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  • 1.
    Kroona, Liv
    Malmö University, Faculty of Odontology (OD).
    Oral contact allergy to carvone: with a focus on oral lichen2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis examines carvone (l-carvone), a mint flavour, andcontact allergy to carvone with a focus on oral lichen. Carvone isa constituent of spearmint oil and is used to flavour toothpaste andfood. Like many flavours and fragrances, carvone may cause contactallergy, but the prevalence is low, between 1.6 and 2.8%. Affectedpatients often have perioral or oral signs. A couple of studies haveshown that patients with oral lichen planus or oral lichenoid lesionsoften have contact allergy to carvone but it is not known if theselichenoid lesions are a manifestation of contact allergy or part of theauto-immune disease, oral lichen planus.In paper I, the amount of carvone was measured in 66 toothpastesand the ingredient lists were studied. Carvone was detected in alltoothpastes with flavour, even fruit flavoured toothpaste, in up to0.35%. The measured concentrations were all within the safe use levelestimated to not induce contact allergy, but carvone concentrationsover 0.1% are high enough to elicit a reaction in already allergicindividuals. The regulation of carvone as a constituent in toothpastewas discussed.Registry data (age, sex, referring information and patch testsresults) on patients with a positive patch test reaction to carvonewas studied in paper II. Data was retrieved from 1996 to 2016 andwas compared with other patch tested groups not allergic to carvone.A matched comparison was also made between carvone-positive andcarvone-negative patients tested with the same test series. Patientswith contact allergy to carvone had a high mean age and were oftenwomen. According to the referrals, they often had oral signs and 57% had oral lichenoid lesions. In the matched comparison, oral(lichenoid) lesions were more common in carvone-positive patients.A provocation test (or use test) with carvone in toothpaste wasperformed in contact allergic subjects in paper III. Subjects with apositive patch test to carvone used toothpaste with 1 % carvoneduring a month. Subject with oral lichen and healthy controls alsoparticipated in the study. The oral mucosa and the perioral area wereexamined three times during the test. The subjects’ oral health-relatedquality of life was also assessed with a questionnaire (S-OHIP-49)before and after the use test. Carvone allergic patients exposedto toothpaste with carvone reacted with perioral eczema and/orincreased oral lichenoid lesions. They also had reduced quality of liferatings after the use test. It is concluded that the clinical appearance ofcontact allergy to flavour ingredients may mimic oral lichen planus.In paper IV, mucosal tissue samples from the subjects in paperIII were investigated with. The inflammatory pattern and immuneexpression were analysed in allergic subjects and subject with orallichen planus. No major differences were found between the groups;only Langerhans cells were more prevalent in oral lichen planus.For most of us, carvone is a harmless flavour despite the life-longexposure from toothpaste. However, for individuals with oral lichenthere is an increased risk to acquire contact allergy to carvone. Patientswith oral lichen and contact allergy to carvone may get aggravatedsymptoms when exposed to carvone. Contact allergic reactions tocarvone may imitate the clinical features of oral lichen planus andaffected patients are potentially left undiagnosed with contact allergyto carvone. Clinicians treating patients with OLP should be madeaware of this contact allergen and other soluble allergens.

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