"Common sensitivities identified, predominantly through patch testing, were to benzoic acid (36%) food additives (33%), perfumes and flavourings (28%), cinnamaldehyde (27%), cinnamon (17%), benzoates (17%) and chocolate (11%). The cinnamon- and benzoate-free diet has been shown to provide benefit in 54–78% of patients with 23% requiring no adjunctive therapies. A negative or positive patch test result to cinnamaldehyde, and benzoates did not predict dietary outcome. The most concentrated source of benzoate exposure is from food preservatives. Use of liquid enteral formulas can offer a further dietary therapy, particularly in children with orofacial granulomatosis. Management of orofacial granulomatosis is challenging but cinnamon- and benzoate-free diets appear to have a definite role to play."
"Looking in the mouth for Crohn's disease" in Inflammatory Bowel Diseases (2010)
"For many patients who are found to have OCD manifestations at the time of assessment for CD, the oral findings are not clinically problematic and often may be completely asymptomatic.10 These patients may not need specific oral treatment and the majority will resolve over time.23 On the other hand, patients with OFG and the more florid manifestations of OCD may have very troublesome symptoms and often need medical intervention. The approach to treatment of these patients recently has been reviewed.30 Some authors advocate food exclusion, particularly exclusion of foods containing additives, such as cinnamaldehyde and benzoate. This approach is supported by the findings of a recent open nonrandomized study of patients with OFG who appear to have achieved considerable reduction in inflammation using this approach.39
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In conjunction with our dental colleagues, our approach is to attempt a cinnamon- and benzoate-free diet in the first instance."
"Improvement in Orofacial Granulomatosis on a Cinnamon- and Benzoate-free Diet" in Inflammatory Bowel Disease (2006)
"Orofacial granulomatosis (OFG) is a chronic inflammatory disorder presenting characteristically with lip
swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Most cases of OFG occur as a separate clinical entity, but a proportion present in association with established Crohn`s disease of the small or large intestine. ... Although Crohn`s disease and OFG share a number of clinical and histological features, the exact relationship between the 2 conditions is unknown. We have demonstrated that microscopic granulomatous inflammation is frequently present in the intestine of patients with OFG despite a lack of gut symptoms. Few studies have addressed the immunological features of OFG and Crohn`s disease, and at present, it seems likely that these are 2 separate clinical entities.
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In conclusion, the results of this study suggest that dietary manipulation with a CB-free [cinnamon- and benzoate] diet is effective as a first-line approach for OFG [orofacial granulomatosis]. We suggest that all newly confirmed patients with OFG be offered a CB-free diet as first-line therapy for an initial period of 8 weeks. Topical and systemic immunomodulatory therapies may then be avoided or used as second-line treatments. OFG presents a difficult clinical challenge and, although rare, is important because of the significant physical and psychological morbidity it creates in young individuals. Further studies are needed to determine not only the cause but also whether more specific dietary regimens may be fully effective as sole treatment."
"Orofacial granulomatosis (OFG) is a chronic inflammatory disorder presenting characteristically with lip
swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Most cases of OFG occur as a separate clinical entity, but a proportion present in association with established Crohn`s disease of the small or large intestine. ... Although Crohn`s disease and OFG share a number of clinical and histological features, the exact relationship between the 2 conditions is unknown. We have demonstrated that microscopic granulomatous inflammation is frequently present in the intestine of patients with OFG despite a lack of gut symptoms. Few studies have addressed the immunological features of OFG and Crohn`s disease, and at present, it seems likely that these are 2 separate clinical entities.
...
In conclusion, the results of this study suggest that dietary manipulation with a CB-free [cinnamon- and benzoate] diet is effective as a first-line approach for OFG [orofacial granulomatosis]. We suggest that all newly confirmed patients with OFG be offered a CB-free diet as first-line therapy for an initial period of 8 weeks. Topical and systemic immunomodulatory therapies may then be avoided or used as second-line treatments. OFG presents a difficult clinical challenge and, although rare, is important because of the significant physical and psychological morbidity it creates in young individuals. Further studies are needed to determine not only the cause but also whether more specific dietary regimens may be fully effective as sole treatment."
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