LAUSR

A 4-year-old girl with a history of atopic dermatitis presented with a 3-year history of frequent episodes (ie, many times monthly) of bright red erythema of the labia majora (per photograph of flare-up), whichwere painful enough to awaken her from sleep. Her parents attributed the flare-ups to certain foods: tomato, vegetable broth, and celery. She also experienced lesser perioral and lip inflammation. Treatment with hydrocortisone 2.5% ointment did not yield resolution. Extensive patch testing was performed to 122 allergens including a pediatric core series and a food, spice, and dental care series revealing a 2 reaction to balsam of Peru (BOP), a 3 reaction to nickel sulfate, and reactions to 2 BOPcomponents: a 2 reaction to eugenol and a 3 reaction to isoeugenol. She was placed on a targeted BOP avoidance diet, which avoided foods in the eugenol subgroup. Her genital flare-ups resolved completely shortly after dietary modifications were implemented, and there was also significant improvement in her lip and perioral inflammation. Strict tomato avoidance with no flares noted and flares upon reexposure support her parents' belief that tomato and vegetable broth were the responsible allergens. How do food-related allergens (such as BOP components) cause contact allergy? Systemic contact allergy to BOP has been reported, and our case may have represented systemic contact allergy to BOP