Patch tests with 24 Compositae species were performed on 81 patients suspected of having a plant dermatitis, of whom 16 had positive reactions to various species.



When Compositae were included in the standard series, 10 of 488 consecutive patients (2%) were found to be sensitive to one or more species. Most of the positive test reactions were relevant.



Fourteen of 16 sensitivities could have been detected by testing with two mixtures of Compositae. Alantolactone could not serve as a screening agent, since four of seven Compositae-sensitive patients had negative reactions to it. Concomitant reactions to balsams were found in four of 10 patients with unexpected sensitivitytoCompositae.



The clinical pattern of Compositae dermatitis may be that of a lichenified photo dermatitis. These cases are invariably missed, unless patch tests with Compositae are performed. Another group of patients have hand ezcema and also require patch tests with Compositae for etiological diagnosis. Because positive, relevant reactions are common, inclusion of a safe and reliable Compositae screening test in the standard series is urgently required. At the present stage, however, our test materials are sometimes irritant and they have occasionally caused active sensitization.

Compositae sensitivity among patients with contact dermatitis: value of compositae oleoresins in a standard test series.

Background Chrysanthemum, dandelion, and mugwort belong to the Compositae (Asteraceae) family. Their cross-allergenicity has not yet been completely evaluated. Objective To investigate the sensitization and cross-allergenicity of these 3 plants. Methods We reviewed 6,497 respiratory allergic patients who underwent skin prick tests (SPTs) during the last 10 years (1995-2005) and analyzed the sensitization rates of the 3 pollens. We sorted this population by wheal size and selected the monosensitized or cosensitized patients. Their serum samples were used to evaluate specific IgE (sIgE) and cross-allergenicity of the 3 pollens by CAP, immunoblotting, and inhibition enzyme-linked immunosorbent assay (ELISA). Results On SPTs, mugwort, chrysanthemum, and dandelion sensitized 13.4%, 10.0%, and 8.5% of the enrolled population, respectively, and 5.2% of the population was cosensitized to all 3 pollens. Some patients were monosensitized to 1 species (1.5% to chrysanthemum, 1.4% to dandelion, and 4.5% to mugwort). In inhibition ELISA that used a pooled serum sample cosensitized to all 3 pollens, mugwort inhibited sIgE bindings to chrysanthemum, dandelion, and mugwort up to 95%, 86%, and 96%, respectively. The 50% inhibitory allergen concentrations for sIgE to each of the 3 species were not different between solid-phase antigen and mugwort. The mugwort sIgE of this pooled serum was suppressed up to 74% and 27% by chrysanthemum and dandelion, respectively. The 50% inhibitory allergen concentrations of chrysanthemum and dandelion for mugwort sIgE were 0.3 and 57.0 μg/mL, respectively, whereas that of mugwort was 0.05 μg/mL. We found a patient who was truly monosensitized to dandelion. Conclusion Chrysanthemum and dandelion were frequently cosensitized with mugwort in the general population with respiratory allergic diseases. These 2 species also showed extensive cross-allergenicity with mugwort. True monosensitization to these 2 species was possible.

Cross-allergenicity of pollens from the Compositae family : Artemisia vulgaris, Dendranthema grandiflorum, and Taraxacum officinale

Three patients with occupational contact dermatitis due to Arnica longifolia Eaton and Arnica montana L. are reported. During cultivation, harvesting of the flower heads, chemical investigation of the sesquiterpene lactone constituents and preparation of therapeutic tinctures, they had frequent contact with the plant materials. Patch tests with the two sesquiterpene lactones carabron and helenalin, isolated during investigation from A. lungifolia Eaton, were positive in all three patients, though the second patient had never shown visible allergic reactions of the skin. Sensitization experiments with carabron in five guinea pigs were successful.



The investigation results revealed that carabron, helenalin and the acetyl derivative of helenalin must be considered as the sensitizers of A. longifolia, and helenalin acetate and properly arnifolin as sensitizeis of A. motana.



Studies on cross reactivity in the sensitized animals with six related sesquiterpene lactones showed that only those compounds gave a positive test response which contain an α-methylene γ-lactone group. Cross reactions were obtained with a crude extract of Chrysanthemum indicum L.



The case reports supported by the patch test and investigation results demonstrate that persons handling a new drug from the Compositae family run a risk of developing an allergy after intensive contact with the plant and its constituents.

The sensitizing capacity of Compositae plants I. Occupational contact dermatitis from Arnica longifolia Eaton

Pyrethrum has been reported to produce allergic contact dermatitis in humans. Moreover, it has been speculated that cross reactions occur in ragweed-sensitized people. This review presents the botany, contemporary chemistry, and case reports of alleged allergic contact dermatitis. Our interpretation suggests that the evidence presented in literature does not show that allergic contact dermatitis results from exposure to pyrethrum. Similarly, the data do not suggest cross reactions in ragweed-sensitized people. Changes in the chemical composition of the refined pyrethrins suggest the putative sensitizer is present at a lower level in today's refined extracts than in ground pyrethrum flowers or the extracts used earlier.

Pyrethrum allergic contact dermatitis in humans--real?, common?, or not documented? An evidence-based approach.

2. Riva F, Pigatto P D, Altomare F G, Riboldi A. Sensitization to dental acrylic compounds. Contact Dermatitis 1984: 10: 245. 3. Dahlquist I, Fregert S. Allergic contact dermatitis from volatile epoxy hardeners and reactive diluents. Contact Dermatitis 1979: 5: 406-407. 4. Tosti A, Guerra L, Toni F. Occupational airborne contact dermatitis due to epoxy resin. Contact Dermatitis 1988: 19: 220-222. Contact Dermatitis 1991: 24: 153

A simple method of isolating parthenolide from Tanacetum and other sensitizing plants.

Experimental studies on allergic contact dermatitis due to Chrysanthemum indicum 1. (Chrysanthemum x-morifolium) (chrysanthemum of the florists) have indicated the following results: 1. In 5 patients with allergic contact dermatitis from chrysanthemum oil of turpentine and its sensitizing compounds gave no patch test responses. No relationship between contact allergy due to chrysanthemus and to turpentine oil could be determined. 2. The pyrethrins, constituents with insecticidal activity, derived from certain Chrysanthemum species and often suspected as the causative agents, play no role in chrysanthemum allergy. 3. Tests on sensitized guinea pigs (pirl bright white strain) with flowers of chrysanthemum as well as with the two sesquiterpene lactones parthenolide and alantolactone, derived from different Composite species, gave positive patch test reactions. The results showed that parthenolide produced stronger reactions than alantolactone. 4. By thin layer chromatography neither parthenolide, nor alantolactone or pyrethrosin could be detected in extracts of chrysanthemum flowers of the florists. But the investigations indicated that several other terpenic compounds are present, which gave positive color reactions to certain lactone reagents. Five of them showed strong positive patch test reactions in our patients as well as in sensitized guinea pigs. Further studies are required to identify these compounds.

L Wallhöfer

Papers

Chrysanthemum allergy. Pt. II: Experimental studies on the causative agents.