Minciullo Paola Lucia, Paolino Giovanni, Vacca Maddalena, Gangemi Sebastiano, Nettis Eustachio
School and Division of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital "G. Martino", Messina, Italy.
Unit of Dermatology, "Sapienza" University of Rome, Rome, Italy.
Clin Mol Allergy. 2016 Sep 1;14(1):10. doi: 10.1186/s12948-016-0047-y. eCollection 2016.
The oral mucosa including the lips is constantly exposed to several noxious stimuli, irritants and allergens. However, oral contact pathologies are not frequently seen because of the relative resistance of the oral mucosa to irritant agents and allergens due to anatomical and physiological factors. The spectrum of signs and symptoms of oral contact allergies (OCA) is broad and a large number of condition can be the clinical expression of OCA such as allergic contact stomatitis, allergic contact cheilitis, geographic tongue, oral lichenoid reactions, burning mouth syndrome. The main etiological factors causing OCA are dental materials, food and oral hygiene products, as they contain flavouring agents and preservatives. The personal medical history of the patient is helpful to perform a diagnosis, as a positive history for recent dental procedures. Sometimes histology is mandatory. When it cannot identify a direct cause of a substance, in both acute and chronic OCA, patch tests can play a pivotal role in the diagnosis. However, patch tests might have several pitfalls. Indeed, the presence of metal ions as haptens and specifically the differences in their concentrations in oral mucosa and in standard preparation for patch testing and in the differences in pH of the medium might result in either false positive/negative reactions or non-specific irritative reactions. Another limitation of patch test results is the difficulty to assess the clinical relevance of haptens contained in dental materials and only the removal of dental materials or the avoidance of other contactant and consequent improvement of the disease may demonstrate the haptens' responsibility. In conclusion, the wide spectrum of clinical presentations, the broad range of materials and allergens which can cause it, the difficult interpretation of patch-test results, the clinical relevance assessment of haptens found positive at patch test are the main factors that make sometimes difficult the diagnosis and the management of OCA that requires an interdisciplinary approach to the patient.
包括嘴唇在内的口腔黏膜不断受到多种有害刺激物、刺激原和过敏原的影响。然而，由于解剖学和生理学因素，口腔黏膜对刺激剂和过敏原具有相对抵抗力，因此口腔接触性病变并不常见。口腔接触性过敏（OCA）的体征和症状范围广泛，许多病症都可能是OCA的临床表现，如过敏性接触性口炎、过敏性接触性唇炎、地图舌、口腔苔藓样反应、灼口综合征。导致OCA的主要病因是牙科材料、食物和口腔卫生用品，因为它们含有调味剂和防腐剂。患者的个人病史有助于进行诊断，如近期牙科治疗的阳性病史。有时组织学检查是必要的。当无法确定某种物质是直接病因时，在急性和慢性OCA中，斑贴试验在诊断中可发挥关键作用。然而，斑贴试验可能存在一些缺陷。实际上，作为半抗原的金属离子的存在，特别是它们在口腔黏膜、斑贴试验标准制剂中的浓度差异以及介质pH值的差异，可能导致假阳性/阴性反应或非特异性刺激性反应。斑贴试验结果的另一个局限性是难以评估牙科材料中所含半抗原的临床相关性，只有去除牙科材料或避免接触其他接触物并随之改善病情，才能证明半抗原的作用。总之，临床表现范围广泛、可导致该病的材料和过敏原种类繁多、斑贴试验结果难以解释、对斑贴试验呈阳性的半抗原进行临床相关性评估，这些都是有时使OCA的诊断和管理变得困难的主要因素，而OCA需要对患者采取跨学科方法。
