title: Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach?
abstract: BACKGROUND
  Orofacial granulomatosis (OFG) is a chronic granulomatous condition of the mouth, face and lips. Recent work demonstrates a high rate of atopy and silver birch sensitisation from skin prick testing (SPT). Oral allergy syndrome (OAS) is an acute oro-pharyngeal IgE mediated reaction, triggered by foods that cross react with pollens, most commonly silver birch. The aim of this study was to determine if patients with OFG and positive SPT to common OAS associated pollens responded to avoidance of cross reactive foods.
  
  
  METHODS
  Patients with OFG and positive SPT to silver birch, grass, mugwort, ragweed and latex were required to avoid cross reacting foods, for 6 weeks and, in those who responded, for a total of 12 weeks. All had standardized oral examinations and were given severity scores (SS) at each appointment.
  
  
  RESULTS
  Twenty two of 47 (47%) patients had one or more positive SPT and 13/22 completed 6 weeks on the diet. No difference was seen in SS between weeks 0 (14.62 ± 11.16) and 6 (13.31 ± 10.33; P = 0.656). Six of 14 (43%) had significantly improved SS (week 0; 19.17 ± 12.95, week 6; 10.83 ± 4.99, P = 0.027). Five completed 12 weeks and no further improvement was seen (week 6; 11 ± 5.57, week 12; 10.4 ± 9.94; P = 0.068). Two patients required no further treatments.
  
  
  CONCLUSIONS
  On an intention to treat basis, only 2/14 patients improved and required no further intervention. Whilst this diet cannot be recommended routinely, the improvement seen in some patients raises questions about the role of OAS in patients with OFG.
authors.affiliation: Diabetes and Nutritional Sciences Division, King's College London (KCL), London, UK. helen.1.campbell@kcl.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Campbell
authors.forename: M P
authors.initials: MP
authors.lastname: Escudier
authors.forename: J
authors.initials: J
authors.lastname: Brostoff
authors.forename: P
authors.initials: P
authors.lastname: Patel
authors.forename: P
authors.initials: P
authors.lastname: Milligan
authors.forename: S J
authors.initials: SJ
authors.lastname: Challacombe
authors.forename: J D
authors.initials: JD
authors.lastname: Sanderson
authors.forename: M C E
authors.initials: MC
authors.lastname: Lomer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D031164:Ambrosia / Q000276:immunology; D019306:Artemisia / Q000276:immunology; D029662:Betula / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000276:immunology; D003429:Cross Reactions / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000178:diet therapy* / Q000276:immunology; D051261:Granulomatosis, Orofacial / Q000145:classification / Q000178:diet therapy*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology; D007428:Intradermal Tests; D020315:Latex Hypersensitivity / Q000276:immunology; D008297:Male; D008875:Middle Aged; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology; D011446:Prospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology; D016896:Treatment Outcome; D055815:Young Adult
keywords: oral allergy syndrome; orofacial granulomatosis