Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food.

Systemic contact dermatitis (SCD) develops when a person who was previously sensitized to an allergen is exposed to the same allergen via the systemic route. In East Asia, the use of lacquer for polishing furniture is common and a part of the traditional culture. Contact exposure to tableware polished with Rhus lacquer may lead to sensitization. In Korea, SCD is commonly observed after systemic exposure to Rhus, a nutritious food item consumed because of the common belief of it improving the immune system. In this study, we reviewed the medical records of 21 Korean patients with SCD caused by Rhus ingestion. We found that the most significant epidemiological factor for SCD was the season of the year. Furthermore, 66.67% of the patients presented with leucocytosis and 23.81% showed increased liver enzyme levels. It is important to educate people on the risks associated with the systemic ingestion of Rhus.

Phytodermatitis in eastern Turkey: a retrospective, observational study.

BACKGROUND: Plant life is extremely diverse, with a great deal of geographic and seasonal variation. Consequently, the range of reported adverse reactions is large, and there are important differences worldwide in the incidence and prevalence of these reactions. Systemic ingestion of some plants containing furocoumarins can cause erythema, edema, vesicle and bulla formation and later hyperpigmentation, after exposure to sunlight. They may at times exhibit clinical manifestations that mimic angioedema, and rarely progress to necrosis. This condition is named phyto-phototoxic reaction. OBJECTIVE: Our aim was to identify plant dermatitis such as allergic contact dermatitis, irritant contact dermatitis, and phyto-phototoxic dermatitis in eastern Turkey and to add new data to the literature. METHODS: Thirty patients diagnosed with plant dermatitis were evaluated retrospectively. The demographic and clinical characteristics of the patients (age, gender, the type of dermatitis, and the name of the causative plant) were recorded. CONCLUSIONS: A phyto-phototoxic reaction to Chenopodium album (Chenopodiaceae) developed in 12 cases. Irritant contact dermatitis developed due to Ranunculus kotschyi (Ranunculaceae) in 11 cases. The other plants studied were Malva neglecta Wallr (Malvaceae), Mandragora autumnalis (Solanaceae), Eryngium billardieri (Apiaceae), Ceratocephalus falcatus (Ranunculaceae), Ranunculus damascenus (Ranunculaceae), and Plantago lanceolata (Plantaginaceae).

Clinical and immunologic features of systemic contact dermatitis from ingestion of Rhus (Toxicodendron).

Oral or parenteral exposure to certain contact allergens may elicit an eczematous skin reaction in sensitized individuals. This phenomenon has been called systemic contact dermatitis (SCD) and is relatively rare when compared with classical contact dermatitis. We reviewed and analysed the clinical and immunologic features of 42 patients with SCD caused by ingestion of Rhus (Toxicodendron), 24 males and 18 females, average age 44 years (range 24-72). Several of such patients (33%) had a known history of allergy to lacquer. The patients developed skin lesions such as generalized maculopapular eruptions (50%), erythroderma (29%), vesiculobullous lesions (14%) and erythema multiform (EM)-like lesions (7%). Many patients (57%) developed leucocytosis with neutrophilia (74%). In some patients (5%), abnormalities of liver function developed. We also analysed lymphocyte subsets in the peripheral blood of 12 patients. The lymphocyte subsets studied were T cells (CD3), B cells (CD19), natural killer (NK) cells (CD3-CD16+/CD56+), helper/inducer cells (CD4), cytotoxic/suppressor cells (CD8) and helper/suppressor ratio (CD4/CD8). The lymphocyte subsets of all 12 patients studied were within the normal range. Moreover, there were no differences between patients with a history of allergy to lacquer and those without a history of allergy to lacquer. Therefore, rather than an immunologic response, the skin eruption seems to be caused by a toxic reaction because of Rhus.

Occupational injury and illness among migrant and seasonal farmworkers in New York State and Pennsylvania, 1997-1999: pilot study of a new surveillance method.

BACKGROUND: Traditional worksite injury surveillance methods are often ineffective for Northeastern farms employing seasonal harvest labor. Many are small farms, exempt from mandatory injury reporting. The high proportion of foreign workers and the temporary nature of the work further discourages reporting. Therefore, an alternative migrant health center-based occupational injury and illness surveillance system was piloted during 1997-1999. METHODS: Anonymous medical chart data from nine migrant health centers and four regional hospital emergency rooms was collected during 1997-1999. RESULTS: There were 516 injury/illness cases over two seasons. Joint/muscle straining (31%), falling (18%), poison ivy contact (10%), and object strikes (8%) were most common injurious events. The participation rate of health care was 75%; 130 cases were reported by hospital emergency rooms; and optimal health center participation was associated with: being a farmworker-dedicated program, and including the chart reviewer in the health center's decision to participate. CONCLUSIONS: Further development of a medical records-based surveillance system should include hospital emergency rooms and focus on identified health center performance factors.

Allergic contact dermatitis to Toxicodendron succedaneum (rhus tree): an autumn epidemic.

AIMS: To document all cases of allergic contact dermatitis (phytodermatitis) due to contact with Toxicodendron succedaneum (rhus tree) presenting to a dermatology clinic during 1993. METHOD: Case-note review of all cases of phytodermatitis attributed to exposure to rhus tree seen during 1993 in a dermatology clinic. RESULTS: Twenty cases of phytodermatitis to T succedaneum were reviewed. Eight patients were females and 12 males with a bimodal age distribution (ten children under age of 15 yr, five adults between 35-45 yr of age). Younger patients presented with facial dermatitis reflecting facial contact whilst playing under rhus trees. Older patients presented largely with a dermatitis affecting the upper limbs reflecting contact whilst gardening (usually pruning). Fifteen out of twenty presented during the months of March through May (ie. autumn), with the remainder presenting in summer (Dec-Feb). The majority of patients required systemic steroids to settle the intense dermatitis. CONCLUSIONS: Phytodermatitis to T succedaneum is not uncommon in New Zealand, particularly during the autumn months. The clinical presentation varies according to the patient's activity.

Contact dermatitis in black patients.

Black patients readily acquire allergic contact dermatitis from such contactants as paraphenylenediamine, nickel, chromates, and mercaptobenzothiazole. Such dermatitis is often complicated by hyperpigmentation and lichenification unless treated early anf vigorously with systemic corticosteroids. Patch testing is reliable on black skin. In addition, acne veneate (pomade acne, Vaselinoderma), which is characterized by noninflammatory acneiform lesions, is very common in black persons. Finally, the old wives' tale that blacks do not get poison ivy may be laid to rest, along with the popular notion that Indians chewed poison ivy leaves in order to prevent poison ivy dermatitis. Several years ago, I interviewed an Indian Chief on a western reservation and inquired whether, to his knowledge, Indians did ever chew poison ivy leaves. The chief's immediate answer was, "You white men must be crazy to think that we would be that foolish!".