Contact allergies to potential allergens in patients with oral lichen lesions

Increased Rates of Gold and Acrylate Allergy in Individuals with Fibromyalgia Tested with an Extended Dental Patch Test Series

Fibromyalgia is a common chronic pain condition. Rates of contact allergy in individuals with fibromyalgia have not been widely studied. Systemic contact allergy can present with muscle and joint pain and general malaise. The aim of this study is to investigate contact allergy rates in individuals with fibromyalgia to the sensitizers in an extended dental series and compare with control groups. Contact allergy to gold was significantly more common in the fibromyalgia group than the dermatitis control group. When corrected for patch test system, contact allergy to gold was significantly more common in the fibromyalgia group than the dental control group. Contact allergy to hydroxyethyl methacrylate and grouped acrylates and methacrylates was significantly more common in the fibromyalgia group than the dental control group. In conclusion, individuals with fibromyalgia may have a propensity to sensitization to gold, either via an increased exposure or an alteration in the oral environment. Gold is also implicated in systemic contact dermatitis and may be a factor in elicitation of symptoms in individuals with fibromyalgia. Acrylate allergy is also common in the fibromyalgia population and may be a consequence of occupational exposure or dental treatment.

Contact sensitisation in oral lichen planus: An Australian perspective

BACKGROUND

The role of contact sensitisation in the pathogenesis of oral lichen planus (OLP) has not been clearly defined.

OBJECTIVE

We aimed to evaluate relevant contact sensitisers in OLP.

METHODS

A retrospective study was conducted on OLP patients who underwent patch testing from 1 January 2006 to 31 December 2020 at an Australian tertiary dermatology institution, compared to cheilitis patients patch tested over the same time period.

RESULTS

Ninety-six OLP patients and 152 cheilitis patients were patch tested during the 15-year period. Seventy-one (73.9%) OLP patients and 100 (65.8%) cheilitis patients recorded one or more relevant reactions. Forty-three (44.8%), 22 (22.9%), 21 (21.9%) and 17 (17.7%) OLP patients had relevant reactions to mercury-related chemicals, amalgam, spearmint and carvone, respectively, compared to 6 (3.9%), 3 (2.0%), 4 (2.6%) and 0 (0%) cheilitis patients, respectively (p-value <0.001 each). Four (4.2%) OLP patients had relevant positive reactions to sodium metabisulfite, compared to none in the cheilitis group (p-value 0.021).

CONCLUSION

While dental amalgam is used less frequently these days, we report that mercury (found in amalgam) and additionally spearmint and carvone are relevant sensitisers in OLP in Australia. Sodium metabisulfite may also be a relevant sensitiser in OLP, which has not previously been reported.

Chemical Composition of Essential Oils from Nepeta transcaucasica Grossh. and Nepeta cataria L. Cultivated in Bulgaria and Their Antimicrobial and Antioxidant Activity

The genus Nepeta, belonging to the family Lamiaceae, includes about 300 species, most of which are used in folk medicine due to their pronounced biological properties. The aim of the present study was to evaluate the agrobiological characteristics of Nepeta transcaucasica (N. transcaucasica) Grossh. and Nepeta cataria (N. cataria) L., cultivated in Bulgaria, and obtain their essential oils and determine their antimicrobial and antioxidant activities. The agrobiological characteristics of the two species growing in Kazanlak were analyzed; therefore, high variability in the population of N. transcaucasica and comparative homogeneity in N. cataria was shown. The species N. transcaucasica contained 0.28% essential oil with main components β-citronellol (52.05%), eucalyptol (7.34%), β-citronellal (6.06%), germacrene D (5.45%), (Z)-β-ocimene (5.14%), and β-caryophyllene (3.06%). The species N. cataria consisted of 0.19% essential oil with main components β-citronellol (26.31%), geraniol (15.92%), neral (11.45%), nerol (9.56%), carvacrol (6.04%), and β-citronellal (5.35%). The antibacterial activity against Gram-positive bacteria Listeria monocytogenes and Staphylococcus aureus and Gram-negative bacteria Escherichia coli (E. coli) and Salmonella enterica subsp. enterica serovar Abony was determined. The essential oils showed antimicrobial activity only against E. coli. The diameters of the inhibition zones were found to be 26 mm for the species N. transcaucasica and 10 mm for the species N. cataria. The antioxidant activity of the two essential oils was also determined by four different methods, DPPH, ABTS, FRAP, and CUPRAC, with the highest values for the ABTS radical, for the species N. transcaucasica (48.72 μM TE/mL), and the species N. cataria (310 μM TE/mL).

The use of carvone in consecutive patch testing

BACKGROUND

Carvone (l-carvone) is a mint-tasting flavour additive that most of us is exposed to and can cause allergic contact reactions.

OBJECTIVES

To analyse the frequency and the relevance of positive carvone reactions in a dermatitis population.

METHOD

A retrospective analysis of dermatitis patients consecutively tested with carvone from 2017 to 2021. Data were retrieved from the department's patch-test database.

RESULTS

Of 3554 patients tested with carvone, 28 (0.79%) had a positive reaction. Carvone-positive patients had higher mean age, were significantly more likely female (p < 0.001) and had often an intraoral/lip involvement (p < 0.001). In the carvone-positive group, 50% (n = 14) had a relevant reaction, and in 4 of 14, the relevance was first revealed after test reading. Of the carvone-positive patients, 18 of 28 did not have a coexisting allergy to a fragrance/flavour allergen and of these 44% had a relevant allergy.

CONCLUSIONS

The study suggests that a significant fraction of relevant carvone contact allergies may be overlooked if the allergen is not tested. Furthermore, as the exposure is widespread, inclusion of carvone in the Swedish baseline series may be justified even if the contact allergy prevalence is below 1%.

Influence of vegetation on the composition of essential oil from (Melissa officinalis L.)

Lemon balm (Melissa officinalis L.) is a perennial plant of the family Lamiaceae, which is used in folk medicine and the food industry, as well as being processed to obtain essential oil. The aim of the special work is to monitor the influence of vegetation on the composition of the essential oil. The chemical composition of essential oils, obtained by steam distillation from lemon balm cultivated in North-eastern Bulgaria, has been determined. The plants were harvested in two periods of vegetation - the first at the end of June and second - at the end of August 2020. The main components in the oil from the first cut are geranial (26.41%), neral (19.55%), (E)-β-caryophyllene (17.46%), germacrene D (7.86%) and β-citronellal (3.24%). In the oil from the second cut, the main components are geranial (37.26%), neral (28.46%), (E)-β- caryophyllene (6.65%), geraniol (4.72%), and β-citronellal (3.04%). The oil from the second harvest has a high content of the main components of geranial, neral and geraniol and a lower content of (E)-β- caryophyllene and germacrene D. Variations in the amounts are also present in other compounds.

Patch Testing to Carvone: North American Contact Dermatitis Group Experience, 2009 to 2018

BACKGROUND/OBJECTIVES

Carvone, a flavoring agent, may cause allergic contact dermatitis. This study summarizes patch test reactions to carvone in patients tested by the North American Contact Dermatitis Group, 2009 to 2018.

METHODS

This was a retrospective analysis of patients positive to carvone (5% petrolatum). Demographics were compared with those of patients who were negative. Other analyses included reaction strength, clinical relevance, coreactivity with other fragrance/flavor allergens, and exposure sources.

RESULTS

Of 24,124 patients tested to carvone, 188 (0.78%) were positive. As compared with carvone-negative patients, carvone-positive patients were significantly more likely older than 40 years (P = 0.0284). Women (76.1%) and/or facial involvement (33.0%) were common in the carvone-positive group but not statistically different from carvone-negative patients; 73.3% (n = 138) of the reactions were currently relevant. Relevant sources were personal care products (46.3%, n = 87) and food (14.3%, n = 27). Coreactivity with other fragrance/flavor markers was present in 60.6% of carvone-positive patients, most commonly fragrance mix I (34.6%), balsam of Peru (24.5%), and cinnamic aldehyde (15.4%).

CONCLUSIONS

Ten-year prevalence of carvone sensitivity was 0.78%. Most carvone-positive patients were female, were older than 40 years, and/or had facial dermatitis. Personal care products were the most common source. Two-fifths of carvone reactions would have been missed by relying on other fragrance/flavoring allergens.

Oral Hypersensitivity Reactions

Allergic contact hypersensitivity reactions of the oral mucosa pose a significant medical concern for some patients. Oral hypersensitivity reactions can result from a vast number of allergenic chemicals, but occur commonly from dental materials, flavorings, and preservatives. Clinical presentation is varied and often overlaps with other oral conditions, complicating their diagnosis and management. The most common clinical entities associated with oral hypersensitivity reactions are oral lichenoid reactions and allergic contact cheilitis. In addition to reviewing these conditions and their most common corresponding allergens, this article summarizes the pathogenesis of oral hypersensitivity reactions and addresses patch testing pearls.

Amalgam Contact Allergy in Oral Lichenoid Lesions

BACKGROUND

Oral lichenoid lesions (OLLs) cannot be distinguished from oral lichen planus (OLP) except that causative factors can be identified. Amalgam is one of the causative allergens, and replacement may lead to resolution.

OBJECTIVES

The aim of this study was to determine the prevalence, prognosis, and aggravating factors of amalgam contact allergy in patients with OLLs.

METHODS

A clinical retrospective and prospective cohort study was carried out at the Dermatology Department, Siriraj Hospital, Mahidol University. In cases with patch test positive for an amalgam component, patients were suggested to replace their amalgam restorations.

RESULTS

Of 53 patients with OLLs, 39 (73.6%) had positive patch test results, and 31 (58.5%) reacted to at least one amalgam component. The most common causative allergen was mercury (35.8%). Lesions on bilateral buccal mucosa and gingiva tended to have negative patch test results (P < 0.05). Spicy food was the main aggravating factor. Amalgam replacements were performed in 10 patients. Clinical improvement was observed in all cases with complete healing in 3 cases.

CONCLUSIONS

The prevalence of amalgam contact allergy in patients with OLLs was 58.5%. Mercury was the most common allergen, followed by copper sulfate. An association between clinical, topographic relation, and positive patch test results would be a useful predictor for favorable outcome after amalgam removal.

Anti-inflammatory properties of a wound dressing combination of zinc oxide and turmeric extract

Aim:

The aim of this study was to determine the effect of a wound dressing consisting of a zinc oxide with turmeric extract combination as an anti-inflammatory on the healing process through the expression of MAC387 and cyclooxygenase-2 (COX-2).

Materials and Methods:

Forty Wistar rats were divided into four control and four treatment groups (n=5). On day 1, a 6 mm×6 mm square of skin in the area of the vertebralis thoracis was excised from all subjects. The wound was then dressed with a combination of zinc oxide and turmeric extract for the treatment groups, while the control groups were left undressed. Both the control and treatment groups were then sequentially sacrificed on days 3, 5, 7, and 14 to obtain subepithelial excision samples. These samples subsequently underwent immunohistochemistry examination through the expression of MAC387 and COX-2 to ascertain the anti-inflammatory reaction to the wound healing process.

Results:

The highest expression of MAC387 was found in the treatment group to which a dressing of zinc oxide with turmeric extract had been applied on the day 5 before slowly reducing on days 7 and 14. MAC387 peaked in the undressed control group on day 14. The COX-2 expression results in control groups showed their higher expression on day 3, increased up to day 5, began to decline on day 7 before, and finally, decreasing on day 14. This result was different to those treatment groups which presented a high COX-2 expression on day 3, before gradually decreasing between days 5 and 7 and reaching its lowest point on day 14.

Conclusion:

A wound dressing consisting of a combination of zinc oxide and turmeric extract has been proven effective as an anti-inflammatory in the healing process.

Quantification of l-carvone in toothpastes available on the Swedish market

BACKGROUND

Toothpastes have widespread use in the population, and contain flavours to give a pleasant and often minty aroma. Flavours are prevalent allergens in toothpastes, and adverse reactions often present as perioral dermatitis or stomatitis. l-Carvone, a mint flavour found in spearmint oil, is one of these allergens. There are few studies on contact allergy to l-carvone, and some of them have indicated a positive relationship with oral lichenoid lesions.

OBJECTIVES

To qualitatively and quantitatively investigate the presence of l-carvone in commercially available toothpastes on the Swedish market.

METHODS

l-Carvone in 66 toothpastes was analysed with straight-phase high-performance liquid chromatography. The product labels were studied with regard to limonene.

RESULTS

l-Carvone was found in 64 of 66 toothpastes (concentration: 0.00005-0.35%). In 10 of these, the concentration exceeded 0.1%. Higher concentrations of l-carvone were found if limonene was listed on the label.

CONCLUSION

The majority of toothpastes on the Swedish market contain l-carvone, but the concentration hardly relates to the advertised flavour or labelled ingredients. It is hitherto unknown whether the found concentrations are sufficient for induction of contact allergy in individuals with healthy oral mucosa or in those with oral lichenoid lesions or other mucosal disease.

Symptomatic oral lesions may be associated with contact allergy to substances in oral hygiene products

OBJECTIVE

Dental materials and oral hygiene products may be responsible for oral contact allergic reactions. We aimed to determine the occurrence of allergies in patients with symptomatic oral lichen planus (OLP), oral lichenoid lesions (OLLs) and stomatitis and investigate if patch testing could identify contact allergies to dental materials and oral hygiene products in these patients.

METHODS

Forty-nine patients (7 men, 42 women) aged 31 to 77 years (61 ± 10.3 years) with symptomatic OLP, OLL or stomatitis and 29 healthy age- and gender-matched control subjects were included. They underwent an interview, clinical examination, oral mucosal biopsy and epicutan testing to the European baseline series, a toothpaste and dental material series.

RESULTS

Nineteen patients had OLP, 19 OLL and 11stomatitis. Oral burning/itching was the most common symptom (83.7%), and 65.3% patients had more than one symptom. Patients visited their dentist more often than the healthy subjects and had statistically higher DMF-T and DMF-S scores. Nineteen patients (38.8%) and 10 healthy control subjects (34.5%) had allergic contact reactions primarily to fragrance ingredients. No differences could be found between OLP, OLL, stomatitis and healthy controls with regard to allergic contact reactions. However, contact allergy to aroma substances differed significantly between the patients and the healthy control subjects (p = 0.02). This type of contact allergy was most common in patients with OLP and OLL (p = 0.01). Avoidance cleared symptoms in all cases.

CONCLUSION/CLINICAL RELEVANCE

Allergic reactions to aroma substances in oral hygiene products are common in patients with symptomatic OLP, OLL and stomatitis.

Mucosal Lesions in an Allergy Practice

The diagnosis and treatment of mucosal disease with an allergic pathogenesis are challenging. Oral allergy is often a hypersensitivity reaction with variable symptoms and physical exam findings. Clinical diagnosis requires a history of prior allergen exposure, a delay from exposure to clinical findings, and improvement following allergen removal. The past decades have seen great contributions to the field of oral allergy. The aim of this review is to provide an approach to the diagnosis and treatment of oral dermatologic disease with a focus on diseases with an investigated allergic pathogenesis.

The role of patch testing in the management of oral lichenoid reactions

BACKGROUND AND OBJECTIVES

The distinction of oral lichenoid reactions from oral lichen planus may be difficult in a clinical setting. Our aims were to ascertain the utility of patch testing to confirm the association of oral lichenoid reactions with dental restorations and to identify the benefits of replacement of restorations, primarily made of amalgam.

METHODS

Patients seen in an oral medicine unit over a 10-year period diagnosed with oral lichenoid reactions, with oral lichen planus resistant to treatment or with atypical lichenoid features were included in this study. All had been subjected to skin patch testing. Histopathology reports blinded to patch test results were scrutinized. Patch-test-positive subjects were advised to have their restorations replaced. All were followed up to determine disease resolution for at least 3 months thereafter.

RESULTS

Among 115 patients, 67.8% patients reacted positive to a dental material and nearly a quarter to mercury or amalgam. No correlation was found between pathology and skin patch testing results (P = 0.44). A total of 87 patients were followed up in clinic, and among 26 patch-test-positive patients who had their amalgam fillings replaced, moderate to complete resolution was noted in 81%.

CONCLUSIONS

Skin patch testing is a valuable tool to confirm clinically suspected oral lichenoid reactions. Pathology diagnoses of oral lichenoid reactions did not correlate with patch test results. Prospective studies are needed to ascertain that a clinically suspected oral lichenoid reaction with a positive patch test result may resolve after the replacement of amalgam fillings.