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Not all recurring ulcers represent RAS, however, so the clinician must distinguish localized RAS from lesions arising from an underlying systemic disorder.Proposed causative factors for RAS include nutritional deficiency, immunologic factors, psychological stress, and dietary allergies, as well as trauma in patients with genetic susceptibility to RAS.RAS normally first arises in childhood or adolescence, predominantly between the ages of 10 and 19 years, with the frequency decreasing in subsequent years.The chance of children with RAS-positive parents presenting with RAS is high, up to 90%, while the chance of presentation in children with RAS-negative parents is just 20%.Phagocytic and cytotoxic T cells probably aid in destruction of oral epithelium that is directed and sustained by local cytokine release.Patients with active RAS have an increased proportion of gamma-delta T cells compared with control subjects and patients with inactive RAS.Children with extensive ulcers should receive proper diet and hydration, as they may avoid food intake as well as hydration.

Recurrent aphthous stomatitis (RAS) is a common ulcerative inflammatory condition of the oral cavity; it typically starts in childhood or adolescence as small recurrent, painful, round or ovoid ulcers with well-defined erythematous margins, like a halo, and a central yellow or gray floor. A positive family history of RAS is common, and the natural history typically involves resolution in the third decade of life.Cross-reactivity between a streptococcal 60- to 65-kd heat shock protein (hsp) and the oral mucosa has been demonstrated, and significantly elevated levels of serum antibodies to hsp are found in patients with RAS.Lymphocytes of patients with RAS have reactivity to a peptide of , which cross-react with the mitochondrial hsp and induce oral mucosal damage.In the study, patch testing was used to test for reactions to 23 food additives in 24 patients with RAS and 22 controls.The study found that 21 (87.5%) of the patients with RAS demonstrated positive patch test reactions to one or more allergens, compared with 3 (13.6%) of the controls, with the additives producing the most positive reactions in the RAS patients being cochineal red (15 patients; 62.5%), azorubine (11 patients; 45.8%), and amaranth (6 patients; 25%).

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