Could Food and Additives Be Triggering Persistent Oral and Perioral Diseases?
New insights from allergy testing in patients with burning mouth syndrome, cheilitis, and related conditions
Why Oral and Perioral Allergies Matter
The mouth and the skin around it are constantly exposed to what we eat and drink. From everyday foods to food additives, this area faces a continuous stream of potential allergens. For some people, this exposure may contribute to persistent or recurrent conditions such as burning mouth syndrome, cheilitis, angioedema, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis.
While these conditions are often difficult to diagnose and manage, allergies—especially immediate-type allergic reactions—may be an overlooked piece of the puzzle.
What Did the Researchers Aim to Find Out?
Previous studies on oral and perioral diseases mainly focused on delayed allergic reactions, using patch tests. However, immediate-type allergies, which occur shortly after exposure, had received far less attention.
Researchers from Croatia set out to answer a key question:
Are food and food additive allergies more common in patients with persistent oral and perioral diseases than in healthy individuals?
To explore this, they used skin prick tests, a standard method to detect immediate allergic reactions.
How Was the Study Conducted?
The five-year prospective study involved 230 participants:
180 patients diagnosed with one of six oral or perioral conditions
50 healthy individuals as a control group
Each disease group consisted of 30 patients. The researchers tested reactions to:
Foods such as fruits, vegetables, mushrooms, milk, meat, fish, eggs, and flour
Food additives including citric acid, glutaraldehyde, sodium glutamate (MSG), potassium metabisulfite, sodium benzoate, and tartrazine
A reaction was considered positive if a visible skin response appeared within 15 minutes.
Key Findings: Allergies Were Not Rare
The results revealed that immediate-type allergies were more common in patients than in healthy controls.
Food allergies
Detected in 8.3% of patients
Most frequent in:
Burning mouth syndrome (16.7%)
Cheilitis (13.3%)
The most common triggers were fruits, vegetables, and mushrooms
Additive allergies
Found in 17.8% of patients
Most frequent in:
Burning mouth syndrome
Angioedema
Cheilitis
The most common additives involved were:
Glutaraldehyde
Citric acid
Sodium glutamate (MSG)
In comparison, positive allergy tests were less frequent among healthy individuals.
Why Are These Results Important?
Many oral and perioral conditions are chronic, uncomfortable, and frustrating for both patients and clinicians. This study suggests that hidden allergies to everyday foods and additives may contribute to persistent symptoms, especially in cases where no clear cause is found.
Importantly, identifying these allergies opens the door to a practical intervention:
avoiding the offending food or additive.
What Can Clinicians and Patients Take Away?
The findings highlight the importance of:
Considering food and additive allergies in patients with long-lasting oral or perioral symptoms
Using skin prick tests as part of a comprehensive diagnostic approach
Providing targeted dietary and lifestyle advice once allergens are identified
Rather than treating symptoms alone, addressing underlying allergic triggers may improve long-term outcomes.
Conclusion
This study reinforces the idea that what we eat—and what is added to our food—can influence oral and perioral health. In patients with persistent or unexplained symptoms, immediate-type allergies should not be overlooked. Incorporating allergy testing into clinical evaluation may help uncover hidden triggers and support more effective, personalized care.
Original Article Reference
Domić I, Budmir J, Novak I, Mravak-Stipetić M, Lugović-Mihić L.
Assessment of allergies to food and additives in patients with angioedema, burning mouth syndrome, cheilitis, gingivostomatitis, oral lichenoid reactions, and perioral dermatitis.
Acta Clinica Croatica. 2021;60(2):276–281.
DOI: 10.20471/acc.2021.60.02.14