A possible link between cow milk and recurrent aphtous stomatitis

Frequencies of abnormal humoral and cellular immune component levels in peripheral blood of patients with recurrent aphthous ulceration

BACKGROUND/PURPOSE

Recurrent aphthous ulceration (RAU) has an incidence of approximately 20% in general population. However, its exact cause remains unknown. Increasing evidence suggests that immunologic mechanisms may play crucial roles in the etiology of this disease.

MATERIALS AND METHODS

The peripheral blood samples were obtained from 85 patients with RAU during acute phase and 87 healthy controls. The serum levels of IgG, IgA, IgM, C3 and C4 were measured by immunoturbidimetry. In addition, the serum IgE levels were measured by electro-chemiluminescence immunoassay. Furthermore, the percentages of B, T, CD4+ T, CD8+ T lymphocytes and natural killer (NK) cells in peripheral blood were determined by flow cytometry.

RESULTS

Our findings showed that the serum IgG, IgA, IgE, C3 and C4 levels of RAU patients were significantly higher than those of healthy controls. The percentages of CD4+ T cells and B cells in peripheral blood of RAU patients were significantly decreased, whereas the percentages of CD8+ T cells and NK cells of RAU patients were remarkably increased. Our results indicated that the IgG level was elevated in 18 patients (21.2%) and that the IgE level was increased in 21 patients (24.7%). Our results also showed that the frequency of abnormal IgG or IgE levels were significantly correlated with that of abnormal CD8+ T cell percentage in RAU patients.

CONCLUSION

The levels of both humoral and cellular immune components could be altered in RAU. The relationship between humoral and cellular immune may be potentially important immunologic aspects involved in the pathogenesis of RAU.

Salivary Alpha-Amylase Enzyme, Psychological Disorders, and Life Quality in Patients with Recurrent Aphthous Stomatitis

Objective. The aim of this study was to evaluate stress, anxiety, and salivary alpha-amylase (SAA) activity in patients with recurrent aphthous stomatitis (RAS). The impact of this disease on the life quality was also evaluated. Design. Twenty-two patients with RAS and controls, matched by sex and age, were selected. Stress and anxiety were assessed using Lipp's Inventory of Stress Symptoms and Beck Anxiety Inventory. Life quality was assessed through the World Health Organization Quality of Life-bref (WHOQOL-BREF) and the Oral Health Impact Profile-14 (OHIP-14). Saliva samples were collected in the morning and afternoon and the SAA activity was analyzed by enzymatic kinetic method. Results. No significant difference was observed between the groups regarding the SAA activity (p = 0.306). Patients with RAS had higher scores of anxiety (p = 0.016). The scores of WHOQOL-BREF were significantly lower in patients with RAS. The values obtained through OHIP-14 were significantly higher in these patients (p = 0.002). Conclusion. RAS negatively affects the life quality. Patients with the disease have higher levels of anxiety, suggesting its association with the etiopathogenesis of RAS.

Resolution of recurrent aphthous ulcers after discontinuation of cow's milk protein intake

BACKGROUND AND OVERVIEW

Authors of published studies have reported elevated levels of circulating antibodies to cow's milk protein (CMP) in patients with recurrent aphthous ulcers (RAUs), and authors of case reports have described resolution of RAU after dairy elimination.

CASE DESCRIPTION

A 10-year-old girl and an 11-year-old boy, both with 5-year histories of frequent RAU episodes, with multiple ulcerations, underwent dairy elimination trials. Both were free of oral ulcers within 2 weeks of discontinuing CMP and remained so with a CMP-free diet. In addition, the first patient had recurrence of ulcerations after occasional ingestion of CMP-containing foods. She showed elevated blood levels of immunoglobulin E in reaction to CMP and soy. Soy intake did not trigger the ulcerations.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The proportion of patients with RAU in whom CMP acts as a trigger is unknown. However, CMP elimination trials are safe and feasible and, therefore, should be considered, particularly before use of medications with potential side effects.

Predicting recurrent aphthous ulceration using genetic algorithms-optimized neural networks

Objective

To construct and optimize a neural network that is capable of predicting the occurrence of recurrent aphthous ulceration (RAU) based on a set of appropriate input data.

Participants and methods

Artificial neural networks (ANN) software employing genetic algorithms to optimize the architecture neural networks was used. Input and output data of 86 participants (predisposing factors and status of the participants with regards to recurrent aphthous ulceration) were used to construct and train the neural networks. The optimized neural networks were then tested using untrained data of a further 10 participants.

Results

The optimized neural network, which produced the most accurate predictions for the presence or absence of recurrent aphthous ulceration was found to employ: gender, hematological (with or without ferritin) and mycological data of the participants, frequency of tooth brushing, and consumption of vegetables and fruits.

Conclusions

Factors appearing to be related to recurrent aphthous ulceration and appropriate for use as input data to construct ANNs that predict recurrent aphthous ulceration were found to include the following: gender, hemoglobin, serum vitamin B12, serum ferritin, red cell folate, salivary candidal colony count, frequency of tooth brushing, and the number of fruits or vegetables consumed daily.