An Unusual Case of Multiple Food Allergies Comorbid with Multiple Chemical Sensitivity: A Case Report

Figures & data

Table 1 Differential Diagnostic Approach

Test	Result	Diagnosis Discarded
Spirometry	FVC: 3.38 (94%) (normal)	Restrictive pattern diseases
	FEV1: 3.38 (110%) (normal)
	FEV1/FVC: 100 (normal)
Chest radiography	Both lungs are clear and expanded with no infiltrates. Bibasilar atelectasis are presented. Heart size within normal limits. No pleural effusion.	Eosinophilic pneumonia
		Tuberculosis
		Pulmonary infectious diseases
		Sarcoidosis
		Hypersensitivity pneumonitis
Complete blood count	Leucocytes: 7260 cells/µL (normal)	Anemia
	Erythrocytes: 4.97 M/µL (normal)	Eosinophilic pneumonia
	Hematocrit: 47.4% (normal)	Lymphomas and leukemias
	Hemoglobin: 15.8 g/dL (normal)
	Medium corpuscular hemoglobin: 31.8 pg (normal)
	Medium corpuscular volume: 95.5 (normal)
	Basophils: 74 cells/µL (normal)
	Eosinophils: 311 cells/µL (normal)
	Neutrophils: 4639 cells/µL (normal)
	Lymphocytes: 1648 cells/µL (normal)
	Monocytes: 582 cells/µL (normal)
	Platelets: 316.000 cells/µL (normal)
Kidney function tests	Creatinine: 0.63 mg/dL (normal)	Nephropathies
	Blood urea nitrogen: 14.60 mg/dL (normal)
Metabolic function test	TSH: 1.41 uUI/mL (normal)	Hypo/hyperthyroidism
	T3 (total): 1.25 ng/mL (normal)	Graves’ disease
	T4 (free): 1.60 ng/dL (normal)	Hashimoto thyroiditis
	Folic acid: 15.5 ng/mL (normal)	Folate deficiency (celiac disease)
	Vitamin B12: 409 pg/mL (normal)	Vitamin B12 deficiency (celiac disease)
	Total 25-hydroxy vitamin D: 16.5 ng/mL (decreased)	Muscular dystrophies
	Creatine phosphokinase: 42 U/L (normal)	Rhabdomyolysis
Hepatic diseases	Iron levels: 45 ug/dL (normal)	Hemochromatosis
	Ferritin: 48.4 ng/mL (normal) Transferrin: 290 mg/dL (normal)	Iron deficiency anemia secondary to intestinal absorption disorders (celiac disease)
		Liver disease
		Iron poisoning
Inflammatory and infectious test	Reactive C protein: <1 mg/dL (normal)	Aspergillosis
	Galactomannan antigen: 0.22 (normal)
Immunologic test	C3 turbidometry: 0.614 g/L (normal)	Immunodeficiencies: ataxia telangiectasia, hyper-IgM syndrome, Wiskott-Aldrich syndrome, common variable immunodeficiency, selective IgA deficiency Systemic autoimmune diseases (rheumatoid arthritis and systemic lupus erythematous)
	C4 turbidometry: 0.406 g/L (mildly decreased)
	IgG turbidometry: 11.1 g/L (normal)
	IgA turbidometry: 2.84 g/L (normal)
	IgM turbidometry: 0.994 g/L (normal)
	IgE turbidometry: 651 UI/mL (increase)
	Rheumatoid factor: < 40 UI/mL (normal)
	Antinuclear antibodies: negative (normal)
	Anti-DNAds antibodies: negative (normal)

Abbreviations: FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; TSH, thyroid-stimulating hormone; T3, triiodothyronine; T4, thyroxine; C3, complement component 3; C4, complement component 4; IgA, immunoglobulin A; IgE, immunoglobulin E; IgG, immunoglobulin G; IgM, immunoglobulin M; Anti-DNAds antibodies, anti-double-stranded DNA antibodies.

Figure 1 QEESI symptom Star21: Illustration representing the symptom severity in our patient before and after the exposure event. Scale ranges from 1 to 10 in symptom severity. (A) Pre-exposure: circles represent pre-exposure. Each nomenclature represents a system. Circles were placed in the score corresponding to the symptoms before exposure. The most affected systems were cognitive, neuromuscular, and musculoskeletal. (B) Post-exposure: squares represent post-exposure. Each nomenclature represents a system. Squares were placed in the score corresponding to the symptoms after exposure. The symptoms showed a significant increase compared with the pre-exposure symptoms in all systems. The affective, neuromuscular, and cognitive systems were usually affected independently of exposure.