masquerader of food allergy." J Allergy Clin Immunol 97(3): 851-2.
• Weinberg, S. and B. Kryshtalskyj (1996). "Analysis of facial and trigeminal nerve function after arthroscopic surgery of the temporomandibular joint." J Oral Maxillofac Surg 54(1): 40-3; discussion 43-4.
• Scrivani, S. J., D. A. Keith, et al. (1998). "Posttraumatic gustatory neuralgia: a clinical model of trigeminal neuropathic pain." J Orofac Pain 12(4): 287-92.
• Laskawi, R., M. Ellies, et al. (1999). "Gustatory sweating: clinical implications and etiologic aspects." J Oral Maxillofac Surg 57(6): 642-8; discussion 648-9.
• Mehta, M., S. G. Friedman, et al. (1999). "Frey's syndrome after carotid endarterectomy." Ann Vasc Surg 13(2): 232-4.
• Kaddu, S., J. Smolle, et al. (2000). "Auriculotemporal (Frey) syndrome in late childhood: an unusual variant presenting as gustatory flushing mimicking food allergy." Pediatr Dermatol 17(2): 126-8.
• von Lindern, J. J., B. Niederhagen, et al. (2000). "Frey syndrome: treatment with type A botulinum toxin." Cancer 89(8): 1659-63.
• Karunananthan, C. G., H. L. Kim, et al. (2002). "An unusual case of bilateral auriculotemporal syndrome presenting to an allergist." Ann Allergy Asthma Immunol 89(1): 104-5.