Dietary intervention for oral allergy syndrome as a treatment in orofacial granulomatosis: a new approach?

BackgroundOrofacial 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. MethodsPatients with OFG and positive SPT to silver birch, grass, mugwort, ragweed and latex were required to avoid cross reacting foods, for 6weeks and, in those who responded, for a total of 12weeks. All had standardized oral examinations and were given severity scores (SS) at each appointment. ResultsTwenty two of 47 (47%) patients had one or more positive SPT and 13/22 completed 6weeks on the diet. No difference was seen in SS between weeks 0 (14.6211.16) 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 12weeks 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. ConclusionsOn 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.