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Plants and Plant Products 41 Christophe J 41_751_800 05.11.2005 11:33 Uhr Seite 751 Chapter 41 Plants and Plant Products 41 Christophe J. Le Coz, Georges Ducombs Contents 41.3.14.1 Araliaceae (Ginseng, Aralia, Ivy Family) . 785 41.1 Introduction . 751 41.3.14.2 Papaveraceae (Poppy Family) . 786 41.3.14.3 Guttiferae (St John’s Wort 41.2 Clinical Pictures . 752 or Mangosteen Family) . 786 41.2.1 Immediate-Type Reactions . 752 41.3.14.4 Hydrangeaceae . 786 41.2.1.1 Contact Urticaria . 752 41.3.14.5 Iridaceae (Iris Family) . 786 41.2.1.2 Protein Contact Dermatitis . 753 41.3.14.6 Solanaceae (Nightshade Family) . 786 41.2.2 Irritant Contact Dermatitis . 754 41.4 Diagnosis of Plant Dermatitis . 787 41.2.2.1 Mechanical Irritation . 754 41.4.1 Raw Plants . 787 41.2.2.2 Chemical Irritation . 755 41.4.1.1 Plant Identification . 787 41.2.3 Allergic Contact Dermatitis . 755 41.4.1.2 Prick Tests . 787 41.2.3.1 Acute ACD: Acute Eczema . 755 41.4.1.3 Patch Tests . 787 41.2.3.2 Chronic ACD and the Example of “Tulip Fingers” . 755 41.4.2 Plant Extracts . 788 41.2.3.3 Erythema Multiforme-like 41.4.3 Allergen Identification . 788 and Atypical Dermatitis . 757 41.4.4 Commercial Allergens . 788 41.2.3.4 Airborne Contact Dermatitis . 758 41.4.5 Photopatch Testing . 788 41.2.4 Photodermatitis (Phytophotodermatitis) . 758 41.4.6 Results and Relevance . 789 41.2.4.1 Phytophototoxicity . 758 41.4.7 Multiple Plant Reactions 41.2.4.2 Phytophotoallergic Contact Dermatitis . 761 and Cross-sensitivity . 790 41.3 Inducers of Dermatitis . 761 41.5 Prevention and Treatment . 790 41.3.1 Alliaceae (Onion Family) . 761 41.5.1 Removal of the Allergens and Irritants . 790 41.3.2 Alstroemeriaceae (Alstroemer Family) 41.5.2 Barrier Creams . 790 and Liliaceae (Lily Family) . 762 41.5.3 Gloves . 790 41.3.3 Amaryllidaceae (Daffodil Family) . 764 41.5.4 Acute Dermatitis . 790 41.3.3.1 Anacardiaceae, Ginkgoaceae, and Proteaceae 764 41.5.5 Chronic Dermatitis . 790 41.3.4 Compositae (Asteraceae) and Liverworts . 769 41.5.6 Hyposensitization . 791 41.3.4.1 Asteraceae/Compositae (Daisy Family) . 769 41.6 Example of Botanical Nomenclature . 791 41.3.4.2 Liverworts (Jubulaceae) . 772 References . 791 41.3.4.3 Sesquiterpene Lactone Allergens . 772 41.3.5 Cruciferae (Cabbage or Mustard Family, Brassicaceae) . 774 41.3.6 Euphorbiaceae (Spurge Family) . 775 41.3.7 Lichens . 776 41.3.8 Primulaceae (Primrose Family) . 778 41.1 Introduction 41.3.9 Ranunculaceae (Buttercup Family) . 779 41.3.10 Umbelliferae/Apiaceae (Carrot Family), Contact dermatitis from plants or plant products, Rutaceae (Rue Family) and Moraceae phytodermatitis (Mulberry Family) . 780 , is frequently observed in clinical 41.3.11 Woods . 781 practice. It is likely that the most frequent reactions 41.3.11.1 American and Australian Woods . 782 of this type, which occur due to occasional and irri- 41.3.11.2 Asian Woods . 783 tant contacts such as those encountered during lei- 41.3.11.3 African Woods . 783 sure activities,are not seen by dermatologists.Practi- 41.3.11.4 European Woods . 784 tioners usually see more severe dermatitis cases, with 41.3.12 Mushrooms . 785 irritant or allergic mechanisms, of immediate or de- 41.3.13 Ferns . 785 layed type, and sometimes photoworsened or even 41.3.14 Miscellaneous Plants . 785 photoinduced dermatitis. 41_751_800 05.11.2005 11:33 Uhr Seite 752 752 Christophe J. Le Coz, Georges Ducombs The exact incidence of dermatitis from plants and tanical Dermatology Database, owner Richard J. plant products is not known, but this problem is not Schmitt, see http : //bodd.cf.ac.uk/index.html) for its rare. Many patients likely self-medicate following interesting content [10]. self-diagnosis or diagnosis by a pharmacist,or attend their family doctor who prescribes palliative treat- ment without necessarily ascertaining the cause of 41.2 Clinical Pictures the skin reaction. In other instances, cases do reach the dermatologist. For example, among 1752 patients 41.2.1 Immediate-Type Reactions considered to have occupational dermatitis, Fregert found that 8% of women and 6% of men were react- The types of reaction reviewed in this section belong ing to plant-derived products [1]. We can therefore to the class of immediate responses that have immu- estimate that, among patients attending dermatolog- nological or nonimmunological mechanisms. ic clinics for dermatitis, an average of 5–10% suffer from dermatitis caused by plants or plant products.It is, however, evident that geographical variations in 41.2.1.1 Contact Urticaria flora considerably influence the epidemiology of plant dermatitis. Contact urticaria appears within minutes following In Europe, many phytodermatitis cases are occu- contact with the plant. It has been described for vari- pationally acquired. Florists, gardeners, horticultur- ous species [11, 12]. ists, foresters, woodworkers, farmers, cookers and people in contact with food preparation are at risk, as Nonimmunological Contact Urticaria described by Paulsen [2–4]. Hobby gardeners, house- wives and those who handle or come into contact Probably the best known urticant plants are the net- with plant materials non-occupationally are also at tles belonging to family Urticaceae, like Urtica dioica risk. Indeed, any persons enjoying leisure pursuits in L., U. urens L., and U. pilulifera L. The stinging hairs the garden or countryside (children playing, camp- are disposed on the ventral faces of the leaves, per- ers, walkers and so on) are likely to come into contact mitting skin penetration of histamine, acetylcholine with plant material with the potential to cause con- and 5-hydroxytryptamine after only a very slight tact dermatitis. touch. Nettles are used for rheumatic disorders in For plants and plant products, reactions of mixed folk medicine [7, 13]. aetiology are frequent, like allergic reactions super- Among other nonprotein substances, plant-de- imposed on irritant reactions due to Asteraceae, or rived pharmacological elicitors of urticaria are nu- mechanical plus chemical irritations evoked by merous, and include Myroxylon pereirae (balsam of stinging nettles. It is frequently hard to distinguish Peru) and the cinnamic acid derivatives contained between allergic and irritant mechanisms in clinical therein (Fig. 1), thapsigargin from Thapsia garganica examination and during patch test procedure, and L. (family Apiaceae) [11, 14, 15], and capsaicin from the reader will have to bear this in mind constantly. different species of capsicum, such as paprika and We will limit this chapter to plant contact, and will cayenne (Capsicum spp., family Solanaceae). The not consider the effect of systemic administration of mechanism by which nonimmunologic urticant plants of plant extracts. agents elicit their effect (at least for those agents list- It is clearly impossible to provide an exhaustive ed above) appears to involve the release of histamine catalog of cutaneous side-effects of plants in this from mast cells. chapter (which owes much to the previous edition by Georges Ducombs and Richard J. Schmitt), and the reader will sometimes be invited to examine the Core Message 41 question in more detail using other sources. Some books are prominent in botanical dermatology, like í Contact urticaria from nonprotein those written by Mitchell and Rook [5], Lovell [6], chemicals is most often due to a Sell [7], or Benezra, Ducombs, Sell and Foussereau non-immunological mechanism. [8]. Others focus on, are devoted to, or are restricted to geographical areas [9]. Many (but not all) impor- tant medical articles and reviews are indexed in Immunological (IgE-mediated) Contact Urticaria international databases like the United States National Library of Medicine (see http://www.nlm.nih.gov/). Fruits and vegetables may induce allergic contact ur- We also warmly recommend the website BoDD (Bo- ticaria, mainly in people with previous dermatitis, 41_751_800 05.11.2005 11:33 Uhr Seite 753 Plants and Plant Products Chapter 41 753 Fig. 1. Cinnamic acid, CAS 621–82–9, cinnamic aldehyde, CAS 104–55–2, thapsigargin, CAS 67526–95–8 and capsaicin CAS 404–86–4 like atopic dermatitis (see Sect. 41.2.1.2, Protein Con- exposure to dust derived from cinchona bark (Cin- tact Dermatitis). For example, sensitization from chona spp., family Rubiaceae) [18]. birch pollen (Betula alba L., family Betulaceae) may Allergic urticaria may spread from the initial site be complicated by immediate symptoms occurring of contact, become generalized or be associated with after ingestion (mouth swelling) or skin contact systemic symptoms of anaphylaxis. (contact urticaria) due to apples, hazelnuts, almonds, plums, apricot, peach, cherries, or celery and carrot. This is due to strong homologies with the birch pol- Core Message len allergens Bet v 1 and/or Bet v 2. A case report of occupational contact urticaria í Immunologic-type contact urticaria and type I sensitization attributable to a gerbera is due to specific IgE synthesis, mainly (probably Gerbera jamesonii Bolus, family Astera- to proteins, and can be severe, with ceae) has been reported. Conjunctivitis and respira- generalized or systemic symptoms. tory symptoms are possible [16]. Airborne contact urticaria can be associated with rhinitis, conjunctivitis or asthma. This has been largely reported as an occupational problem in health workers with hypersensitivity to latex proteins 41.2.1.2 Protein Contact Dermatitis from rubber gloves made with natural latex (usually derived from Hevea brasiliensis Muell.Arg., family Protein contact dermatitis is mostly seen in persons Euphorbiaceae). Airborne transmission of the latex (with atopy in 50% of cases) who handle foods, meat allergens is enhanced by their adsorption onto the or vegetables, and has been described with frequent cornstarch (derived from Zea mays L., family Grami- foods like onion, lettuce, potato, carrot or more rare- neae) used as glove powder [17].Airborne contact ur- ly with asparagus (personal observation).
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