Everyday Foods and Drinks Linked to Allergic Contact Cheilitis: Case Study Implies Role of Sulfites and Cinnamon

One patient, an 81-year-old woman, sought medical help after experiencing recurrent swelling and erythema on her lower lip, accompanied by a burning sensation in her oral mucosa. These symptoms persisted for six months, disappearing intermittently without any clear cause. Despite consulting multiple specialists and undergoing various tests, including biopsies and serological examinations, no autoimmune condition was diagnosed. However, a patch test revealed a positive reaction to sodium metabisulphite, a preservative commonly found in sparkling wines. The patient’s daily consumption of wine, containing about 170 ppm of sulphite, was identified as the trigger. Upon discontinuing the wine, her symptoms improved, confirming the diagnosis of allergic contact cheilitis due to sulphites in beverages.

This case underscores the significance of considering beverages, particularly alcoholic drinks containing sulphites, as potential allergens. Sulphites, both naturally occurring and as additives in wine, have been increasingly recognized as a cause of allergic reactions. Despite being included in baseline patch testing, sulphites may be misclassified as irritants rather than allergens. It is essential for clinicians to thoroughly investigate potential sources of allergens in non-occupational settings, such as daily food and drink habits.

Another case involved a 50-year-old woman referred for suspected autoimmune disease due to persistent aphthous ulcers on her lower lip and swelling around her eyelids. Initial investigations ruled out conditions like lupus and dermatomyositis. Patch testing, however, revealed positive reactions to several allergens, including cinnamic alcohol, a compound found in cinnamon. A detailed history revealed her daily consumption of apples with cinnamon, which she was advised to stop. Within weeks, her symptoms completely disappeared, confirming the diagnosis of allergic contact stomatitis caused by cinnamon.

Both cases highlight the critical role of patch testing in diagnosing allergic contact cheilitis and stomatitis. These conditions often result from allergens in everyday foods and beverages, such as sulphites and cinnamon. Clinicians should consider ACD in cases of persistent or unexplained oral symptoms and take a comprehensive history to identify potential triggers. Avoidance of the offending agent remains the primary treatment, offering relief and preventing recurrence.

The increasing recognition of food and beverage-related ACD calls for greater awareness among healthcare providers to better diagnose and manage this often underreported condition.

"Comprehensive patient history and patch testing are crucial for pinpointing contact allergens responsible for treatment-resistant oral ulcers," the researchers concluded.

Reference:

Kerre, S., & Goossens, A. Allergic contact cheilitis/stomatitis due to beverages and food, an underreported diagnosis. Contact Dermatitis. https://doi.org/10.1111/cod.14725