Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach?
Article first published online: 9 JAN 2013
© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
Journal of Oral Pathology & Medicine
Volume 42, Issue 7, pages 517–522, August 2013
How to Cite
J Oral Pathol Med (2013) 42: 517−522
- Issue published online: 23 JUL 2013
- Article first published online: 9 JAN 2013
- Manuscript Accepted: 27 NOV 2012
- The National Institute of Health Research Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust
- Kings College London, UK
- Kings College London
- Guy's and St Thomas' Charity
- oral allergy syndrome;
- orofacial granulomatosis
Orofacial granulomatosis (OFG) is a chronic granulomatous condition of the mouth, face and lips. Recent work demonstrates a high rate of atopy and silver birch sensitisation from skin prick testing (SPT). Oral allergy syndrome (OAS) is an acute oro-pharyngeal IgE mediated reaction, triggered by foods that cross react with pollens, most commonly silver birch. The aim of this study was to determine if patients with OFG and positive SPT to common OAS associated pollens responded to avoidance of cross reactive foods.
Patients with OFG and positive SPT to silver birch, grass, mugwort, ragweed and latex were required to avoid cross reacting foods, for 6 weeks and, in those who responded, for a total of 12 weeks. All had standardized oral examinations and were given severity scores (SS) at each appointment.
Twenty two of 47 (47%) patients had one or more positive SPT and 13/22 completed 6 weeks on the diet. No difference was seen in SS between weeks 0 (14.62 ± 11.16) and 6 (13.31 ± 10.33; P = 0.656). Six of 14 (43%) had significantly improved SS (week 0; 19.17 ± 12.95, week 6; 10.83 ± 4.99, P = 0.027). Five completed 12 weeks and no further improvement was seen (week 6; 11 ± 5.57, week 12; 10.4 ± 9.94; P = 0.068). Two patients required no further treatments.
On an intention to treat basis, only 2/14 patients improved and required no further intervention. Whilst this diet cannot be recommended routinely, the improvement seen in some patients raises questions about the role of OAS in patients with OFG.