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Contact hypersensitivity in patients with orofacial granulomatosis
D K Armstrong1, P Biagioni, P J Lamey
1Department of Dermatology, Royal Group of Hospitals, Belfast, Northern Ireland.
Background:
Orofacial granulomatosis is a clinical entity presenting with chronic swelling of the oral or facial tissues in association with histological evidence of noncaseating granulomatous inflammation. Its cause remains unclear, but a possible role of contact sensitivity to dietary components has been proposed.
Objectives:
This study was performed to document the prevalence of contact sensitivity to food additives in patients with orofacial granulomatosis and assess the role of elimination diets in management.
Methods:
Successive patients with a clinical diagnosis of orofacial granulomatosis were patch tested to the European Standard series and an Oral Battery containing common food additives. In addition, testing for immediate contact reactions to components of the Oral Battery was performed. In selected cases, appropriate elimination diets were implemented.
Results:
Forty-eight patients were investigated. Ten showed positive reactions to components of the Oral Battery on standard patch testing and, of these, seven showed improvement on an elimination diet.
Conclusions:
Orofacial granulomatosis is a heterogenous clinical entity. Patch testing permits identification of a subgroup of patients likely to benefit from dietary manipulation and allows more appropriate targeting of such treatment.