title: 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.
  
  
  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.affiliation: Department of Dietetics, Kings College London, Medical and Dental Schools, Guy's, Kings and St Thomas's Hospital, London, UK.
authors.forename: Allison
authors.initials: A
authors.lastname: White
authors.forename: Carlo
authors.initials: C
authors.lastname: Nunes
authors.forename: Michael
authors.initials: M
authors.lastname: Escudier
authors.forename: Miranda C E
authors.initials: MC
authors.lastname: Lomer
authors.forename: Kate
authors.initials: K
authors.lastname: Barnard
authors.forename: Penelope
authors.initials: P
authors.lastname: Shirlaw
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Challacombe
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Sanderson
mesh_terms: D000328:Adult; D001565:Benzoates; D002935:Cinnamomum zeylanicum; D004032:Diet; D005260:Female; D051261:Granulomatosis, Orofacial / Q000178:diet therapy* / Q000473:pathology; D006801:Humans; D008046:Lip / Q000473:pathology; D008297:Male; D009055:Mouth / Q000473:pathology; D010328:Patch Tests
chemical_list: D001565:Benzoates