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Dietary management of orofacial granulomatosis: quantification of benzoates in foods and cosmetics

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Abstract:

Background: 

Orofacial granulomatosis (OFG) is a chronic inflammatory disorder of unknown aetiology that typically presents with lip swelling, although a number of intra-oral sites may also be affected. Management is challenging but recent evidence implicates dietary antigens. Benzoates are used as preservatives and occur naturally in some foods, particularly spices, some fruit and vegetables. A strict cinnamon and benzoate free diet is used as first line treatment with a clinical response in 68% patients (White et al., 2006). The benzoate free dietary treatment was recently extended to avoid cosmetics and toiletries containing benzoates. The aim of the current study is to quantify the level of added benzoates in food, cosmetics and toiletries for the development of education material to minimise benzoate exposure in long term management of OFG. Methods: 

Food, drink, cosmetic and toiletry manufacturers (n = 174) were identified by visiting local supermarkets and chemists. They were contacted by letter for information about whether benzoates were used in their products and, if so, at what levels. Companies that did not respond within 4 weeks were then contacted by telephone for information. An updateable database of benzoates in food, drinks, cosmetics and toiletries was developed for analysis of data and development of patient information. Results: 

Ninety manufacturers (51%) responded to the request for information on benzoates in their products. Sixteen manufacturers confirmed that some of their products (2–534) contained added benzoates. Of these, two food/drink and seven cosmetic/toiletry manufacturers provided quantitative data relating to the levels of benzoates in their products. A total of 136 products contained benzoates (foods 0.54–0.8 mg kg−1, non alcoholic drinks 140 mg L, cosmetics 5.2–11 511 mg kg−1, pharmaceuticals 0.001–0.25 mg/100 mL), while all other products were free from added benzoates. Discussion: 

Obtaining quantitative data on the level of benzoates in the diet, cosmetics and toiletries is difficult due to manufacturers’ unwillingness to disclose information. Further research using an analytical technique may be the way forward to further quantify benzoates added to food, drinks, cosmetics and toiletries. It would also help to establish the levels at which benzoates occur naturally in some foods. Conclusions: 

Identification of the amount of benzoates in the diet, cosmetics and toiletries is not easy and using an analytical method to measure benzoates in products directly may help to increase quantitative information. Reference 

White, A., Nunes, C., Escudier, M., Lomer, M.C.E., Barnard, K., Shirlaw, P., Challacombe, S.J. & Sanderson, J.D. (2006) Improvement in oro-facial granulomatosis on a cinnamon and benzoate free diet. Inflamm. Bowel Dis.12, 508–514.

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-277X.2008.00881_34.x

Affiliations: 1: Nutritional Sciences Division, King's College London, UK 2: Department of Nutrition and Dietetics, London, UK

Publication date: August 1, 2008

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