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Kern JA, Amanullah AA, Sahni DR, Mathis JG, Hull CM, Powell DL, Secrest AM. Granulomatous cheilitis - is there a role for allergen screening and avoidance? J DERMATOL TREAT 2023; 34:2171707. [PMID: 36688603 DOI: 10.1080/09546634.2023.2171707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Jessica A Kern
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | - Dev R Sahni
- Department of Dermatology, University of Utah Health, Salt Lake, UT, USA
| | - Jason G Mathis
- Department of Dermatology, University of Utah Health, Salt Lake, UT, USA
| | - Christopher M Hull
- Department of Dermatology, University of Utah Health, Salt Lake, UT, USA
| | - Douglas L Powell
- Department of Dermatology, University of Utah Health, Salt Lake, UT, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah Health, Salt Lake, UT, USA
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2
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Cecchin-Albertoni C, Pieruccioni L, Canceill T, Benetah R, Chaumont J, Guissard C, Monsarrat P, Kémoun P, Marty M. Gingival Orofacial Granulomatosis Clinical and 2D/3D Microscopy Features after Orthodontic Therapy: A Pediatric Case Report. Medicina (B Aires) 2023; 59:medicina59040673. [PMID: 37109631 PMCID: PMC10146811 DOI: 10.3390/medicina59040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/11/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Orofacial granulomatosis (OFG) represents a heterogeneous group of rare orofacial diseases. When affecting gingiva, it appears as a chronic soft tissue inflammation, sometimes combined with the enlargement and swelling of other intraoral sites, including the lips. Gingival biopsy highlights noncaseating granulomatous inflammation, similar to that observed in Crohn’s disease and sarcoidosis. At present, the etiology of OFG remains uncertain, although the involvement of the genetic background and environmental triggers, such as oral conditions or therapies (including orthodontic treatment), has been suggested. The present study reports the results of a detailed clinical and 2D/3D microscopy investigation of a case of gingival orofacial granulomatosis in an 8-year-old male patient after orthodontic therapy. Intraoral examination showed an erythematous hyperplasia of the whole gingiva with a granular appearance occurring a few weeks after the installation of a quad-helix. Peri-oral inspection revealed upper labial swelling and angular cheilitis. General investigations did not report ongoing extra-oral disturbances with the exception of a weakly positive anti-Saccharomyces cerevicae IgG auto-antibody. Two- and three-dimensional microscopic investigations confirmed the presence of gingival orofacial granulomatosis. Daily corticoid mouthwashes over a period of 3 months resulted in a slight improvement in clinical signs, despite an intermittent inflammation recurrence. This study brings new insights into the microscopic features of gingival orofacial granulomatosis, thus providing key elements to oral practitioners to ensure accurate and timely OFG diagnosis. The accurate diagnosis of OFG allows targeted management of symptoms and patient monitoring over time, along with early detection and treatment of extra-oral manifestations, such as Crohn’s disease.
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Affiliation(s)
- Chiara Cecchin-Albertoni
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Correspondence:
| | - Laetitia Pieruccioni
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Thibault Canceill
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- InCOMM (Intestine ClinicOmics Microbiota & Metabolism) UMR1297 Inserm, Université Toulouse III, French Institute of Metabolic and Cardiovascular Diseases (i2MC), CEDEX 4, 31432 Toulouse, France
| | - Robin Benetah
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Jade Chaumont
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
| | - Christophe Guissard
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Paul Monsarrat
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
- Artificial and Natural Intelligence Toulouse Institute ANITI, 31013 Toulouse, France
| | - Philippe Kémoun
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- RESTORE Research Center, Université de Toulouse, INSERM, CNRS, EFS, ENVT, Batiment INCERE, 4bis Avenue Hubert Curien, 31100 Toulouse, France
| | - Mathieu Marty
- Oral Medicine Department and CHU de Toulouse, Competence Center of Oral Rare Diseases, Toulouse Institute of Oral Medicine and Science, CEDEX 9, 31062 Toulouse, France (M.M.)
- LIRDEF, Faculty of Educational Sciences, Paul Valery University, CEDEX 5, 34199 Montpellier, France
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3
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Joshi S, Mawdsley J, Hullah E, Ormond M, Carey B. Management of orofacial granulomatosis. Br J Hosp Med (Lond) 2023; 29:1-16. [PMID: 36989148 DOI: 10.12968/hmed.2022.0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Orofacial granulomatosis is a chronic relapsing-remitting inflammatory condition that shares a similar phenotypic presentation to some other granulomatous diseases, particularly Crohn's disease. However, subtle clinical and pathological differences justify it as a separate disease entity. Previous studies have assessed the effectiveness of interventions used in the management of orofacial granulomatosis. This article reviews the management options available. A literature search was conducted to identify studies, in English, which assessed the effect of non-pharmacological and pharmacological interventions in the treatment of orofacial granulomatosis. The interventions were categorised into dietary modification, pharmacological (topical, intralesional and systemic therapy), surgery and psychological. A combination of interventions is often required to effectively manage each patient. There is convincing evidence that diet plays a role in disease severity. In patients where dietary manipulation alone is unsuccessful, topical, intralesional and/or systemic treatment may be considered to manage the condition.
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Affiliation(s)
- Sandeep Joshi
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Esther Hullah
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martyn Ormond
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Barbara Carey
- Department of Oral Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Courtney A, Holmes Z, Sharma S, Brand R. Orofacial granulomatosis: Challenges in diagnosis and treatment. J Paediatr Child Health 2023; 59:159-161. [PMID: 36036750 DOI: 10.1111/jpc.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/16/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Ashling Courtney
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Zack Holmes
- Dermatology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Surabhi Sharma
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roland Brand
- Dermatology Department, Perth Children's Hospital, Perth, Western Australia, Australia
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5
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Haigh R, Grahame L, Vallabhaneni P. Lips do not lie. Arch Dis Child Educ Pract Ed 2022; 107:433-434. [PMID: 34131010 DOI: 10.1136/archdischild-2021-321908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rachel Haigh
- Swansea University College of Medicine, Swansea, UK
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6
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Johnston L, Warrilow L, Fullwood I, Tanday A. Fifteen-minute consultation: oral ulceration in children. Arch Dis Child Educ Pract Ed 2022; 107:257-264. [PMID: 34045290 DOI: 10.1136/archdischild-2021-321597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review common presentation of oral ulcers in children and discuss management of symptoms and subsequent investigation. CONCLUSION Although a common presentation in children, diagnosis can be challenging. Thorough history taking is critical towards diagnosis and supports signposting to relevant specialities. Clinicians should be able to support first-line symptomatic management of oral ulceration.
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Affiliation(s)
- Laura Johnston
- Paediatric Dentistry, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Laura Warrilow
- Paediatric Dentistry, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | | | - Ajit Tanday
- Paediatric Dentistry, University of Birmingham, Birmingham, UK
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7
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Pagani K, Lukac D, Bhukhan A, McGee JS. Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview. Am J Clin Dermatol 2022; 23:481-497. [PMID: 35441942 DOI: 10.1007/s40257-022-00689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 11/30/2022]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal (GI) tract that is subdivided into Crohn's disease (CD) and ulcerative colitis (UC). CD is characterized by involvement of the entire GI tract, while UC mainly affects the distal GI tract. Moreover, both CD and UC can present with extraintestinal manifestations (EIMs) of the disease affecting multiple organ systems including the hepatobiliary tract, kidney, bones, eyes, joints, and skin. These complications can cause significant morbidity and negatively impact the quality of life for IBD patients. Although the pathogenesis of EIMs is not clearly elucidated, it is postulated that the diseased GI mucosa similarly stimulates excess immune responses at the extraintestinal sites. Cutaneous EIMs occur in up to 15% of patients with IBD, often predating their IBD diagnosis. They are categorized into (1) specific, (2) reactive, (3) associated, and (4) treatment-induced. Here, we review the epidemiological, clinical, diagnostic, and histologic features of the most commonly described cutaneous EIMs of IBD along with their respective treatment options.
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Affiliation(s)
- Kyla Pagani
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danitza Lukac
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aashni Bhukhan
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Ft. Lauderdale, FL, USA
| | - Jean S McGee
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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8
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CHENG T, WANG L, GUO Z, LI B. Technological characterization and antibacterial activity of Lactococcus lactis subsp. cremoris strains for potential use as starter culture for cheddar cheese manufacture. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tianfu CHENG
- Northeast Agricultural University, China; Heilongjiang Beidahuang Green Health Food Co., Ltd, China
| | - Lin WANG
- Northeast Agricultural University, China
| | | | - Bailiang LI
- Northeast Agricultural University, China; Northeast Agricultural University, China
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9
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Ali NS, Sahni VN, Ma BC, Sahni DR, Hull CM, Powell DL, Secrest AM. Reply to: low response of granulomatous cheilitis to currently established treatments. J Eur Acad Dermatol Venereol 2021; 35:e930-e931. [PMID: 34370336 DOI: 10.1111/jdv.17591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- N S Ali
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - V N Sahni
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - B C Ma
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - D R Sahni
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| | - C M Hull
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| | - D L Powell
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA
| | - A M Secrest
- Department of Dermatology, University of Utah Health, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah Health, Salt Lake City, UT, USA
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10
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Galdiero MR, Maio F, Arcoleo F, Boni E, Bonzano L, Brussino L, Cancian M, Cremonte L, Del Giacco SR, De Paulis A, Detoraki A, Firinu D, Lamacchia D, Loffredo S, Nettis E, Parente R, Parronchi P, Pellacani G, Petraroli A, Rolla G, Senter R, Triggiani M, Vitiello G, Spadaro G, Bova M. Orofacial granulomatosis: Clinical and therapeutic features in an Italian cohort and review of the literature. Allergy 2021; 76:2189-2200. [PMID: 33641182 DOI: 10.1111/all.14799] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is characterized by granulomatous inflammation of the soft tissues of maxillofacial region. We explored OFG patients from 10 different Italian centers and summarized the most recent literature data. METHODS A review of patients with OFG was carried out. An extensive online literature search was performed to identify studies reporting diagnosis and management of OFG. RESULTS Thirty-nine patients were recruited between January 2018 and February 2020. Most of them (97.4%) displayed involvement of the lips, and 28.2% suffered from Melkersson-Rosenthal syndrome. Two patients received diagnosis of CD and one patient of sarcoidosis, suggesting secondary OFG. Oral aphthosis and cervical lymphadenopathy were also described. The mean diagnostic delay was 3.4 years. Histological evaluation was performed in 34/39 patients (87.2%); non-caseating granulomas were found in 73.5% of them. Neurological symptoms (28.2%), gastrointestinal symptoms in absence of overt inflammatory bowel disease (IBD) (20.5%), and atopy (35.9%) were also identified. Therapeutic approaches varied among the centers. Steroids (51.3%) were used with good or partial results. Anti-TNF-α and anti-IgE monoclonal antibodies were used in 6 (15.4%) and 1 (2.6%) patients, respectively, with variable results. Surgery was the choice for 2 patients with good response. CONCLUSIONS OFG is a rare and neglected disease showing multiple clinical phenotypes. While early diagnosis is crucial, management is difficult and highly dependent on the expertise of clinicians due to the lack of international guidelines. There is a need to establish registry databases and address challenges of long-term management.
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Affiliation(s)
- Maria R. Galdiero
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Filomena Maio
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Francesco Arcoleo
- Ospedali Riuniti Villa Sofia‐CervelloUnità Operativa Complessa di Patologia Clinica Palermo Italy
| | - Elisa Boni
- Laboratorio Unico Metropolitano Maggiore Hospital AUSL Bologna Italy
| | - Laura Bonzano
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | - Mauro Cancian
- Department of Medicine University of Padova Padova Italy
| | - Luigi Cremonte
- Allergy Unit San Giacomo HospitalNovi Ligure Alessandria Italy
| | - Stefano R. Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | - Amato De Paulis
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
| | | | - Stefania Loffredo
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Eustachio Nettis
- Department of Emergency and Organ Transplantation School of Allergology and Clinical Immunology University of Bari Aldo Moro Bari Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology University of Salerno Salerno Italy
| | - Paola Parronchi
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giovanni Pellacani
- Dermatology and Allergy Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology University of Turin & AO Mauriziano “UmbertoI” Turin Italy
| | | | - Massimo Triggiani
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Gianfranco Vitiello
- Experimental and Clinical Medicine Department University of Florence Florence Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
| | - Maria Bova
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research (CISI) WAO Center of ExcellenceUniversity of Naples Federico II Naples Italy
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11
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Craig JM. Additives in pet food: are they safe? J Small Anim Pract 2021; 62:624-635. [PMID: 34109637 DOI: 10.1111/jsap.13375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 01/10/2023]
Abstract
A good, nutritious diet is essential for the health and well-being of our domestic pets. Today, most pet dogs and cats are fed highly processed food bearing little resemblance to canine and feline ancestral diets. Additives are included in processed pet food to provide nutritional benefits, ensure food safety, and maintain the desirable features of colour, flavour, texture, stability and resistance to spoilage. This paper reviews the safety of various additives in processed pet food. Labelling, safety assessment, and ethical concerns regarding existing toxicity testing procedures are also considered. The adequacy of testing for many additives and the scientific basis for determining safety are questioned. Additives can be synthetic or 'natural' although the distinction can be blurred when naturally derived substances are synthesised in the laboratory, or extracted using a high level of physical and chemical processing. Although additives play important roles in processed food production, updated strategies and technologies may be required to establish their safety in the pet food industry.
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Affiliation(s)
- J M Craig
- Re-Fur-All Referrals, Newbury, Berkshire, RG14 7QH, UK
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12
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Tailor A, Hegarty AM, Brierley DJ. Orofacial granulomatosis: presentation and management. Br J Hosp Med (Lond) 2021; 82:1-6. [PMID: 33792397 DOI: 10.12968/hmed.2020.0509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Artysha Tailor
- Oral Medicine Unit, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anne M Hegarty
- Oral Medicine Unit, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Daniel J Brierley
- School of Clinical Dentistry, Academic Unit of Oral and Maxillofacial Medicine and Pathology, Sheffield, UK
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13
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Brown R, Farquharson A, Cherry-Peppers G, Lawrence L, Grant-Mills D. <p>A Case of Cheilitis Granulomatosa/Orofacial Granulomatosis</p>. Clin Cosmet Investig Dent 2020; 12:219-224. [PMID: 32606993 PMCID: PMC7320889 DOI: 10.2147/ccide.s254899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
A case of a 19-year-old female patient is presented to a private practice dental clinician with swelling of the lower lip and inflammation of the anterior dorsal tongue. The patient presented with moderate oral pain as well as abdominal pain. The lesions were biopsied and noted for a granulomatous histopathologic appearance. The patient reported a history of using cinnamon as a flavoring agent. The lesions resolved within two weeks after the biopsy procedures and topical steroid therapy. The lesions were diagnosed as cheilitis granulomatosa/orofacial granulomatosis. The patient has remained lesion free as of the three-year follow-up. Etiologic, diagnostic and therapeutic issues related to this relatively rare condition of cheilitis granulomatosa/orofacial granulomatosis are discussed.
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Affiliation(s)
- Ronald Brown
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
- Correspondence: Ronald Brown Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, 600 W Street, NW, Washington, DC20059, USATel +1 202-806-0020 Email
| | - Andre Farquharson
- Department of Oral Diagnosis & Radiology, Howard University College of Dentistry, Washington, DC, USA
| | - Gail Cherry-Peppers
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Leslie Lawrence
- Department of Pediatric Dentistry, Howard University College of Dentistry, Washington, DC, USA
| | - Donna Grant-Mills
- Department of Restorative Dentistry, Howard University College of Dentistry, Washington, DC, USA
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14
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Dhawan SR, Saini AG, Singhi PD. Management Strategies of Melkersson-Rosenthal Syndrome: A Review. Int J Gen Med 2020; 13:61-65. [PMID: 32161488 PMCID: PMC7049838 DOI: 10.2147/ijgm.s186315] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/22/2020] [Indexed: 12/23/2022] Open
Abstract
Melkerrson-Rosenthal syndrome is a rare disorder of unknown aetiology and characterized by the triad of oro-facial edema, facial nerve palsy, and furrowing of the tongue. Two or more of the above are essential for making a clinical diagnosis. The mainstay of treatment is corticosteroids. Intralesional triamcinolone acetonide may be used for the treatment of oro-facial edema. Another treatment option for oro-facial edema includes intralesional betamethasone, along with oral doxycycline. The review discusses the management strategies in Melkersson-Rosenthal syndrome.
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Affiliation(s)
- Sumeet R Dhawan
- Department of Pediatrics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, 133207, India
| | - Arushi G Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Pratibha D Singhi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.,Medanta, The Medicity, Gurgaon, Haryana, India
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15
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Orofacial granulomatosis: a questionnaire study among Norwegian dental clinicians. Eur Arch Paediatr Dent 2020; 21:557-564. [PMID: 32020549 PMCID: PMC7518990 DOI: 10.1007/s40368-020-00511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/23/2020] [Indexed: 11/21/2022]
Abstract
Aims To evaluate awareness on orofacial granulomatosis (OFG) and oral Crohn disease (oral CD) among Norwegian dental clinicians. Methods A precoded questionnaire (QuestBack) was sent electronically to dentists and dental hygienists treating children and adolescents in the public dental service (PDS) in Norway. Data on the clinicians’ knowledge of OFG and oral CD related to working experience were analysed by Chi square tests and bivariate logistic regression analyses. Results A total of 1097 clinicians were invited to participate, 778 dentists and 319 dental hygienists; 48.2% returned the completed form. Fifty-four percent of the participants had ≥ 10 year experience of clinical practice. Two-thirds (68.4%) of the dentists and all but one of the dental hygienists graduated in Norway. Approximately half of the respondents were aware of OFG (41.2%) and oral CD (57.8%). One-quarter (24.6%) reported that they most likely had seen a patient with OFG and 20.6% with oral CD. Recently graduated dentists (≤ 10 years ago) were more aware of OFG and oral CD than those who graduated > 10 years ago (p ≤ 0.001). Regarding dental hygienists, this difference was observed for OFG only (p < 0.05). Country of education did not affect the clinicians’ reported knowledge. Approximately 90% would refer a patient suspected of having OFG or oral CD either to a dental specialist or to a physician. Conclusion The high prevalence of clinicians observing OFG and oral CD in this study may indicate that OFG and/or oral CD are under-reported and that OFG in particular is more common than hitherto believed. The high frequency of awareness was promising for the benefit of the patients.
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16
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Orofacial Granulomatosis in a Child. Case Rep Pediatr 2019; 2019:7519267. [PMID: 31885999 PMCID: PMC6915030 DOI: 10.1155/2019/7519267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/11/2019] [Accepted: 11/16/2019] [Indexed: 11/17/2022] Open
Abstract
Orofacial granulomatosis (OFG) is a rare, idiopathic disorder of the orofacial region. It is clinically characterized by persistent and/or recurrent enlargement of the soft tissues of the oral and maxillofacial region, often manifesting as labial enlargement and swelling of intraoral sites such as the gingiva, tongue, and buccal mucosa. Full-thickness mucosal biopsy reveals noncaseating granulomatous inflammation, similar to Crohn's disease and sarcoidosis. Thus, OFG must be distinguished from other chronic granulomatous disorders. We report a case of a young female patient who presented with labial and maxillary gingival enlargement without any identifiable systemic causes, with suggested involvement of environmental triggers.
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17
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Fok JS, Katelaris CH. Angioedema Masqueraders. Clin Exp Allergy 2019; 49:1274-1282. [PMID: 31310036 DOI: 10.1111/cea.13463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/27/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Angioedema is a common reason for referral to immunology and allergy specialists. Not all cases are in fact angioedema. There are many conditions that may mimic its appearance, resulting in misdiagnosis. This may happen when a clinician is unfamiliar with conditions resembling angioedema or when there is a low index of clinical suspicion. In this article, we explore a list of differential diagnoses based on body parts, including the lips, the limbs, periorbital tissues, the face, epiglottis and uvula, as well as the genitalia, that may pose as a masquerader even to an experienced eye.
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Affiliation(s)
- Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Constance H Katelaris
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
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18
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Goel RM, Prosdocimi EM, Amar A, Omar Y, Escudier MP, Sanderson JD, Wade WG, Prescott NJ. Streptococcus Salivarius: A Potential Salivary Biomarker for Orofacial Granulomatosis and Crohn's Disease? Inflamm Bowel Dis 2019; 25:1367-1374. [PMID: 30796823 PMCID: PMC6635823 DOI: 10.1093/ibd/izz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare disease characterised by chronic, noncaseating, granulomatous inflammation primarily affecting the oral cavity. Histologically, it is similar to Crohn's disease (CD), and a proportion of patients have both OFG and CD. The cause of OFG remains elusive, but it has been suggested that microbial interactions may be involved. The aim of this study was to compare the salivary microbial composition of subjects with OFG and/or CD and healthy controls. METHODS Two hundred sixty-one subjects were recruited, of whom 78 had OFG only, 40 had both OFG and CD, 97 had CD only with no oral symptoms, and 46 were healthy controls. Bacterial community profiles were obtained by sequencing the V1-V3 region of the 16S rRNA gene. RESULTS There were no differences in richness or diversity of the salivary bacterial communities between patient groups and controls. The relative abundance of the Streptococcus salivarius group was raised in patients with OFG or CD only compared with controls, whereas that of the Streptococcus mitis group was lower in CD compared with both OFG and controls. One S. salivarius oligotype made the major contribution to the increased proportions seen in patients with OFG and CD. CONCLUSIONS The salivary microbiome of individuals with OFG and CD was similar to that found in health, although the proportions of S. salivarius, a common oral Streptococcus, were raised. One specific strain-level oligotype was found to be primarily responsible for the increased levels seen.
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Affiliation(s)
- Rishi M Goel
- Department of Gastroenterology, Kingston Hospital, London, United Kingdom
| | - Erica M Prosdocimi
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - Ariella Amar
- Department of Medical and Molecular Genetics, Faculty of Life Science and Medicine, King’s College London, London, United Kingdom
| | - Yasmin Omar
- Department of Medical and Molecular Genetics, Faculty of Life Science and Medicine, King’s College London, London, United Kingdom
| | - Michael P Escudier
- Oral Medicine Unit, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - Jeremy D Sanderson
- Department of Gastroenterology, Guy’s & St. Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - William G Wade
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - Natalie J Prescott
- Department of Medical and Molecular Genetics, Faculty of Life Science and Medicine, King’s College London, London, United Kingdom
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19
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Jácome-Santos H, Resende RG, Silva AMB, Cruz AF, Tanos de Lacerda SH, Mesquita RA, Tanos de Lacerda JC. Low-level laser as a complementary therapy in orofacial granulomatosis management: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:e1-e5. [DOI: 10.1016/j.oooo.2019.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/03/2019] [Accepted: 02/23/2019] [Indexed: 12/20/2022]
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20
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Hullah EA, Escudier MP. The mouth in inflammatory bowel disease and aspects of orofacial granulomatosis. Periodontol 2000 2019; 80:61-76. [DOI: 10.1111/prd.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Esther A. Hullah
- Faculty of DentistryOral & Craniofacial SciencesKing's College London UK
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21
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Persistent Upper Lip Swelling in a Young Woman: Answer. Am J Dermatopathol 2019; 41:386-387. [PMID: 31009412 DOI: 10.1097/dad.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Orofacial granulomatosis and dietary interventions: health information on the internet. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00327-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Plug-and-play metabolic transducers expand the chemical detection space of cell-free biosensors. Nat Commun 2019; 10:1697. [PMID: 30979906 PMCID: PMC6461607 DOI: 10.1038/s41467-019-09722-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/21/2019] [Indexed: 11/14/2022] Open
Abstract
Cell-free transcription–translation systems have great potential for biosensing, yet the range of detectable chemicals is limited. Here we provide a workflow to expand the range of molecules detectable by cell-free biosensors through combining synthetic metabolic cascades with transcription factor-based networks. These hybrid cell-free biosensors have a fast response time, strong signal response, and a high dynamic range. In addition, they are capable of functioning in a variety of complex media, including commercial beverages and human urine, in which they can be used to detect clinically relevant concentrations of small molecules. This work provides a foundation to engineer modular cell-free biosensors tailored for many applications. The range of chemicals detectable by cell-free systems is still limited. Here the authors combine metabolic cascades with transcription factor networks to detect small molecules in complex environments.
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24
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Ormond M, McParland H, Donaldson A, Andiappan M, Cook R, Escudier M, Hullah E, Higham J, McMillan R, Taylor J, Shirlaw P, Challacombe S, Setterfield J. An Oral Disease Severity Score validated for use in oral pemphigus vulgaris. Br J Dermatol 2018; 179:872-881. [DOI: 10.1111/bjd.16265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ormond
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - H. McParland
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - A.N.A. Donaldson
- Biostatistics and Research Methods Centre; Dental Institute; King's College London; London U.K
| | - M. Andiappan
- Biostatistics and Research Methods Centre; Dental Institute; King's College London; London U.K
| | - R.J. Cook
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - M. Escudier
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
| | - E. Hullah
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - J. Higham
- Birmingham Dental Hospital; Birmingham U.K
| | - R. McMillan
- Eastman Dental Hospital; UCLH/Eastman Dental Institute; University College London; London U.K
| | - J. Taylor
- University Dental Hospital; Manchester U.K
| | - P.J. Shirlaw
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
| | - S.J. Challacombe
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
| | - J.F. Setterfield
- Department of Oral Medicine; Dental Institute; Guy's and St Thomas’ NHS Foundation Trust and King's College London; London U.K
- Mucosal and Salivary Biology Division; Dental Institute; King's College London; London U.K
- St John's Institute of Dermatology; Guy's and St Thomas's NHS Foundation Trust; London U.K
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25
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Espinoza I, Navarrete J, Benedetto J, Borzutzky A, Roessler P, Ortega-Pinto A. Orofacial granulomatosis and diet therapy: a review of the literature and two clinical cases. An Bras Dermatol 2018; 93:80-85. [PMID: 29641703 PMCID: PMC5871368 DOI: 10.1590/abd1806-4841.20185828] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/09/2016] [Indexed: 03/04/2023] Open
Abstract
Orofacial granulomatosis is a nonspecific term that contains a wide variety of
granulomatous entities, which share a clinical and histopathological
presentation. It manifests as persistent or recurrent orofacial swelling,
amongst other findings. Idiopathic orofacial granulomatosis, characterized by an
absence of systemic granulomatous disease, is a diagnosis of exclusion. The main
differential diagnosis is Crohn's disease. Its pathogenesis is unknown, however,
it seems to be immune-mediated. Patch-test sensitivity to multiple allergens is
well documented. Currently, therapeutic options consider restrictive diets,
topical, intralesional, and systemic agents. First-line therapy is currently a
matter of debate. We present a review of the value of diet therapy in this
syndrome, along with two illustrative cases.
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Affiliation(s)
- Iris Espinoza
- Oral Biopsy Service at Dental School, University of Chile - Santiago, Chile
| | - Jorge Navarrete
- Dermatology Service, Clinics Hospital Dr. Manuel Quintela - University of the Republic - Montevideo, Uruguay
| | - Juana Benedetto
- Dermatology Service, Alemana de Santiago Clinic - Santiago, Chile.,Dermatology Department, University del Desarrollo - Región del Bío Bío, Chile
| | - Arturo Borzutzky
- Immunology, Allergy and Pediatric Rheumatology, Pontifical Catholic University of Chile - Santiago, Chile
| | | | - Ana Ortega-Pinto
- Department of Oral Pathology and Medicine, University of Chile - Santiago, Chile
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26
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Orofacial granulomatosis: an unsuccessful response to weekly azithromycin pulse therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e83-e85. [DOI: 10.1016/j.oooo.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 11/18/2022]
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27
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Tan CXW, Brand HS, de Boer NKH, Forouzanfar T. Gastrointestinal diseases and their oro-dental manifestations: Part 1: Crohn's disease. Br Dent J 2018; 221:794-799. [PMID: 27982000 DOI: 10.1038/sj.bdj.2016.954] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2016] [Indexed: 02/06/2023]
Abstract
Widely varying prevalence rates of oral lesions in patients with Crohn's disease have been reported, ranging from 0.5% to 37%. These manifestations may coincide with or precede intestinal symptoms. Oral manifestations can be classified as specific lesions, when macroscopic examination shows similar changes to those observed endoscopically in the intestine, and non-specific lesions including aphthous ulcerations. The most frequently observed oral lesions are oedema, ulcers and hyperplastic lesions on the buccal mucosa. In most patients these lesions are asymptomatic, however, some patients may experience discomfort. In this review we describe the most relevant oro-dental manifestations observed in patients with Crohn's disease and discuss the potential implications for oro-dental management.
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Affiliation(s)
- C X W Tan
- Departments of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre/Academic entre for Dentistry Amsterdam (ACTA)
| | - H S Brand
- Departments of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre/Academic entre for Dentistry Amsterdam (ACTA).,Department of Oral Biochemistry, VU University Medical Centre/Academic entre for Dentistry Amsterdam (ACTA)
| | - N K H de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Centre.,Departments of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre/Academic entre for Dentistry Amsterdam (ACTA)
| | - T Forouzanfar
- Departments of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Centre/Academic entre for Dentistry Amsterdam (ACTA)
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28
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Laube R, Liu K, Schifter M, Yang JL, Suen MK, Leong RW. Oral and upper gastrointestinal Crohn's disease. J Gastroenterol Hepatol 2018; 33:355-364. [PMID: 28708248 DOI: 10.1111/jgh.13866] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/31/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Crohn's disease is a heterogeneous, inflammatory condition that can affect any location of the gastrointestinal tract. Proximal gastrointestinal involvement occurs in 0.5-16% of patients, and it is usually diagnosed after recognition of intestinal disease. Symptoms are often mild and nonspecific; however, upper gastrointestinal disease predicts a more severe Crohn's phenotype with a greater frequency of complications such as obstruction and perforation. Gastroscopy and biopsy is the most sensitive diagnostic investigation. There is a paucity of data examining the treatment of this condition. Management principles are similar to those for intestinal disease, commencing with topical therapy where appropriate, progressing to systemic therapy such as glucocorticoids, 5-aminosalicylic acid, immunomodulators, and biologics. Acid suppression therapy has symptomatic but no anti-inflammatory benefit for gastroduodenal and esophageal involvement. Surgical intervention with bypass, strictureplasty, or less frequently, endoscopic balloon dilation may be required for complications or failed medical therapy.
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Affiliation(s)
- Robyn Laube
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Ken Liu
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Schifter
- Department of Oral Medicine, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Dentistry, Sydney University, Sydney, New South Wales, Australia
| | - Jessica L Yang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael K Suen
- Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Rupert W Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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29
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Del Olmo A, Calzada J, Nuñez M. Benzoic acid and its derivatives as naturally occurring compounds in foods and as additives: Uses, exposure, and controversy. Crit Rev Food Sci Nutr 2018; 57:3084-3103. [PMID: 26587821 DOI: 10.1080/10408398.2015.1087964] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Benzoic acid is an aromatic carboxylic acid naturally present in plant and animal tissues, which can also be produced by microorganisms. Benzoic acid and a wide range of derivatives and related benzenic compounds, such as salts, alkyl esters, parabens, benzyl alcohol, benzaldehyde, and benzoyl peroxide, are commonly used as antibacterial and antifungal preservatives and as flavoring agents in food, cosmetic, hygiene, and pharmaceutical products. As a result of their widespread occurrence, production, and uses, these compounds are largely distributed in the environment and found in water, soil, and air. Consequently, human exposure to them can be high, common, and lengthy. This review is mainly focused on the presence and use of benzoic acid in foods but it also covers the occurrence, uses, human exposure, metabolism, toxicology, analytical methods for detection, and legal limits for benzoic acid and its derivatives. Their controversial effects and potential public health concerns are discussed.
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Affiliation(s)
- Ana Del Olmo
- a Departamento de Tecnología de Alimentos , INIA , Madrid , Spain
| | - Javier Calzada
- a Departamento de Tecnología de Alimentos , INIA , Madrid , Spain
| | - Manuel Nuñez
- a Departamento de Tecnología de Alimentos , INIA , Madrid , Spain
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30
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Lalosevic J, Gajic-Veljic M, Nikolic M. Orofacial granulomatosis in a 12-year-old girl successfully treated with intravenous pulse corticosteroid therapy and chloroquine. Pediatr Dermatol 2017; 34:e324-e327. [PMID: 28940800 DOI: 10.1111/pde.13279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Orofacial granulomatosis, a rare disease in childhood, is characterized by orofacial swelling in the absence of systemic disease. We report the case of a 12-year-old girl with asymptomatic erythematous infiltration of her upper lip, cheeks, and chin that had persisted for more than 2 years; biopsy confirmed granuloma formation. Because a large area was affected, intralesional corticosteroids were inappropriate and six cycles of 3-day intravenous pulse corticosteroid therapy (dexamethasone 1.5mg/kg), repeated once after 4 weeks, was given. Our patient also received oral chloroquine and topical emollients. At the end of the sixth pulse cycle, the infiltration had completely resolved, leaving slight residual erythema.
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Affiliation(s)
- Jovan Lalosevic
- Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Mirjana Gajic-Veljic
- Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milos Nikolic
- Division of Pediatric Dermatology, Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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31
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Gülseren D, Hapa A, Ersoy-Evans S, Elçin G, Karaduman A. Is there a role of food additives in recurrent aphthous stomatitis? A prospective study with patch testing. Int J Dermatol 2016; 56:302-306. [DOI: 10.1111/ijd.13515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/07/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Duygu Gülseren
- Hacettepe University; School of Medicine; Department of Dermatology; Ankara Turkey
- University of Virginia Medical Center; Division of Dermatopathology; Charlottesville VA USA
| | - Asli Hapa
- Hacettepe University; School of Medicine; Department of Dermatology; Ankara Turkey
| | - Sibel Ersoy-Evans
- Hacettepe University; School of Medicine; Department of Dermatology; Ankara Turkey
| | - Gonca Elçin
- Hacettepe University; School of Medicine; Department of Dermatology; Ankara Turkey
| | - Ayşen Karaduman
- Hacettepe University; School of Medicine; Department of Dermatology; Ankara Turkey
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32
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Abstract
The diagnosis and treatment of mucosal disease with an allergic pathogenesis are challenging. Oral allergy is often a hypersensitivity reaction with variable symptoms and physical exam findings. Clinical diagnosis requires a history of prior allergen exposure, a delay from exposure to clinical findings, and improvement following allergen removal. The past decades have seen great contributions to the field of oral allergy. The aim of this review is to provide an approach to the diagnosis and treatment of oral dermatologic disease with a focus on diseases with an investigated allergic pathogenesis.
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33
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Hancı D, Altun H, Çetinkaya EA, Muluk NB, Cengiz BP, Cingi C. Cinnamaldehyde is an effective anti-inflammatory agent for treatment of allergic rhinitis in a rat model. Int J Pediatr Otorhinolaryngol 2016; 84:81-7. [PMID: 27063758 DOI: 10.1016/j.ijporl.2016.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/28/2016] [Accepted: 03/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The effect of cinnamaldehyde on the treatment of allergic rhinitis (AR) was investigated in rat model. METHODS Twenty-eight female Wistar albino rats were randomly divided into four groups: Group 1 (control) (C), Group 2 (AR with no treatment) (AR+NoTr), Group 3 (AR+Azelastine HCl) (AR+Aze), and Group 4 (AR+cinnamaldehyde) (AR+Cin). At day 21, AR+Aze rats were given an Azelastine HCl drop, and AR+Cin rats were given cinnamaldehyde intranasally. In all groups, allergic symptoms histopathological results were evaluated. RESULTS The AR+NoTr group showed the worst allergic symptoms, cilia loss and greater inflammation. In the AR+Aze and AR+Cin groups, allergic symptom scores were higher than those in the control group. However, between AR+Aze and AR+Cin groups, there were no significant differences in the allergic symptom scores Histopathological analysis revealed vascular congestion and an increase in goblet cell numbers in the AR+Cin group. However, AR+Cin rat nasal mucosa had less plasma cell infiltration compared with the AR+NoTr group. In rats from the AR+Aze group, analysis of the nasal mucosa revealed less eosinophil infiltration than that seen in the AR+NoTr group. A lower score for mast cell (MC) infiltration was observed in the nasal mucosa of rats treated with Azelastine HCl compared with cinnamaldehyde. CONCLUSIONS In this study we observed that both Azelastine HCl and cinnamaldehyde reduced allergic symptoms in an AR rat model. Cinnamaldehyde decreased vascular congestion as well as plasma cell, eosinophil, and inflammatory cell infiltration into the lamina propria.
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Affiliation(s)
- Deniz Hancı
- Okmeydanı Training and Research Hospital, ENT Clinics, Istanbul, Turkey
| | - Hüseyin Altun
- Yunus Emre Hospital, ENT Department, Uskudar, Istanbul, Turkey
| | | | - Nuray Bayar Muluk
- Kırıkkale University, Medical Faculty, ENT Department, Kırıkkale, Turkey.
| | | | - Cemal Cingi
- Eskişehir Osmangazi University, Medical Faculty, ENT Department, Eskişehir, Turkey
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34
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Jensen-Jarolim E, Roth-Walter F, Leitner E, Buchleitner S, Vogelsang H, Kinaciyan T. Prime and boost aerosol exposure via fog machine or shisha smoke followed by cinnamon hypersensitivity and anaphylaxis to spiced food. World Allergy Organ J 2016; 9:4. [PMID: 26839630 PMCID: PMC4730641 DOI: 10.1186/s40413-016-0091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cinnamon aldehyde (alias cinnamaldehyde) is widely used in food, textile or cosmetic industry. It is mostly associated with contact allergy, but immediate type allergies have been reported. The present study was triggered by a case of anaphylactic events to cinnamon in food and upon skin prick test. We investigated a possible correlation of exposure to a disco fog machine and/or shisha consumption with immediate type hypersensitivity to cinnamon aldehyde in the patient and healthy volunteers. METHODS & RESULTS In both fog machines and shisha pipes heating of glycerol-based fluids before evaporation renders chemical transversion to malodorous acrolein. Therefore, both methods are frequently operated with aroma additives. Cinnamon aldehyde and derivatives could be detected by gas chromatography in sampled fog flavored with cola fragrance. The patient as well as healthy (mostly female) volunteers were skin prick tested using cinnamon aldehyde diluted in 0.9 % NaCl, Vaseline® or fog fluid. Persons with a history of exposure to disco fog or shisha (n = 10, mean 32.8 years) reacted with a significantly larger wheal and flare reaction in the skin test (p = 0.0115, p = 0.0146, or p = 0.098) than the non-exposed (n = 8, mean 37.3 years). Both groups were gender matched, but differed in the mean age by 4.5 years. This reaction was specific as compared to skin reactivity to cinnamon alcohol, with only a trend to higher reactivity in exposed persons (ns). CONCLUSION From our data we conclude that hapten fragrances such as cinnamon aldehyde may during heating in glycerol fluids associate to complete antigens and via inspiration lead to specific immediate type hypersensitivity. In some cases the hypersensitivity may be unmasked by spiced food containing cinnamon aldehyde or related chemicals, and lead to severe adverse reactions.
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Affiliation(s)
- Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria ; AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria ; Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Erich Leitner
- Institute of Analytical Chemistry and Food Chemistry, Graz University of Technology, Graz, Austria
| | - Stefan Buchleitner
- Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Harald Vogelsang
- Divison of Gastroenterology, Univ. Clinic of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Tamar Kinaciyan
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Währinger G. 18-20, 1090 Vienna, Austria
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Skypala IJ, Williams M, Reeves L, Meyer R, Venter C. Sensitivity to food additives, vaso-active amines and salicylates: a review of the evidence. Clin Transl Allergy 2015; 5:34. [PMID: 26468368 PMCID: PMC4604636 DOI: 10.1186/s13601-015-0078-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/24/2015] [Indexed: 12/31/2022] Open
Abstract
Although there is considerable literature pertaining to IgE and non IgE-mediated food allergy, there is a paucity of information on non-immune mediated reactions to foods, other than metabolic disorders such as lactose intolerance. Food additives and naturally occurring 'food chemicals' have long been reported as having the potential to provoke symptoms in those who are more sensitive to their effects. Diets low in 'food chemicals' gained prominence in the 1970s and 1980s, and their popularity remains, although the evidence of their efficacy is very limited. This review focuses on the available evidence for the role and likely adverse effects of both added and natural 'food chemicals' including benzoate, sulphite, monosodium glutamate, vaso-active or biogenic amines and salicylate. Studies assessing the efficacy of the restriction of these substances in the diet have mainly been undertaken in adults, but the paper will also touch on the use of such diets in children. The difficulty of reviewing the available evidence is that few of the studies have been controlled and, for many, considerable time has elapsed since their publication. Meanwhile dietary patterns and habits have changed hugely in the interim, so the conclusions may not be relevant for our current dietary norms. The conclusion of the review is that there may be some benefit in the removal of an additive or a group of foods high in natural food chemicals from the diet for a limited period for certain individuals, providing the diagnostic pathway is followed and the foods are reintroduced back into the diet to assess for the efficacy of removal. However diets involving the removal of multiple additives and food chemicals have the very great potential to lead to nutritional deficiency especially in the paediatric population. Any dietary intervention, whether for the purposes of diagnosis or management of food allergy or food intolerance, should be adapted to the individual's dietary habits and a suitably trained dietitian should ensure nutritional needs are met. Ultimately a healthy diet should be the aim for all patients presenting in the allergy clinic.
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Affiliation(s)
- Isabel J. Skypala
- />Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP UK
| | - M. Williams
- />Somerset Partnership NHS Foundation Trust, Somerset, UK
| | - L. Reeves
- />Oxford Health NHS Foundation Trust, Oxford, UK
| | - R. Meyer
- />Great Ormond Street NHS Foundation Trust, London, UK
| | - C. Venter
- />The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
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Katsanos KH, Torres J, Roda G, Brygo A, Delaporte E, Colombel JF. Review article: non-malignant oral manifestations in inflammatory bowel diseases. Aliment Pharmacol Ther 2015; 42:40-60. [PMID: 25917394 DOI: 10.1111/apt.13217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/04/2015] [Accepted: 04/08/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal manifestation, with nutritional deficiencies or with complications from therapy. AIM To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases [ulcerative colitis (UC), Crohn's disease (CD)] and to critically review all relevant data. METHODS A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases (UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies. RESULTS Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one-third of patients and are usually nonspecific. CONCLUSIONS Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required.
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Affiliation(s)
- K H Katsanos
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Torres
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Roda
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Brygo
- Department of Stomatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - E Delaporte
- Department of Dermatology, Centre Hospitalier Régional Universitaire de Lille 2, Lille Cedex, France
| | - J-F Colombel
- The Henry D. Janowitz Division of Gastroenterology, The Leona M. Harry B. Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder of the orofacial region. It is characterized by subepithelial noncaseating granulomas and has a spectrum of possible clinical manifestations ranging from subtle oral mucosal swelling to permanent disfiguring fibrous swelling of the lips and face. Etiopathogenesis is unknown. A range of systemic granulomatous disorders, including Crohn disease and sarcoidosis, may cause orofacial manifestations that cannot be distinguished from those of OFG. Treatment of OFG has proven difficult and unsatisfactory, with no single therapeutic model showing consistent efficacy in reducing orofacial swelling and mucosal inflammation.
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Affiliation(s)
- Arwa Al-Hamad
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; Dental Services, Ministry of National Guard, King Abdulaziz Medical City-Riyadh, Riyadh, Saudi Arabia
| | - Stephen Porter
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | - Stefano Fedele
- Oral Medicine Unit, UCL Eastman Dental Institute, University College London, 256 Gray's Inn Road, London WC1X 8LD, UK; NIHR University College London Hospitals Biomedical Research Centre, Maple House, Suite A, 1st floor, 149 Tottenham Court Road, London W1T 7DN, UK; Oral Medicine Unit, Eastman Dental Hospital, University College London Hospitals Trust, 256 Gray's Inn Road, London WC1X 8LD, UK.
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39
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Turnbull JL, Adams HN, Gorard DA. Review article: the diagnosis and management of food allergy and food intolerances. Aliment Pharmacol Ther 2015; 41:3-25. [PMID: 25316115 DOI: 10.1111/apt.12984] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 05/23/2014] [Accepted: 09/16/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adverse reactions to food include immune mediated food allergies and non-immune mediated food intolerances. Food allergies and intolerances are often confused by health professionals, patients and the public. AIM To critically review the data relating to diagnosis and management of food allergy and food intolerance in adults and children. METHODS MEDLINE, EMBASE and the Cochrane Database were searched up until May 2014, using search terms related to food allergy and intolerance. RESULTS An estimated one-fifth of the population believe that they have adverse reactions to food. Estimates of true IgE-mediated food allergy vary, but in some countries it may be as prevalent as 4-7% of preschool children. The most common food allergens are cow's milk, egg, peanut, tree nuts, soy, shellfish and finned fish. Reactions vary from urticaria to anaphylaxis and death. Tolerance for many foods including milk and egg develops with age, but is far less likely with peanut allergy. Estimates of IgE-mediated food allergy in adults are closer to 1-2%. Non-IgE-mediated food allergies such as Food Protein-Induced Enterocolitis Syndrome are rarer and predominantly recognised in childhood. Eosinophilic gastrointestinal disorders including eosinophilic oesophagitis are mixed IgE- and non-IgE-mediated food allergic conditions, and are improved by dietary exclusions. By contrast food intolerances are nonspecific, and the resultant symptoms resemble other common medically unexplained complaints, often overlapping with symptoms found in functional disorders such as irritable bowel syndrome. Improved dietary treatments for the irritable bowel syndrome have recently been described. CONCLUSIONS Food allergies are more common in children, can be life-threatening and are distinct from food intolerances. Food intolerances may pose little risk but since functional disorders are so prevalent, greater efforts to understand adverse effects of foods in functional disorders are warranted.
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Affiliation(s)
- J L Turnbull
- Department of Paediatrics, John Radcliffe Hospital, Headington, Oxford, UK
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Gale G, Ostman S, Saalman R, Telemo E, Jontell M, Hasséus B. Immunophenotype in orofacial granulomatosis with and without Crohn's disease. Med Oral Patol Oral Cir Bucal 2014; 19:e584-591. [PMID: 25350593 PMCID: PMC4259375 DOI: 10.4317/medoral.20187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/22/2014] [Indexed: 01/29/2023] Open
Abstract
Objectives: The aim of this investigation was to characterise and compare the inflammatory infiltrates in patients with orofacial granulomatosis solely (OFG-S) and OFG with coexisting Crohn’s disease (OFG+CD).
Study Design: Biopsy specimens with granulomas were obtained from patients with OFG-S (n=11) and OFG+CD (n=11) and immunostained with antibodies against CD1a, CD3, CD4, CD8, CD11c, CD20, CD68 and mast cell tryptase, followed by quantitative analysis.
Results: Analyses of the connective tissue revealed a significantly higher number of CD3-expressing T cells and CD11c-expressing dendritic cells in the connective tissue of patients with OFG-S compared to patients with OFG+CD. Mast cells displayed a high level of activation, although no significant difference was detected when comparing the two groups.
Conclusions: The results show a different composition of the inflammatory infiltrate in patients with OFG-S compared to patients with OFG+CD. The present observations support that partly divergent immune mechanisms are involved in these two different subcategories of OFG.
Key words:Granulomas, autoimmunity, T cells, B cells, dendritic cells, children, adults.
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Affiliation(s)
- Gita Gale
- Department of Oral Medicine and Pathology, Institute of Odontology The Sahlgrenska Academy, University of Gothenburg, Box 450, SE405 30 Gothenburg, Sweden,
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Eustace K, Clowry J, Kirby B, Lally A. Thalidomide in the treatment of refractory orofacial granulomatosis. Br J Dermatol 2014; 171:423-5. [DOI: 10.1111/bjd.12944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. Eustace
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - J. Clowry
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - B. Kirby
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
| | - A. Lally
- Department of Dermatology; St Vincent's Hospital; Dublin 4 Ireland
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Simonsen AB, Deleuran M. Orofacial Granulomatosis in Children can be the Initial Manifestation of Systemic Disease: A Presentation of Two Cases. Dermatol Reports 2014; 6:5039. [PMID: 25386323 PMCID: PMC4223999 DOI: 10.4081/dr.2014.5039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/17/2013] [Accepted: 12/20/2013] [Indexed: 02/07/2023] Open
Abstract
Orofacial granulomatosis is a chronic granulomatous condition characterized by relapsing and remitting lip swelling and oral involvement that may include deep ulcers, tags and cobblestone formation. It occurs as an independent entity but also in conjunction with systemic diseases such as tuberculosis, sarcoidosis and Crohn’s disease. The clinical presentation is not indicative of concomitant systemic disease. To highlight the importance of thorough examination to rule out systemic disease, we present two childhood cases of orofacial granulomatosis, one of which was associated to Crohn’s disease.
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Affiliation(s)
| | - Mette Deleuran
- Department of Dermatology, Aarhus University Hospital , Aarhus, Denmark
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Gale G, Östman S, Rekabdar E, Torinsson Naluai Å, Högkil K, Hasséus B, Saalman R, Jontell M. Characterisation of a Swedish cohort with orofacial granulomatosis with or without Crohn's disease. Oral Dis 2014; 21:e98-104. [DOI: 10.1111/odi.12236] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 12/30/2022]
Affiliation(s)
- G Gale
- Department of Oral Medicine and Oral Pathology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - S Östman
- Department of Infectious Diseases The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - E Rekabdar
- Genomics Core Facility The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - Å Torinsson Naluai
- Genomics Core Facility The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - K Högkil
- Eastman Institute Public Dental Health Stockholm Sweden
| | - B Hasséus
- Department of Oral Medicine and Oral Pathology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - R Saalman
- Department of Paediatrics Institute of Clinical Sciences The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
| | - M Jontell
- Department of Oral Medicine and Oral Pathology Institute of Odontology The Sahlgrenska Academy University of Gothenburg Göteborg Sweden
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Abstract
Cheilitis granulomatosa (CG) is a cosmetically disturbing and persistent idiopathic lip swelling. It is one manifestation of orofacial granulomatosis (OFG), which is a clinical entity describing facial and oral swelling in the setting of non-caseating granulomatous inflammation and in the absence of systemic disease such as Crohn's disease and sarcoidosis. CG can occur by itself or as part of the Melkersson-Rosenthal syndrome, which includes facial palsy and a plicated tongue. Other proposed causes of OFG include dietary allergens such as cinnamon and benzoates. Similar orofacial swelling may be an early manifestation of Crohn's disease or sarcoidosis, and so clinical history is important in diagnosis. The cause of CG has not been wholly elucidated, but a current hypothesis holds that a random influx of inflammatory cells is responsible. Other granulomatous and edematous causes of lip swelling must be investigated prior to diagnosis. Options for treatment include dietary modifications, antibiotics, systemic or intralesional corticosteroids, and surgery, although treatment is not always necessary. CG should be considered in the differential of persistent lip swelling.
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Abstract
With new insights into the pathogenesis of specific granulomatous diseases, and with the advent of high-throughput genetic screening and availability of next-generation biological therapies, clinicians have several options at their disposal to help ensure accurate diagnosis and effective treatment. This article highlights some of the current knowledge about the more common granulomatous systemic diseases that may be encountered in clinical practice.
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Affiliation(s)
- Faizan Alawi
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Room 328B, Philadelphia, PA 19104-6002, USA.
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46
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Campbell HE, Escudier MP, Milligan P, Challacombe SJ, Sanderson JD, Lomer MCE. Development of a low phenolic acid diet for the management of orofacial granulomatosis. J Hum Nutr Diet 2013; 26:527-37. [PMID: 23574355 DOI: 10.1111/jhn.12046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy. METHODS A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values. RESULTS The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713]. CONCLUSIONS A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.
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Affiliation(s)
- H E Campbell
- Diabetes and Nutritional Sciences Division, King's College London (KCL), London, UK; Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust (GSTFT), London, UK
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