Contact sensitivity to menthol and peppermint in patients with intra‐oral symptoms

Abstract

We report 12 cases of contact sensitivity to the flavouring agents menthol and peppermint oil in patients presenting with intra-oral symptoms in association with burning mouth syndrome, recurrent oral ulceration or a lichenoid reaction. The patients were referred from the Glasgow Dental Hospital over a 4-year period for assessment of the possible contribution of contact sensitivity to their complaints. 5 patients with burning mouth syndrome demonstrated contact sensitivity to menthol and/or peppermint, with 1 patient sensitive to both agents, 3 positive to menthol only and 1 to peppermint only. 4 cases with recurrent intra-oral ulceration were sensitive to both menthol and peppermint. 3 patients with an oral lichenoid reaction were positive to menthol on patch testing, with 2 also sensitive to peppermint. 9 of the 12 cases demonstrated additional positive patch test results. After a mean follow-up of 32.7 months (range 9-48 months), of the 9 patients that could be contacted, 6 patients described clearance or improvement of their symptoms as a consequence of avoidance of menthol/peppermint.

Contact allergy in oral disease

“…[1][2][3][4][5][6][7][8][9][10][11] However, few studies have used larger oral allergen screening series that, in addition to metals, included flavorings, preservatives, and dental acrylates. [12][13][14][15][16] We report the results of patch tests to the 85 allergens in our oral screening series.…”

Allergenic Potency of Spices: Hot, Medium Hot, or Very Hot

“…For example, peppermint or cinnamon oil are used to flavour toothpaste or are applied in dental care and have been shown to induce contact allergy [33, 34]. Other sources may be massage oils, which contain oil of cinnamon and cloves [35], and many cosmetics or essential oils are derived from ‘spicy’ sources, for instance star anise [36], sesame seed [37], vanilla [38] or rosemary [39].…”

Menthol: A Review of Its Sensitization Potential

“…He improved quickly after avoiding mint-flavored toothpastes. Morton et al [54] reported the largest series of patients with positive reactions to menthol and/or peppermint. They tested 512 patients complaining of intraoral symptoms with a large series of substances including menthol and peppermint oil.…”

“…Menthol and menthol-containing substances have resulted in dermatitis [43][44][45][46], perioral eczema [44,[47][48][49][50], cheilitis [49][50][51][52][53], stomatitis [54,55] and other intraoral reactions [48,51,54,55]. Allergic contact dermatitis from mint was first suggested by Sams in 1940 [43] as occupational allergic hand dermatitis in 2 Florida bartenders, who made drinks containing locally grown European mint (Mentha citrata).…”

“…This may be due to the characteristics of the oral mucosa (short period of contact and removal of the allergens with saliva), lack of recognition and, mostly, to the low sensitizing potential of these agents. However, some patients with oral symptoms can benefit from patch testing with an intended series of dental products, medicaments, flavors and food additives including menthol and menthol-containing products, such as peppermint oil [48,54,63]. Other reported sources of menthol hypersensitivity included foods and confectionery [45,48], hemorrhoid salves and suppositories [64].…”