Recurrent aphthous stomatitis caused by food allergy

Abstract

Recurrent Aphthous Stomatitis (RAS) is one of the most common oral lesions which occur either in single or multiple forms in oral mucosa. The mouth is subjected to a wide spectrum of antigenic agents, including foodstuff, and allergic reactions to such antigens may manifest in a number of diverse ways. Food allergy, however, has not been widely investigated as the cause of RAS. The main complaint of RAS typically is pain, and the main therapy is still corticosteroids, besides avoiding allergenic foodstuff. In RAS, there is often a genetic basis. More than 42 percent of patients with RAS have first-degree relatives with RAS. The likelihood of RAS is 90 percent when both parents are affected, but only 20 percent when neither parent has RAS, and it is also likely to be more severe and to start at an earlier age in patients with a positive family history. The primary goals of therapy of RAS are relief of pain, reduction of ulcer duration, and restoration of normal oral function. The secondary goals include reduction in frequency and severity of recurrences and maintenance of remission. Diagnostic elimination diets are frequently utilized both in diagnosis and management of RAS caused by food allergy. Patients with RAS may have increased levels of CD8+ T-lymphocytes and/or decreased CD4+ T-lymphocytes. There may be a reduced percentage of "virgin" T-cells and an increased of "memory" T-lymphocytes. Patients with active RAS have an increased proportion of gd T-cells compared with healthy control subjects and RAS patients with inactive disease. The gd T-cells may play a role in ADCC and it is believed that gd T-cells play a role in immunological damages. Preventive treatment is a consideration for patients with RAS caused by food allergy who report regular exacerbations of their condition. It focuses on dietary modifications, the earliest stage, the prodromal stage, and attempts to intercept ulcer development again by the use of topical immunosuppressant and particularly corticosteroids.