Evy Paulsen

Contact sensitization from Compositae‐containing herbal remedies and cosmetics

The Compositae (Asteraceae) family of plants is currently an important cause of allergic plant contact dermatitis in Europe. The family comprises some of the oldest and most valued medicinal plants, and the increasing popularity of herbal medicine and cosmetics may theoretically result in a growing number of Compositae sensitizations from these sources. According to the literature at least 15 species, including among others arnica (Arnica montana), German and Roman chamomile (Chamomilla recutita and Chamaemelum nobile), marigold (Calendula officinalis), Echinacea and elecampane (Inula helenium), have been suspected of sensitization or elicitation of Compositae dermatitis. Epidemiological data are available for 2 species only, arnica and German chamomile, the rest of the evidence being anecdotal. Based on this, sensitization seems to occur relatively frequently with a few species such as arnica and elecampane, and occurs rarely with the majority, especially the widely used German chamomile. Sesquiterpene lactones are the most important allergens, but there are a few cases of sensitization from a coumarin, a sesquiterpene alcohol and a thiophene. The risk of elicitation of dermatitis by using Compositae‐containing products in Compositae‐sensitive individuals is by‐and‐large unknown.

Compositae dermatitis in a Danish dermatology department in one year (I). Results of routine patch testing with the sesquiterpene lactone mix supplemented with aimed patch testing with extracts and sesquiterpene lactones of Compositae plants.

To investigate the frequency of Compositae sensitivity, the recently‐developed sesquiterpene lactone mix (SL mix) was included in the standard patch lest series. Patients with positive reaction to this or patients suspected of having a Compositae allergy were supplementary tested with a Compositae mix, consisting of ether extracts of 5 European Compositae plants. In the first year, 686 patients were tested with the SL mix and 79 with the Compositae mix. A total of 31 Compositae‐sensitive patients (4.5%) were found. The frequency of positive reactions to either of the mixes was equal, but only 17 of 30 patients tested were positive to both mixes. Testing with the individual ingredients of the Compositae mix showed frequent positive patch test reactions to feverfew, followed in order by chamoinile, tansy, yarrow and arnica. The reason for this distribution is discussed and the results of standard, photo‐ and other plant patch tests are presented. The only partial overlap between positive reactions to the mixes emphasizes the necessity of supplementary testing in patients suspected of Compositae allergy, as well as the lack of a reliable single screening agent. Since no cases of active sensitization or irritant reactions were seen, both the SL mix and the Composite mix may be considered suitable for routine screening of Compositae allergy.

A double-blind, placebo-controlled study of a commercial Aloe vera gel in the treatment of slight to moderate psoriasis vulgaris

Background  The Aloe vera plant has been used for an array of ailments, including skin diseases. Recent experimental research have substantiated the presence of biologically active compounds in the gel, but there are few controlled, clinical trials to assess the efficacy.

Compositae dermatitis: a survey

Compositae dermatitis in an allergic contact dermatitis, frequently chronic, triggered by plants of the Compositae family The condition, which is seen, in particular, in middle‐aged and elderly persons, typically starts in the summer months with an acute eczema either corresponding to areas exposed to light and air or corresponding to areas of plant contact: it disappears spontaneously during the full of the year. Repealed exposure over a number of years may cause severe intractable dermatitis affecting the patient throughout the year. The responsible allergens are sesquiterpene lactones, and investigations to date indicate that the frequency of the allergy is similar to that seen with some of the contact allergens of the standard patch test series. The diagnosis, however, is difficult, parity due to the fact that the clinical picture may be mistaken for a photodermatosis; and partly owing to the difficulty in obtaining commercially available allergens for patch testing. The diagnosis is therefore based on testing with plant extracts, which can cause pronounced local reactions and possible active sensitization. A survey is given of the possible modes of sensitization, sex and age distribution, the relationship to photosensitivity and atopy, as well as the possible treatment. It is concluded, on the basis of the chronic nature of the disease, and the diagnostic and treatment problems, that continued intensive research into the condition is urgently needed.

Colophonium and Compositae mix as markers of fragrance allergy: cross-reactivity between fragrance terpenes, colophonium and compositae plant extracts.

The aim of this study was to assess the strength of any association between sensitization to ‘new’ fragrance compounds and sensitization to Compositae, fragrance mix, Myroxylon pereirae resin and colophonium, respectively.

Decreasing trends in methyldibromo glutaronitrile contact allergy – following regulatory intervention

Background:  The preservative methyldibromo glutaronitrile (MDBGN) has been banned, first from stay‐on, and later from rinse‐off cosmetics, in the EU countries because of increasing rates of contact allergy.

Sensitization and cross-reaction patterns in Danish Compositae-allergic patients

Results of aimed patch testing with constituents of sesquiterpene lactone (SL) mix, Compositae mix (CM) and other Compositae extracts and allergens in 190 Compositae‐allergic patients detected in an 8‐year period are presented. Feverfew of CM elicited positive reactions most frequently, followed by tansy, wild chamomile, yarrow and arnica, whereas dehydrocostus lactone of SL was the most frequent elicitor of positive reactions, followed by alantolactone and costunolide. Chrysanthemum (Dendranthema) and marguerite (Argyranthemumfrutescens) were the most important suspected sensitizers in both occupationally and nonoccupationally exposed, and cross‐reactions between chrysanthemum and feverfew/tansy/chamomile may partly explain the high prevalence of positive reactions to the 3 last mentioned. In the nonoccupationally sensitized group, garden plants such as feverfew, blanket flower (Gaillardia), elecampane (Inula helenium), large yellow ox‐eye (Telekia speciosa) and cosmea (Cosmos) were additional important allergenic plants. The 3 last mentioned were picked up by SL mix. Most of the lettuce‐sensitized persons were CM‐positive. 19% of the occupationally sensitized group were negative to both SL and CM, making very aimed patch testing necessary, notably when suspecting rare sensitizers such as Gerbera and star of the veldt (Osteospermum). The significance of the weeds dandelion, dog fennel and ox‐eye daisy as sensitizers is not clarified, but they are probably less important than cultivated plants.

An 8-year experience with routine SL mix patch testing supplemented with Compositae mix in Denmark

Routine patch testing with sesquiterpene lactone (SL) mix, supplemented with Compositae mix (CM) and other Compositae extracts and allergens where appropriate, was evaluated over an 8‐year period. 190 of 4386 patients tested (4.3%) were Compositae‐sensitive, 143 females (mean age 51.5 years) and 47 males (mean age 55 years), and 83% of reactions considered clinically relevant. 22% were suspected of occupational sensitization/dermatitis. 62% had a contact allergy to 2 or more compounds, most often to nickel, fragrance and colophonium. SL mix detected 65%, CM 87% of Compositae‐allergic patients, and the overall detection rate with both mixes was 93%. Few irritant reactions and no cases of clear‐cut active sensitization were recorded with the mixes, but our results emphasize the importance of differentiating late‐appearing reactivation reactions from patch test sensitization. The weakly positive CM reactions could reflect some irritancy, but as they were associated with fragrance and/or colophonium allergy to a higher degree than weakly positive SL mix reactions, they probably represented cross‐reactions. In conclusion, the detection rate with SL mix was high enough to support its continued use as a screening mix and it was very well and rather safely supplemented by aimed testing with CM.

Clinical severity and prognosis of hand eczema

Background  Hand eczema (HE) is a frequent, long‐lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms.

Carvone : an overlooked contact allergen cross-reacting with sesquiterpene lactones ?

The terpene l‐carvone is one of the main constituents of spearmint oil. The sensitizing potential of l‐carvone has been considered low, but it has occasionally caused contact allergy in users of spearmint toothpaste and chewing gum. l‐Carvone is also an oxidation product of d‐limonene that occurs in solvents used increasingly in industry. We included l‐carvone 5% pet, in the standard patch test series. In the 1st year, 541 patients were tested and 15 (2.77%) had positive, and 12 doubtful positive (?+) reactions to l‐carvone. The strongest reactions were observed in 9 patients with concomitant Compositae sensitivity. The key clinical Features and other contact allergies of the patients are presented. When re‐testing with l‐carvone in the same or lower concentrations, only 2 out 8 patients had positive reactions. Possible reasons for this discrepancy are discussed in terms of cross‐reactions, concomitant sensitization, excited skin syndrome, irritancy and facilitated immunological response.