Botanicals Botanicals and Contact ‡ plant extracts Allergy ‡ essential oils ‡ increasingly popular additives „ Christen M. Mowad MD „ cosmeceuticals Geisinger Medical Center „ personal care products „ aromatherapy Danville, PA 17821 „ massage therapy [email protected] ‡ medicinal/healing properties ‡ fragrances

Botanicals Botanicals - composition

‡ push to naturals ‡ highly variable ‡ consumers ‡ dependent on plant part „ “If natural has to be OK” „ leaf „ fewer side effects „ ‡ industry has added botanicals everywhere „ fruit „ cosmetics „ stem „ shampoos „ flower „ soaps „ bath gels

Botanicals - composition Botanicals and Adverse Events

‡ highly variable ‡ patients increasingly using them ‡ concentration, antigeniticy can differ ‡ felt to be Natural and therefore harmless „ timing of harvest ‡ patients may neglect to mention usage „ Where the plant was grown ‡ need to ask „ processing of plant

1 Botanicals and Adverse Events Botanicals and Phototoxicity

‡ Irritant contact dermatitis ‡ Balsam of Peru ‡ Allergic contact dermatitis ‡ Carotene ‡ Photocontact dermatitis ‡ Cinnamic aldehyde ‡ Contact urticaria ‡ Essential oils ‡ Pigmentation abnormalities ‡ Furocoumarins ‡ Acneiform eruptions ‡ Oak moss

Seminars in Derm 15(2):78-82,1996.

Botanicals and Contact Urticaria Botanicals and Pigmentation

‡ Balsam of Peru ‡ Red discoloration by terpenes ‡ Benzoic acid „ Lemon, lime, orange, juniper ‡ ‡ Postinflammatory depigmentation „ Cinnamic alcohol ‡ Capsicum ‡ Postinflammatory hyperpigmentation ‡ Caraway oil „ Benzyl alcohol ‡ Cinnamic acid, alcohol, aldehyde „ Benzyl salicylate ‡ Coumarin „ Cananga oil ‡ „ Cinnamic alcohol ‡ Ethyl „ Geraniol ‡ Eugenol Seminars in Derm 15(2):78-82,1996.

Botanicals and Acneiform Eruptions Botanical Allergy Location

‡ Frequency ‡ oil Location Simpson Thomson ‡ Corn oil Axilla 14.3% 10% ‡ Linseed oil Extremities 50% 21% Face/Neck 21.4% 41% ‡ Olive oil Trunk 21.4% 10% ‡ Peanut oil Genitalia 14.3% ‡ Generalized 7% ‡ Sesame oil Exposed 14% Hand 14% Seminars in Derm 15(2):78-82,1996.

2 Botanicals and Contact Allergy ‡ extracted oil from Melaleuca alternifolia „ shrub in Australia ‡ increasing popularity, increased ACD ‡ antimicrobial - bacteria, virus, fungi ‡ anti-inflammatory effects ‡ most allergenic botanical extract

Tea Tree Oil- increasing usage Tea Tree Oil- adverse effects

‡ cosmetic products ‡ allergic contact dermatitis ‡ household products „ occupational contact dermatitis ‡ massage oils ‡ irritant contact dermatitis ‡ aromatherapy products ‡ systemic contact dermatitis ‡ mouthwashes ‡ erythema multiforme- like reaction ‡ moisturizing creams

Tea Tree oil Propolis

‡ occupational allergen in beekeepers ‡ Allergens ‡ “bee glue” „ d-limonene „ collected by bees from poplar and conifer buds „ alpha-terpinene ‡ used in cosmetics and medicinal products „ terpinen-4-ol ‡ not the same as beeswax „ Terpinolene „ secreted by bees „ 1,8 cineole ‡ antiseptic, anti-inflammatory, anesthetic ‡ wound healing, ulcer care

3 Propolis Propolis as Allergen

‡ composition varies ‡ 1.2 – 6.6 % of dermatitis patients allergic ‡ 180-300 components ‡ patch test at 10 % pet ‡ main allergens ‡ linear increase in annual frequency of allergy „ LB-1 (3isomeric pentenyl caffeates) ‡ increased usage „ 3-methyl-2-butenyl caffeate „ Phenylethyl caffeate „ Benzyl salicylate Contact Dermatitis 26: 34-44, 1992. „ Benzyl cinnamate Contact Dermatitis 45: 269-272, 2001.

Lichens Lichens

‡ Plantlike organisms ‡ Lichen acid mix ‡ 17,000 species „ Usnic acid „ Atranorin ‡ lichen acid pickers „ Everinic acid ‡ woodworkers ‡ Usnic acid ‡ cosmetic products „ antimicrobial properties „ axillary dermatitis- deodorants „ anti-inflammatory properties „ Analgesic activity „ Increased usage in personal care products

Feverfew Aloe

‡ Tanacetum parthenium ‡ used for soothing properties ‡ original use- fever, headache, migraines ‡ thousands of individual chemicals ‡ allergens- ‡ exact allergen unknown „ lactones ‡ ACD in literature „ parthenolides ‡ contact urticaria ‡ contact dermatitis ‡ contact stomatitis ‡ uncommon sensitizer

4 Gingko biloba Curcumin- tumeric

‡ anti-inflammatory effects ‡ Curcuma longa ‡ no allergic contact dermatitis reported ‡ used to prevent degradation of products ‡ fruit contains the allergen ‡ anti-inflammatory effects ‡ extracts usually don’t use fruit pulp ‡ antimicrobial effects ‡ known irritant ‡ known contactant

Arnica Chamomile

‡ Arnica Montana ‡ member of Compositae family ‡ sprains, bruises, wounds ‡ several species of plant ‡ cosmetic products „ Anthemis nobilis- Roman Chamomile „ Matricaria chamomilla - German chamomile ‡ allergic contact dermatitis reported ‡ anti-inflammatory effects ‡ often Compositae positive ‡ bacteriostatic effects ‡ can be missed with sesquiterpene lactone ‡ sesquiterpene lactones as allergen ‡ allergic contact dermatitis ‡ contact urticaria

Peppermint Rosemary

‡ Mentha piperita ‡ Rosmarinus officinalis ‡ Lamiaceae or mint family ‡ evergreen shrub ‡ Flavoring agent ‡ antioxidant properties „ toothpaste, gum, mouth wash ‡ anti-cancer activity ‡ Several adverse events ‡ anti-photoaging activity „ ACD stomatitis ‡ allergic contact dermatitis „ burning mouth syndrome „ carnosol, carnosic acid, caffeic acid „ oral ulceration ‡ uncommon allergen „ chronic cheilitis

5 Potential Botanical Screening Allergens Patch Testing and Botanicals

Positive in Pt with ‡ no good screening allergen Screening Allergen Botanical Allergy ‡ large numbers of botanicals Fragrance Mix 33.3% ‡ test to Balsam of Peru 30.0% „ botanical series- most relevant allergens Compositae 20.0% „ fragrances „ patient’s products Sesquiterpene lactone 6.7%

Dermatitis 15(2): 67-72, 2004

Proposed Botanical Screening Tray Botanical Allergy Education

Tea tree oil Lavender ‡ avoid all botanicals Lichen acid mix oil ‡ avoid all fragrances Geranium oil Cananga oil ‡ read labels Spearmint oil Rose oil ‡ CARD Dandelion Ylang-ylang oil Neroli oil Compositae

Dermatitis 15(2);67-72,2004.

Botanicals

‡ increase in usage ‡ increase in allergy ‡ need to ask about usage ‡ difficult to screen for ‡ test to larger screen ‡ test to personal care products

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