Unmet diagnostic needs in contact oral mucosal allergies.
Unmet diagnostic needs in contact oral mucosal allergies.
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DOI：
10.1186/s12948-016-0047-y
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Nettis E
中科院分区：
文献类型：
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作者：
Minciullo PL;Paolino G;Vacca M;Gangemi S;Nettis E
包括嘴唇在内的口腔粘膜经常暴露在几种有害刺激、刺激物和过敏原中。然而，口腔接触性病变并不常见，因为由于解剖和生理因素，口腔粘膜对刺激性物质和过敏原具有相对抵抗力。口腔接触性变态反应(OCA)的体征和症状谱广，大量情况可作为OCA的临床表现，如变应性接触性口炎、变应性接触性唇炎、地理舌象、口腔苔藓样反应、灼口综合征等。引起OCA的主要致病因素是牙科材料、食品和口腔卫生产品，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，作为最近牙科手术的阳性病史。有时组织学是必修课。当它不能确定一种物质的直接原因时，无论是在急性还是慢性OCA中，斑贴测试都可以在诊断中发挥关键作用。然而，补丁测试可能有几个陷阱。事实上，金属离子作为半抗原的存在，特别是它们在口腔粘膜和斑贴测试标准制剂中的浓度差异，以及介质的pH值差异，可能会导致假阳性/阴性反应或非特异性刺激反应。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的半抗原的临床相关性，只有移除牙科材料或避免其他接触物并随后改善疾病才能证明半抗原的责任。总之，临床表现的广泛性、导致OCA的材料和过敏原的广泛范围、斑贴试验结果的难以解释、斑贴试验阳性的半抗原的临床相关性评估是导致OCA诊断和治疗有时困难的主要因素，这需要对患者进行跨学科的处理。
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.