(Disclaimer: This article is for scientific purposes only. To protect the patient’s privacy, the relevant information in the following content has been processed.) Abstract: A child with multiple food allergies diagnosed in the past came to the hospital because of a generalized itchy clammy rash that occurred a few hours after eating shrimp, and the symptoms were slightly enlarged after the administration of cetirizine hydrochloride drops. The parents of the child thought that it must be shrimp allergy, but finally, after detailed consultation and examination, the possibility of shrimp allergy was excluded, and the diagnosis of wheat, peanut, soybean, sesame allergy was made, and the child was instructed to avoid the allergens, and then no allergy occurred. Basic information] Male, 5 years old [Disease type] Food allergy [Hospital] Zhongnan Hospital of Wuhan University [Date of consultation] May 2022 [Treatment plan] Allergen examination + allergen avoidance + food diary [Treatment cycle] Allergen review after half a year [Effect of treatment] No allergic symptoms after eating shrimp and sesame again I. Initial consultation A child diagnosed with multiple food allergies was brought to our clinic by his parents. The child was brought to our department again by his parents. When he came to our department, his face and trunk were itchy, and when he was at home (half an hour ago), he took 10 drops of cetirizine hydrochloride, and the air mass was slightly enlarged, and he recently had symptoms of cold and flu, such as cough, sore throat, fatigue, diarrhea, and runny nose, etc. He has been taking cold and flu granules in the past three days, and he did not have any symptoms of fever, blood in the stools, nausea, vomiting, and hypotension. The child was diagnosed with wheat and soy protein-induced enteritis syndrome at the age of 3 years due to perioral erythema, vomiting, abdominal pain, and diarrhea after repeated intake of soybean and wheat products, and abdominal pain and skin tingling after repeated intake of peanuts, and was diagnosed with peanut allergy in combination with the test results. The parents recalled that the child had been strictly abstained from eating foods with confirmed allergies (peanut, wheat, soybean), but he had eaten shrimp, broccoli, eggs, rice and sesame seeds 2 hours beforehand, and the parents suspected that he was allergic to shrimp, so they went to the department in order to confirm the diagnosis. Because the child was in the acute urticaria flare-up stage and had taken cetirizine hydrochloride drops half an hour before, the skin function was inhibited, so the allergen skin test could not be performed, and only the serum sIgE test was performed, and the results of serum sIgE were consistent with the previous diagnosis. According to the parents’ description, the child developed generalized itchy clammy skin within 2 hours after eating shrimp. If shrimp allergy was considered to be the cause, it should be a rapid-onset hypersensitivity reaction, and then shrimp-specific IgE should be positive, but the results were not consistent with the parents’ inference. After detailed inquiry of the medical history, the child had recently had cold symptoms, and it was considered that the child’s acute urticaria symptoms might be related to colds. After the child’s symptoms had improved and the medication had been stopped for 1 week, in order to further clarify the diagnosis, a skin test and a food provocation test were carried out on the child, and the parents were asked to keep a food diary. The results of skin prick and blood sIgE were negative. The results of the food provocation test were that no urticaria symptoms, such as generalized itching and clamminess, appeared in the hospital after eating 200g of shrimp (the maximum amount of shrimp that the child usually eats), and there were still no symptoms after eating about 200g of shrimp at home on the second day. The shrimp excitation test was negative, and shrimp allergy was excluded. The parents of the child did not experience any further itching of the clammy skin after eating shrimp in the later food diary. The child’s parents were asked to avoid sesame seeds, and the child’s parents reported no allergy or itchy doughnuts when they reviewed the child six months later. We are very glad that the child’s allergens were clarified after the examination, and no allergic symptoms appeared after avoiding the allergens. We would like to inform parents that the diagnosis of food allergy should not be based on food skin test or food serum sIgE test alone, as a positive result of these tests only indicates that the food has caused the sensitization. It is only when clinical symptoms occur after eating these foods that food allergy can be described. From the child’s examination, sIgE was positive for wheat, peanuts, soybeans, and sesame seeds. Since the child had eaten sesame, only sesame sensitization could be diagnosed. In daily life, parents should pay attention to their children’s diet, and after identifying the allergens, they should be careful not to let their children consume food containing such substances, and at the same time, they should avoid products produced on the same production line as the allergens, so as not to make their children feel uncomfortable. For children with food allergy, parents are more worried and anxious. If allergic symptoms such as itchy air masses appear, parents instinctively think that their children may be allergic to food again, and it is easy to misdiagnose the disease, which will result in another limitation to the children who are already limited in food choices, and this limitation is unnecessary, so it is very important to diagnose the food allergy correctly, as in this case. This is why it is so important that food allergies are diagnosed correctly, as in the case of this child, and that the cause is clarified through examination and correct treatment.