A CASE OF VITAMIN B1 DEFICIENCY DUE TO STRICT FOOD RESTRICTION FOR MANAGEMENT OF SEVERE ATOPIC DERMATITIS

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A 6-year-old boy with vitamin B1 deficiency, so called beriberi, who had had pared down and cored rice-based diet free of cow's milk, soy bean, egg, wheat, beaf, pork and chicken for 3 years was reported. This patient was admitted to the hospital because of difficulty in walking, chest disconfort, vomiting and dyspnea. On physical examination, the patient revealed absence of deep tendon reflex in the lower extremities. The electrocardiogram showed ST-segment depression and negative T wave in leads V1 through V5. The blood vitamin B1 level was 6.3μg/dl, the lactate 47mg/dl, pyruvic acid 3.1mg/dl and TPP (thiamin pyrophosphokinase effect) 37%. Marked improvement of electrocardiogram was obtained by 24 hours after intravenous administration of vitami B1 10mg. Because the IgE-RAST and the scratch test detected no causative food allergens, food restriction was step by step cancelled carefully and then no trouble was seen. In this case, no evidence had been obtained to support that food allergy cause atopic dermatitis, and it was thought that food was one of a number of triggers which exacerbate existing atopic dermatitis.Therefore, in practice of dietary elimination, it is emphasized that determination of offending food is diagnosed carefully and the patient should be controlled under the doctor which regard to nutritianal status.
日本小児アレルギー学会の論文