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Immunological study of Melkersson-Rosenthal syndrome. Lack of response to food additive challenge
C Morales1, M Peñarrocha, J V Bagán
1Service of Allergy, University Hospital Clinic, Valencia, Spain.
Abstract:
A study was made of six patients with Melkersson-Rosenthal syndrome (MRS) to establish the aetiological role of foodstuffs and/or additives and the possible associated immunological alterations. In all cases Melkersson-Rosenthal syndrome (MRS) was diagnosed both clinically and histologically, excluding other causes of orofacial granulomatosis (OFG). A detailed study of possible triggering factors was performed in all patients. Blood analysis, x-rays and cultures, were always within normal limits, with the exception of the finding of circulating immune complexes (CICs) in three patients with facial palsy associated, and C-reactive protein positivity in two patients who presented persistent labial oedema. All patients were subjected to skin-prick tests with common inhalant allergens and with foods when sensitization to foods were suspected, and patch tests with European Standard Series and pastry components, organic dyes, perfumes and fragrances series. The results were negative in all cases. When asymptomatic, the patients were subjected to a double-blind oral challenge, under placebo control, with additives (monosodium glutamate, tartrazine, sulfites, erythrosine, paraoxybenzoate, sodium benzoate, lactose, aspirin, and annate), which was again negative. In no case did the patients refer the appearance of outbreaks with exposure to foods or contactants, and the course of the disease was unaffected by exclusion diets and the elimination of contactants. To conclude, we observed no sensitization to foods, additives or contactants in our patients. Likewise, there were no antecedents of atopy or hereditary predisposition related to the aetiopathogeny of MRS. The significance of the CIC encountered only in patients with facial paralysis remains to be established, due to the limited number of patients studied.
Insights
This study found no evidence that foods, additives, or contactants trigger Melkersson-Rosenthal syndrome (MRS). Immune complex findings in patients with facial palsy require further investigation.
Area of Science:
- Immunology
- Dermatology
- Gastroenterology
Background:
- Melkersson-Rosenthal syndrome (MRS) is a rare neurological disorder characterized by facial paralysis, swelling, and fissured tongue.
- The exact etiology of MRS remains unclear, with potential triggers like foodstuffs, additives, and immunological alterations being investigated.
Purpose of the Study:
- To investigate the etiological role of foodstuffs and/or additives in Melkersson-Rosenthal syndrome (MRS).
- To explore possible associated immunological alterations in patients with MRS.
Main Methods:
- Clinical and histological diagnosis of MRS in six patients, excluding other causes of orofacial granulomatosis.
- Comprehensive allergy testing including skin-prick tests, patch tests, and double-blind oral challenges with common allergens and additives.
- Blood analysis for immunological markers, including circulating immune complexes (CICs) and C-reactive protein.
Main Results:
- Allergy tests (skin-prick, patch, and oral challenges) were negative for all patients, indicating no sensitization to foods, additives, or contactants.
- Blood tests revealed circulating immune complexes (CICs) in three patients with facial palsy and C-reactive protein positivity in two patients with persistent labial edema.
- Disease course was unaffected by exclusion diets or elimination of contactants.
Conclusions:
- The study found no evidence supporting foodstuffs, additives, or contactants as triggers for Melkersson-Rosenthal syndrome (MRS) in the studied cohort.
- No history of atopy or hereditary predisposition was identified as a factor in the aetiopathogeny of MRS.
- The clinical significance of CICs in patients with facial paralysis warrants further investigation due to the small sample size.