title: Dietary and Nondietary Triggers of Oral Ulcer Recurrences in Behçet's Disease.
abstract: The nature and impact of food and other external triggers in recurrences of Behçet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and nondietary triggers of BD-related OU recurrences.
  
  
  
  Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (percentage) of positive responses.
  
  
  
  Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behçet's Disease classification criteria, and 53% qualified their OU recurrences during the previous 12 months as very discomforting or discomforting. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a "sure" trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37-47% of patients) and food (32-35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies.
  
  
  
  Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism.
authors.affiliation: Hospital Saint-Louis, University Paris Diderot, Paris, France.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Volle
authors.affiliation: Hospital Saint-Louis, University Paris Diderot, Paris, and Hospital Jean Verdier, University Leonard de Vinci, Bondy, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Fraison
authors.affiliation: Hospital Saint Antoine, University Pierre et Marie Curie, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Gobert
authors.affiliation: Hospital Bichat, University Paris Diderot, Paris, France.
authors.forename: Tiphaine
authors.initials: T
authors.lastname: Goulenok
authors.affiliation: Hospital Avicenne, University Leonard de Vinci, Bobigny, France.
authors.forename: Robin
authors.initials: R
authors.lastname: Dhote
authors.affiliation: Hospital Saint Antoine, University Pierre et Marie Curie, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fain
authors.affiliation: Hospital Saint-Louis, University Paris Diderot, Paris, France.
authors.forename: Solange
authors.initials: S
authors.lastname: Gonzalez-Chiappe
authors.affiliation: Hospital Delafontaine, Saint-Denis, France.
authors.forename: François
authors.initials: F
authors.lastname: Lhote
authors.affiliation: Hospital Bichat, University Paris Diderot, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Papo
authors.affiliation: Hospital Saint-Louis, University Paris Diderot, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Thuillier
authors.affiliation: Hospital Saint-Eloi, University Montpellier, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rivière
authors.affiliation: Hospital Saint-Louis, University Paris Diderot, and Sorbonne Paris Cité Research Center UMR 1153, Inserm, Paris, France.
authors.forename: Alfred
authors.initials: A
authors.lastname: Mahr
mesh_terms: D000328:Adult; D031230:Ananas / Q000009:adverse effects; D001528:Behcet Syndrome / Q000150:complications*; D002611:Cheese / Q000009:adverse effects; D002957:Citrus / Q000009:adverse effects; D004032:Diet / Q000009:adverse effects*; D005221:Fatigue / Q000150:complications*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009754:Nuts / Q000009:adverse effects; D019226:Oral Ulcer / Q000209:etiology*; D012008:Recurrence; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires