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Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet.
Inflamm Bowel Dis 2006; 12(6):508-14IB

Abstract

BACKGROUND

Orofacial granulomatosis (OFG) is a chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Although the cause remains unknown, there is evidence for involvement of a dietary allergen. Patch testing has related responses to cinnamon and benzoate to the symptoms of OFG, with improvement obtained through exclusion diets. However, an objective assessment of the effect of a cinnamon- and benzoate-free diet (CB-free diet) as primary treatment for OFG has not previously been performed. Thus, this study was undertaken to investigate the benefits of a CB-free diet as first-line treatment of patients with OFG.

MATERIALS AND METHODS

Thirty-two patients with a confirmed diagnosis of OFG were identified from a combined oral medicine/gastroenterology clinic. All had received a CB-free diet as primary treatment for a period of 8 weeks. Each patient underwent a standardized assessment of the oral cavity to characterize the number of sites affected and the type of inflammation involved before and after diet.

RESULTS

There was a significant improvement in oral inflammation in patients on the diet after 8 weeks. Both global oral and lip inflammatory scores improved (P<0.001), and there was significant improvement in both lip and oral site and activity involvement. However, improvement in lip activity was less marked than oral activity. Response to a CB-free diet did not appear to be site specific. A history of OFG-associated gut involvement did not predict a response to the diet.

CONCLUSIONS

The impact of dietary manipulation in patients with OFG can be significant, particularly with regard to oral inflammation. With the disease most prevalent in the younger population, a CB-free diet can be recommended as primary treatment. Subsequent topical or systemic immunomodulatory therapy may then be avoided or used as second line.

Authors+Show Affiliations

Department of Dietetics, Kings College London, Medical and Dental Schools, Guy's, Kings and St Thomas's Hospital, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16775496

Citation

White, Allison, et al. "Improvement in Orofacial Granulomatosis On a Cinnamon- and Benzoate-free Diet." Inflammatory Bowel Diseases, vol. 12, no. 6, 2006, pp. 508-14.
White A, Nunes C, Escudier M, et al. Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet. Inflamm Bowel Dis. 2006;12(6):508-14.
White, A., Nunes, C., Escudier, M., Lomer, M. C., Barnard, K., Shirlaw, P., ... Sanderson, J. D. (2006). Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet. Inflammatory Bowel Diseases, 12(6), pp. 508-14.
White A, et al. Improvement in Orofacial Granulomatosis On a Cinnamon- and Benzoate-free Diet. Inflamm Bowel Dis. 2006;12(6):508-14. PubMed PMID: 16775496.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet. AU - White,Allison, AU - Nunes,Carlo, AU - Escudier,Michael, AU - Lomer,Miranda C E, AU - Barnard,Kate, AU - Shirlaw,Penelope, AU - Challacombe,Stephen J, AU - Sanderson,Jeremy D, PY - 2006/6/16/pubmed PY - 2006/11/1/medline PY - 2006/6/16/entrez SP - 508 EP - 14 JF - Inflammatory bowel diseases JO - Inflamm. Bowel Dis. VL - 12 IS - 6 N2 - BACKGROUND: Orofacial granulomatosis (OFG) is a chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Although the cause remains unknown, there is evidence for involvement of a dietary allergen. Patch testing has related responses to cinnamon and benzoate to the symptoms of OFG, with improvement obtained through exclusion diets. However, an objective assessment of the effect of a cinnamon- and benzoate-free diet (CB-free diet) as primary treatment for OFG has not previously been performed. Thus, this study was undertaken to investigate the benefits of a CB-free diet as first-line treatment of patients with OFG. MATERIALS AND METHODS: Thirty-two patients with a confirmed diagnosis of OFG were identified from a combined oral medicine/gastroenterology clinic. All had received a CB-free diet as primary treatment for a period of 8 weeks. Each patient underwent a standardized assessment of the oral cavity to characterize the number of sites affected and the type of inflammation involved before and after diet. RESULTS: There was a significant improvement in oral inflammation in patients on the diet after 8 weeks. Both global oral and lip inflammatory scores improved (P<0.001), and there was significant improvement in both lip and oral site and activity involvement. However, improvement in lip activity was less marked than oral activity. Response to a CB-free diet did not appear to be site specific. A history of OFG-associated gut involvement did not predict a response to the diet. CONCLUSIONS: The impact of dietary manipulation in patients with OFG can be significant, particularly with regard to oral inflammation. With the disease most prevalent in the younger population, a CB-free diet can be recommended as primary treatment. Subsequent topical or systemic immunomodulatory therapy may then be avoided or used as second line. SN - 1078-0998 UR - https://www.unboundmedicine.com/medline/citation/16775496/Improvement_in_orofacial_granulomatosis_on_a_cinnamon__and_benzoate_free_diet_ L2 - http://Insights.ovid.com/pubmed?pmid=16775496 DB - PRIME DP - Unbound Medicine ER -