Improvement in orofacial granulomatosis on a cinnamon- and benzoate-free diet.

Abstract

BACKGROUND:

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

MATERIALS AND METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

• Authors: Allison White, Carlo Nunes, Michael Escudier, Miranda C E Lomer, Kate Barnard, Penelope Shirlaw, Stephen J Challacombe, Jeremy D Sanderson
• Journal: Inflammatory bowel diseases (Inflamm Bowel Dis) Vol. 12 Issue 6 Pg. 508-14 (Jun 2006) ISSN: 1078-0998 [Print] England
• PMID: 16775496 (Publication Type: Journal Article)

Chemical References

• Benzoates

Topics

• Adult
• Benzoates
• Cinnamomum zeylanicum
• Diet
• Female
• Granulomatosis, Orofacial (diet therapy, pathology)
• Humans
• Lip (pathology)
• Male
• Mouth (pathology)
• Patch Tests