Dietary and Non-Dietary Triggers of Oral Ulcer Recurrences in Behçet's Disease

Objectives: The nature and impact of food and other external triggers in recurrences of Behcet's disease (BD)-related oral ulcers (OUs) remain unknown. This survey investigated dietary and non-dietary triggers of BD-related OU recurrences. Methods: Patients with BD who were followed in 7 French hospital departments completed a self-administered patient questionnaire. General and specific dietary triggering factors were sought in open questions. The questionnaire also included closed questions, notably to evaluate the effect of 6 general triggering situations and 24 selected foods. The results were expressed as number (%) of positive responses. Results: Among the 101 questionnaires distributed, 81 were usable. Among the 81 patients, 96% fulfilled the International Criteria for Behcet's Disease classification criteria and 53% qualified their OU recurrences during the previous 12 months as “very discomforting” or “discomforting”. For the 6 general situations suggested, 50 patients (62%) declared ≥1 as a “sure” trigger of OU recurrences. In both open and closed questions, the most frequent triggers were fatigue/stress (37–47% of patients) and food (32–35%). Among the 24 suggested foods, nuts (48%), pineapple (42%), peanuts (32%), Emmental cheese (30%), almonds (23%), lemons (22%), and other cheeses (21%) were the most frequently reported. The corresponding open question gave consistent findings but with lower frequencies. Conclusions: Most patients can identify triggers of recurring BD-related OUs, with fatigue/stress and food representing the most frequent triggers. The management of OU must consider such external factors. The histamine-rich or -liberating properties of the commonly cited OU-triggering foods suggest a hyperreactivity mechanism. This article is protected by copyright. All rights reserved.