Allergic contact dermatitis from the radish, Raphanus sativus

A waitress, aged 38 years, developed acute contact dermatitis of her hands after chopping salad plants. Patch tests to radish (Raphanus) and to allyl wothiocyanate and benzyl wothiocyanate produced positive reactions. Sinigrin, the thioglucoside of allyl isothiocyanate, was mixed in petrolatum with the enzyme myrosinase; the mixture produced a positive patch test reaction. Based on these preliminary findings, the immunochemical requisites of isothiocyanates (mustard oils) are discussed. A tabulation has been made of exposure risk to plants of the mustard family (Cruciferae) which yield these compounds; the plants include some commonly used culinary vegetables, salad plants, condiments and also horticultural plants.     

Contact dermatitis from plants of the caper family, Capparidaceae

Plants of the caper family (Capparidaceae), which is the tropical relative of the mustard family (Cruciferae), yield ‘mustard oil’ (iso thiocyanate). A review has been made of reported effects on the skin and mucous membranes of some of these plants, of their geographical distribution, and of some opportunities for human contact with them. Plants which yield iso thiocyanates can produce irritant dermatitis and some probably can produce allergic contact dermatitis. The Capparidaceae family provides an example of the necessity of recording botanical names rather than common names for plant species, when reporting contact dermatitis from plants.     

Contact allergic reactions to diphenylthiourea and phenylisothiocyanate in PVC adhesive tape

28 patients reacting to a PVC adhesive tape used in routine patch testing gave positive reactions to diphenylthiourea (DPTU) and to phenylisothiocyanate (PITC) in low concentrations. DPTU is a heat stabilizer in the PVC and is partly decomposed to PITC. The two substances were also found in another type of PVC. Thioureas giving isothiocyanates are also used in certain types of rubber. Isothiocyanates are present in plants, mainly of ihe Cruciferae family, and are also formed from thiuram sulfides and thiocarbamates. The connection between isothiocyanates derived from different sources should be investigated.     

Failure of periodic ultraviolet radiation treatments to prevent sensitization to nitrogen mustard: a case report

We have reported that prior ultraviolet radiation (UVR) exposure significantly delayed development of contact sensitivity to nitrogen mustard (Halprin et al. 1981). We felt that this effect was due to disruption of functional Langerhans cells in skin by UVR and suggested that periodic UVR treatments might prevent sensitization to the mustard. We now report on a patient with mycosis fungoides whose epidermal Langerhans cell count was monitored with the ATP-ase stain in order to determine when such ‘booster’ UVR therapy was to be given. Our attempts to interfere with Langerhans cell function in this manner failed to prevent delayed contact sensitivity to nitrogen mustard and may have been partly responsible for the development of contact urticaria to nitrogen mustard after 28 days of use. Whether the reaction was a delayed, cell-mediated reaction, or an antibody mediated reaction is not clear, but the use of UVR did fail to prevent contact sensitivity to the nitrogen mustard in our patient.     

Allergic contact dermatitis from allyl isothiocyanate in a Danish cohort of 259 selected patients

Allyl isothiocyanate is present in many plants. Allergic contact dermatitis from allyl isothiocyanate is well known but infrequently reported. The aim of this study was to investigate the prevalence of contact allergy to allyl isothiocyanate in patients with suspected contact dermatitis from vegetables and food. 259 such patients were tested at the Department of Dermatology, Gentofte Hospital, Denmark, from 1994 to 2003. Only 2 patients (0.8%) had a positive reaction (+) to allyl isothiocyanate and 43 patients (16.6%) had a ?+ reaction. One of the patients with a positive reaction provided samples of margarine, salad cream, oil and mayonnaise. These were analysed with high‐performance liquid chromatography, and a moderate concentration of allyl isothiocyanate (2.5 ppm) was detected in the sample of margarine. This patient was a professional sandwich maker presenting with fingertip dermatitis mimicking ‘tulip fingers’ or allergic contact dermatitis from garlic and onions. In conclusion, allergic contact dermatitis from allyl isothiocyanate occurs in only a limited number of cases, despite frequent exposure. The large number of ?+ reactions raises the question as to whether the recommended patch test concentration is too low.     

Photochemotherapy and topical nitrogen mustard in the treatment of mycosis fungoides

Eight patients with mycosis fungoides limited to the skin have been treated with either topical nitrogen mustard alone or in combination with photochemotherapy. This regime does not prevent contact sensitization to nitrogen mustard but will clear sanctuary sites of disease which may develop when photochemotherapy is used alone.     

Allergic contact dermatitis to nasturtium

In conclusion, oil of mustard, contained in many plants and recognized mainly as a skin irritant, is also capable of causing an allergic contact dermatitis. Nasturtium, which contains mustard oil, should be added to the list of plants capable of causing this dermatitis and must be suspected in any patient who handles plants and presents with hand dermatitis.     

Topical nitrogen mustard therapy in patients with Langerhans cell histiocytosis

Background Langerhans cell histiocytosis (LCH) is characterized by abnormal proliferation and infiltration of Langerhans cells in different organs. The skin is frequently involved either as unisystem or multisystem disease. Objectives To review the clinical response and side‐effects of nitrogen mustard therapy in LCH in children and adults with unisystem or multisystem disease. Patients and methods This retrospective study includes 10 children and four adults with LCH, treated with nitrogen mustard from 1975 to 2010. The median extent of skin involvement was 46% (range 5–100%). Results Overall, 13 patients had complete or partial response. Although eight patients achieved a complete response with a median time of 12·3 months (range 36 days to 1·9 years), six of these patients ultimately relapsed. One patient, who had unisystem disease limited to the skin, initially showed progression of her cutaneous lesions with nitrogen mustard treatment. Although subsequently the cutaneous lesions completely regressed, concomitant systemic involvement was noted. Four other patients similarly experienced improvement of their skin lesions with treatment, but also exhibited progression of the LCH systemically. The patients were treated with other therapies prior and adjunctive to nitrogen mustard. However, five patients had progression to other organs, despite regression of skin lesions, which supports that the treatment effect in the skin is related to topical nitrogen mustard. Six patients developed contact dermatitis to nitrogen mustard. Conclusions Topical nitrogen mustard can be an effective and safe therapy in both children and adults with cutaneous LCH, although relapses are common.     

Recalcitrant atopic dermatitis due to allergy to Compositae

Atopic dermatitis is often complicated by allergic contact dermatitis, although patch testing may reveal positive reactions of uncertain relevance. We report a case of a 35-year-old woman with recalcitrant atopic dermatitis, with a positive patch-test reaction to Compositae mix (CM). Initially, sensitization appeared to be of past relevance only, due to use of calendula. However, it turned out that she followed a self-devised diet consisting largely of food products of the Compositae family. On excluding these food products her skin condition improved quickly. This case report underscores the difficulty in determining the relevance of positive patch tests, and shows that thorough analysis of positive patch tests, by both patient and physician, may reveal unexpected or less common sources of contact allergens.     

Pityriasis rosea-like eruptions due to mustard oil application

A young man employed in a construction company, presented with cutaneous lesions clinically simulating pityriasis rosea. Satisfactory and complete response to corticosteroids and antihistamines was followed by recurrence. Multiple recurrences within a short span of time arose a suspicion of alternative diagnosis. Site visit helped us to rule out occupational contact dermatitis. Further history taking revealed that he was recently using mustard oil for body massage. Subsequent patch testing confirmed contact hypersensitivity to mustard oil. Avoidance of the contact with mustard oil arrested appearance of further skin lesions. We stress the importance of taking a good history in clinical practice in disclosing a possible contactant.     

Occupational contact dermatitis from Cichorium (chicory, endive) and Lactuca (lettuce)

In two cases, occupational contact dermatitis was found to be due to chicory (Cichorium) used as a salad plant. In one of the two cases, contact sensitivity to letuce (Lactuca) was also observed. The sesquiterpene lactones of the plant may be the allergens.     

Systemic allergic dermatitis caused by sesquiterpene lactones

Patients with Compositae sensitization are routinely warned against the ingestion of vegetables, spices, teas and herbal remedies from this family of plants. The evidence for the occurrence of systemic allergic dermatitis caused by sesquiterpene lactone‐containing plants is mostly anecdotal and based on statements from patients rather than scientific data. However, a few clinical reports on accidental sensitization and exposure and oral challenge prove the existence of this kind of reaction, most convincingly for strong contact allergens such as costunolide in bay leaves, and less so for weak allergens such as those of lettuce. Other Compositae species suspected of causing systemic reactions are artichoke, mugwort, yarrow, dandelion, feverfew, and elecampane. Some Compositae vegetables and teas, such as lettuce and chamomile tea, may induce systemic reactions through both humoral and cell‐mediated mechanisms. It is difficult to disentangle the contribution of these reactions to both local and systemic symptoms of skin and mucous membranes in, for example, lettuce contact allergy. Further studies are needed to assess the prevalence of systemic allergic dermatitis caused by sesquiterpene lactones, and to clarify the pathogenesis for individual haptens.     

Occupational contact urticaria caused by food – a systematic clinical review

Food industry workers are at increased risk for occupational contact urticaria (CU). There are many foodstuffs that have been reported to cause occupational CU, including seafood, meat, vegetables, and fruits. The aim of this review is to summarize all reported occupational cases of CU in the food industry. This is a systematic review based on a MEDLINE search of articles in English and German and a manual search, between 1990 and 2014, to summarize the case reports and case series of occupational CU in the food industry. Many different foodstuffs have been implicated in CU. Occupational CU has been reported in many different occupations, mostly in individuals dealing with seafood, meat, vegetables, and fruits, such as chefs, cooks, bakers, butchers, slaughterhouse workers, and fish‐factory workers. Foodstuffs that commonly induce occupational protein contact dermatitis include fish, seafood, meats, vegetables, and fruits. Food handlers may acquire CU resulting from occupational exposures. The prognosis varies widely. The diagnosis of immunological CU is based on the clinical history and on a positive prick test with the suspected substance and/or measurement of specific IgE.     

Contact urticaria

Contact urticaria has been reported following skin contact with a multitude of substances ranging from simple chemicals to macromolecules. Its prevalence amongst the general population is unknown, but it may be a relatively common and under-recognized phenomenon. Non-immunological (irritant) causes typically elicit mild localized reactions, which clear within hours. Such agents can be found widely in food, cosmetics and medicaments. The lower diagnostic end-point for nonimmunological contact urticaria has been the subject of debate, which makes interpretation of the literature difficult. Immunological (allergic) contact urticaria is due to immediate-type hypersensitivity, and occurs most commonly in atopic individuals. It is mediated primarily by histamine, and may be associated with systemic, and potentially life-threatening symptoms. Natural rubber latex is one of the most important causes today, and the recent 'epidemic' of latex protein allergy has helped draw attention to this subject. Immunological contact urticaria to animal or vegetable matter may occasionally affect those who handle food, and other occupations such as agricultural and veterinary workers. This may be associated with development of a protein contact dermatitis. The diagnosis of immunological contact urticaria can often be confirmed by simple investigations such as skin prick testing or measurement of specific IgE.     

Immunological occupational contact urticaria and contact dermatitis from proteins: a review

Protein contact with the skin can be associated with 2 major clinical conditions: contact urticaria and protein contact dermatitis. This article reviews the pathogenesis, clinical pictures and the literature on the proteins having caused immunological occupation-related skin problems, i.e. fruits, vegetables, spices, plants, and woods; animal proteins; grains and enzymes, all affecting a wide variety of jobs. This is illustrated with some cases observed in the contact-allergy unit in Leuven.     

Comparative study of skin sebum and elasticity level in patients with sulfur mustard‐induced dermatitis and healthy controls

Background: Sulfur mustard (SM) – a chemical agent – has both acute and chronic effects on skin. Xerosis, which is deemed to be due to the damage of hydrolipidic barrier of the skin, is the most common complaint of veterans exposed to the chemical. This study was designed to evaluate skin sebum and elasticity in veterans with a history of SM contact. Methods: Three hundred and ten subjects were enrolled in this study and were divided into four groups: SM‐exposed patients with current skin lesions (n=87); SM‐exposed patients without skin lesions (n=71); patients with dermatitis (n=78); and normal controls (n=74). The skin sebum and elasticity were measured in four areas (forehead, suprasternal, palm and back of the hands) using a Sebumeter and a Reviscometer. Results: Skin sebum was higher in participants who presented with dermatitis and had history of contact with SM than others; the difference was only statistically significant on the forehead. There was no significant difference in the skin elasticity between the four groups. Conclusion: While SM may increase skin sebum in long term, there is no evidence that it has a substantial effect on skin elasticity.     

Occupational food-related hand dermatoses seen over a 10-year period

Background. Protein contact dermatitis was originally defined in 1976 by Hjorth and Roed‐Petersen as a distinct kind of dermatitis seen in patients with occupational food contact. Even though occupational skin diseases are frequent in Denmark, little attention has been paid to protein contact dermatitis, and the frequency is unknown. Objectives. To evaluate the frequency of occupational food‐related hand dermatoses and test results in patients occupationally exposed to foods. Materials and Methods. This was a retrospective study based on examinations, including skin prick testing and patch testing, performed at the Department of Dermato‐Allergology, Gentofte University Hospital, Denmark between 2001 and 2010. Results. Of all patients (n = 372), 57.0% had irritant contact dermatitis, 22.0% had protein contact dermatitis, 2.4% had contact urticaria, and 1.8% had allergic contact dermatitis. A suggestion for diagnostic criteria is presented. Frequent risk occupations were cooking in restaurants, baking, and kitchen work. Substantially more patients reacted in skin prick testing with fresh foods than with food extracts. Conclusion. Protein contact dermatitis is a frequent disorder among patients who professionally handle foods, and should be considered to be a distinct clinical entity. When diagnosing protein contact dermatitis and in other food‐related skin prick testing procedures, it is important to include fresh foods.     

Skin hydration and transepidermal water loss in patients with a history of sulfur mustard contact: a case–control study

Background   Skin lesions are among the most common complications of contact with sulfur mustard.
Objective   This study was aimed to measure skin water content and transepidermal water loss (TEWL) in patients with a history of sulfur mustard contact.
Methods   Three hundred ten male participants were included in this study: 87 (28.1%) sulfur mustard–exposed patients with current skin lesions (group 1), 71 (22.9%) sulfur mustard–exposed patients without skin lesions (group 2), 78 (25.2%) patients with dermatitis (group 3) and 74 (23.8%) normal controls (group 4) The water content and TEWL of skin was measured at four different locations of the body: forehead, suprasternal, palm and dorsum of hand. Nonparametric statistical tests (Kruskal–Wallis) were used to compare the four groups, and P  < 0.05 was considered statistically significant.
Results   The mean age of participants were 44.0 ± 6.7, 41.9 ± 5.9, 43.8 ± 9.3 and 44.8 ± 8.9 years in groups 1 to 4, respectively ( P  = 0.146). Xerosis, post-lesional hyperpigmentation and lichenification were significantly more common in either sulfur mustard–exposed participants or non-exposed participants with dermatitis ( P  < 0.05). Skin hydration was higher in subjects with sulfur mustard contact than in non-injured participants ( P  < 0.05) in the dorsum and palm of hands and forehead. TEWL was significantly higher in participants only in suprasternal area and dorsum of hand.
Conclusion   Contact with sulfur mustard agent can alter biophysical properties of the skin-especially the function of stratum corneum as a barrier to water loss-several years after exposure.

Conflicts of interest

None declared.     

中药三伏贴所致痒疹样接触性皮炎1例

目的 报道了1例中医传统疗法三伏贴所致接触性皮炎、并继发有痒疹样损害的病例.方法 依据病史,患者外用中药三伏贴后,背部及双膝下伸侧皮肤出现红肿、水疱、糜烂、渗出、色素沉着11个月余;全身出现结节型丘疹8个月余,瘙痒剧烈.对两处皮损进行组织病理检查,并进行了斑贴试验.组织病理结果均显示表皮角化不全,浅表结痂,棘层增厚,真皮浅层血管周围较多淋巴细胞、组织细胞浸润.斑贴实验结果显示三伏贴配方中白芥子、甘遂阳性.结果 接触性皮炎诊断成立.结论 中药白芥子、甘遂可导致痒疹样接触性皮炎.     

Kutane Symptome nach Genuss pollenassoziierter Nahrungsmittel

The molecular basis of pollen-related food allergy is the marked similarity in sequence and structure of allergenic proteins in pollens and food plants. In affected patients, specific IgE antibodies are primarily directed against pollen allergens but then recognize homologous allergens in plant food. In Central and Northern Europe up to 80% of birch pollen allergic subjects suffer from a food allergy, in particular to stone- and pip fruits, nuts and vegetables. The main clinical manifestation of pollen-related food allergy is the oral allergy syndrome (OAS), a contact urticaria of the oral mucosa. Other features include contact urticaria of the hands in those handling the foods, as well as generalized urticaria and angioedema following ingestion. The impact of pollen-related food allergy on the severity and course of atopic eczema remain to be elucidated.