Dear Dr. K: Dear Dr. K: I get recurrent aphthous ulcers in my mouth and on my tongue. Is this an allergic problem?
Known by various names, including canker sores, this condition of recurrent aphthous stomatitis (RAS) can be due to allergy, but that is one of the least frequent causes. Several systemic illnesses have RAS as part of their disease complex, including Behcet’s disease with RAS, genital ulcers, eye disease and neurologic symptoms; MAGIC syndrome with RAS, genital ulcers and inflamed cartilage; PFAPA syndrome with RAS, periodic fever and swollen lymph nodes; SWEET syndrome with RAS, periodic fever and significant skin rash, and Cyclic neutropenia with RAS, fever every 15 to 24 days and a low white blood count.
In terms of allergy, RAS is very rarely seen as a response to food allergy, but more commonly as an allergy to tooth paste – especially kinds that contain sodium lauryl sulfate. Very rarely it occurs from chewing gums that contain balsam of Peru.
Factors that predispose to, but don’t cause RAS are mouth trauma, tobacco, alcohol and poor nutrition. Occasionally RAS is seen from vitamin deficiencies including B1, B2, B6 and B12, folic acid and zinc. Another uncommon cause is Herpes virus that causes internal sores instead of the usual external fever blisters.
Some medicines can also cause RAS: Beta-blockers, ACE-inhibitors, antibiotics, some anti-arrhythmic drugs, NSAIDs and nicorandil. And there’s more: although uncommon, RAS can be a manifestation of celiac disease (gluten sensitivity). Whew! Pesky ulcers can have many causes!
Therapies vary depending on the cause and severity of the condition. Deficiencies in zinc, folic acid, iron and vitamins can be treated with replacement supplements. Avoiding foods that are irritating, such as alcohol, carbonated drinks, spicy foods and acidic foods can help keep the mucous membranes healthy.
Topical steroids in an oral base can be applied to the ulcers, and mouth rinses with the antibiotic tetracycline help some patients. Application of silver nitrate can cauterize and heal resistant ulcers. Medicated tooth pastes also can help healing.