Methods: male, 7 years old, 2 months ago has increased in frequency and consistency of stools (16 stools bowel movements per day on average ranging from explosive diarrhea, mucus, food debris, foam) weight loss, belching, bloating , flatulence. Personal Background: Premature exclusive breastfeeding until 30 days of life when presented allergic proctocolitis. 15months: open provocation for cow's milk demonstrated tolerance; 5years: after an acute gastroenteritis persisted three months with diarrhea when it was necessary to exclude from his diet the cow milk protein ( CMP) ,fruits and vegetables; 8 weeks after open provocation was performed to CMP and the patient showed tolerance. Fruits and vegetables were reintroduced gradually with good acceptance except apple ,the patient has diarrhea immediately after its ingestion
Results: Prick test negative to cow milk; Prick to Prick negative to cow's milk, apple and corn; APT +++ for apple, corn and ++ to cow's milk, Expired Hydrogen Tests for fructose and lactose intolerancies negative. It was instituted an elimination diet for cow's milk protein, apple and corn with consecutive remission of gastrointestinal symptoms and proper weight gain. After 8 weeks the cow's milk was tolerated
Conclusions: diagnosis of multiple food allergy with delayed symptoms are based on clinical history , in establishing a dietary restriction and confirmation through oral provocation test. In this case the allergy to cow's milk protein was easily recognized, but fruits and vegetables were not tolerated what led to unconfirmed suspicion of fructose intolerance. The elimmination diet caused psychological stress to the patient and his caregivers as well as stopped weight and height gain. The APT was an alternative tool for identifying the allergens involved (corn and apple). All other fruits and vegetables were reintroduced to the diet and the patient had no gastrointestinal symptoms. The restriction for apple and corn persists to the present day.