Departments of Gastroenterology at Guy's & St, Thomas NHS Foundation Trust, London, UK.
Clin Transl Allergy. 2013 Aug 15;3(1):26. doi: 10.1186/2045-7022-3-26.
Orofacial granulomatosis (OFG) causes chronic, disfiguring, granulomatous inflammation of the lips and oral mucosa. A proportion of cases have co-existing intestinal Crohn's disease (CD). The pathogenesis is unknown but has recently been linked to dietary sensitivity. Although allergy has been suggested as an aetiological factor in OFG there are few published data to support this link. In this study, we sought clinical evidence of allergy in a series of patients with OFG and compared this to a series of patients with inflammatory bowel disease (IBD) without oral involvement and to population control estimates.
Prevalence rates of allergy and oral allergy syndrome (OAS) were determined in 88 patients with OFG using questionnaires, skin prick tests, total and specific serum IgE levels. Allergy was also determined in 117 patients with IBD without evidence of oral involvement (79 with CD and 38 with ulcerative colitis (UC)).
Prevalence rates of allergy in patients with OFG were significantly greater than general population estimates (82% versus 22% respectively p = <0.0005). Rates of allergy were also greater in those with CD (39%) and, interestingly, highest in those with OFG and concurrent CD (87%). Conversely, whist OAS was common in allergic OFG patients (35%) rates of OAS were significantly less in patients with concomitant CD (10% vs 44% with and without CD respectively p = 0.006). Amongst CD patients, allergy was associated with perianal disease (p = 0.042) but not with ileal, ileocolonic or colonic disease location. Allergy in UC (18%) was comparable to population estimates.
We provide compelling clinical evidence for the association of allergy with OFG whether occurring alone or in association with CD. The presence of gut CD increases this association but, conversely, reduces the expression of OAS in those with atopy. Interestingly, there is no evidence of increased allergy in UC.
口面肉芽肿病（OFG）可导致嘴唇和口腔黏膜发生慢性、毁容性、肉芽肿性炎症。一部分病例伴有并存的肠道克罗恩病（CD）。其发病机制尚不清楚，但最近与饮食敏感性有关。虽然过敏已被认为是 OFG 的病因因素，但很少有数据支持这种联系。在这项研究中，我们在一系列 OFG 患者中寻找过敏的临床证据，并将其与一系列无口腔受累的炎症性肠病（IBD）患者和人群对照估计值进行比较。
使用问卷、皮肤点刺试验、总血清 IgE 和特异性 IgE 水平，在 88 例 OFG 患者中确定过敏和口腔过敏综合征（OAS）的患病率。还在 117 例无口腔受累的 IBD 患者（79 例 CD 和 38 例溃疡性结肠炎（UC））中确定了过敏。
OFG 患者的过敏患病率明显高于一般人群估计值（分别为 82%和 22%，p<0.0005）。CD 患者的过敏患病率也较高（39%），有趣的是，同时患有 OFG 和 CD 的患者的过敏患病率最高（87%）。相反，虽然过敏性 OFG 患者的 OAS 很常见（35%），但同时患有 CD 的患者的 OAS 发生率明显较低（分别为 10%和 44%，有和无 CD 患者之间，p=0.006）。在 CD 患者中，过敏与肛周疾病有关（p=0.042），但与回肠、回结肠或结肠疾病部位无关。UC 中的过敏（18%）与人群估计值相当。
我们提供了令人信服的临床证据，证明过敏与 OFG 有关，无论是单独发生还是与 CD 相关。肠道 CD 的存在增加了这种关联，但相反，减少了过敏患者中 OAS 的表达。有趣的是，UC 中没有证据表明过敏增加。
