• Yuteng Du, Boyun Yang, Wo Yao, Yongbin Zhu, Xuxia Tang, and Huiying Wang.
• Department of Allergy and Clinical Immunology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
• Medicine (Baltimore). 2024 Sep 6; 103 (36): e39605e39605.

RationaleEczematous external otitis (EEO) is the most difficult-to-treat otitis externa, and characterized by the symptoms of inflammation with hypersensitivity of the external ear canal skin. It is acknowledged as a chronic skin inflammation primarily caused by dermatological and allergic reactions. Food allergens are also considered a cause to induce the inflammation. However, the role of food specific IgG4 in this disease is unclear yet.Patient ConcernsA 54-year-old woman complained of recurrent itching of the external auditory meatus for 3 years and nails chapping of hands for 2 years.Diagnoses And InterventionsShe was diagnosed with EEO and underwent the therapeutic strategy as food elimination of egg, milk and wheat, guided by the result of food specific IgG4 together with probiotics on the basis of previous symptom controlling therapy.OutcomesAfter 17 months' treatment, she was finally free of all the symptoms and the serum IgG4 specific to all foods are under normal limit.LessonsTo the best of our knowledge, it is the first report revealing the clinical significance of food specific IgG4 in EEO, and the successful treatment with diet elimination guided by food specific IgG4 threw a new light on the clinical management of refractory EEO.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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