An Allergy-Based Approach to Orofacial Granulomatosis: A Narrative Review

Area of Science:

• Dermatology
• Allergy Immunology

Background:

• Orofacial granulomatous (OFG) conditions have an evolving relationship with allergy.
• Contact allergies are frequently reported in OFG, but the efficacy of allergen avoidance remains unclear.
• A comprehensive review evaluating allergen avoidance in OFG has not been recently performed.

Purpose of the Study:

• To review and synthesize existing literature on the impact of allergen avoidance in orofacial granulomatous conditions.
• To identify common allergens implicated in OFG through patch testing.
• To assess the reported effectiveness of allergen avoidance strategies in managing OFG.

Main Methods:

• Systematic literature search identifying 46 studies (case reports, series, trials, cohort studies) on allergen avoidance in OFG.
• Analysis of patch testing results from 158 patients to identify frequently reported allergens.
• Review of physician- and patient-reported outcomes and oral disease severity scores to assess treatment effectiveness.

Main Results:

• Commonly identified allergens include cinnamal/cinnamon, grass/plant products, benzoic acid, sorbic acid, nickel, mercury, and fragrance.
• Allergen avoidance was trialed in 171 patients, with 123 (71%) reporting some degree of improvement.
• Lack of validated scoring systems necessitated reliance on subjective outcome measures.

Conclusions:

• Current literature supports patch testing and allergen avoidance/elimination diets for improving OFG in sensitized individuals.
• Further controlled studies are needed to rigorously evaluate the impact of allergen avoidance on OFG.
• For refractory OFG with positive patch tests, a trial of allergen avoidance is recommended as part of a multimodal treatment approach.