|Year : 1992 | Volume
| Issue : 4 | Page : 268-271
Air-borne contact dermatitis due to Chrysanthemum with true cross sensitivity to Parthenium hysterophorus and Xanthium strumarium
JS Pasricha, Th Nandakishore
J S Pasricha
Source of Support: None, Conflict of Interest: None
A 60-year old man living in Srinagar (Jammu and Kashmir) had air-borne contact dermatitis for last 10 years. He had never traveled to any other part of the country where Parthenium hysterophorus or Xanthium strumarium are prevalent but he used to cultivate chrysanthemums. Patch tests with standardized extracts of various plants revealed the strongest reaction with Chrysanthemum, while the reactions with Xanthium strumarium and Parthenium hysterophorus were also positive but milder. This seems to be a case of primary sensitivity to Chrysanthemum with cross sensitivity to Xanthium strumarium and Parthenium hysterophorus.
Keywords: Air-borne contact dermatitis, Chrysanthemum, cross sensitivity, Parthenium hysterophores, Xanthium strumarium
|How to cite this article:|
Pasricha J S, Nandakishore T h. Air-borne contact dermatitis due to Chrysanthemum with true cross sensitivity to Parthenium hysterophorus and Xanthium strumarium. Indian J Dermatol Venereol Leprol 1992;58:268-71
|How to cite this URL:|
Pasricha J S, Nandakishore T h. Air-borne contact dermatitis due to Chrysanthemum with true cross sensitivity to Parthenium hysterophorus and Xanthium strumarium. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Jun 26];58:268-71. Available from: http://www.ijdvl.com/text.asp?1992/58/4/268/3815
| Introduction|| |
Plants causing contact dermatitis vary from country to country and from region to region. The commonest plant causing contact dermatitis in India is Parthenium hysterophores , which was accidentally introduced into India with the imported wheat grains and first detected in Pune in 1956.  Since then it has spread far and wide all over India but still there are certain regions where Parthenium has not been able to infiltrate so far.  In India, we tend to attribute all cases having air-borne contact dermatitis to Parthenium hysterophorus and ignore other plants. If a patient develops air-borne contact dermatitis in a region where Parthenium hysterophorus does not occur, it is essential to look for other plants which can produce a similar clinical picture. Even in the regions where Parthenium is prevalent, testing with other plants is necessary because in rare instances a patients may show a negative patch test with some other plant.  Such a patient is likely to be misdiagnosed if the patch test does not include other plants. Further still, even if a patch test is positive, the actual cause of contact dermatitis may be quite different. [ 1]The following case illustrates this point.
| Case Report|| |
A 60-year-old man, resident of Srinagar (Jammu and Kashmir) had been developing itchy, erythematous papules on the hands, face, neck, upper chest, and upper back, which started 10 years ago on the dorsal surfaces of the hands and then spread to involve the other areas. Initially, the aggravations would occur only between the months of October and January every year, but subsequently the lesions started persisting almost throughout the year. He had been working in an orchard farm which grew apples, plums, and peaches and his symptoms were noticed to be more severe while he was working in his orchard. Some of the episodes were associated with swelling of the face and hands with vesiculation and exudation from these areas. He would be relieved on treatment with oral prednisolone in a dose of 10-30 mg a day and on keeping away from work. All these years he had not gone to any other place , except for the last few days when he came to Delhi to consult us. There was, however, no appreciable change in the severity of the symptoms during his stay in Delhi. Further probing revealed that he also grew plenty of Chrysanthemums in his household and also in the orchards, but he had never seen Parthenium hysterophorus or Xanthium strumarium in his environment. He occasionally grew Helianthus annuus as a household decorative plant.
Examination revealed a classical picture of air-borne contact dermatitis, manifesting as lichenified dermatitis along with erythematous and mildly scaly papules on the dorsal surface of the hands including fingers, cheeks, forehead, `V' area of the neck, upper chest, and upper back. The eyelids were hyperpigmented and mildly scaly, and the helices of the ears also showed erythema and scaling. The cubital fossae and remaining parts of the body were free from the lesions. He was diagnosed to have air-borne contact dermatitis due to plants and patch tested with common plant antigens which also included Chrysanthemum, Parthenium hysterophorus, Xanthium strumarium and Helianthus annuus, using antigen impregnated-discs prepared from standardised plant extracts. , Positive reactions were obtained with Chrysanthemum, Xanthium strumarium, Parthenium hysterophorus and Lantana camera. The intensity of the patch test reaction with Chrysanthemum was maximum, and with Parthenium hysterophorus was the least. Titre of contact hypersensitivity (TCH) (the highest dilution of the standardised extract which produces positive patch test reaction)  with Parthenium hysterophorus and Xanthium strumarium in this patient was UD (undiluted extract) only with both plants. The TCH with Chrysanthemum was not determined.
| Comments|| |
Parthenium hysterophorus has spread to most areas of the country except the desert region in the north west and the hills 2000 meters above the mean sea level. Similarly, Xanthium strumarium is also widely prevalent in India,  but even this plant is not found at the altitudes 2000 meters above the mean sea level. Srinagar valley situated in the extreme north (northwestern) region of India is still free from Parthenium hysterophorus and Xanthium strumarium. A patient is not expected to develop hypersensitivity to an agent to which he is not exposed. This patient had lived all his life in Srinagar and never travelled to any other place where Parthenium hysterophorus and/or Xanthium strumarium are found. Thus the positive patch tests with those 2 plants in this patient cannot be due to primary sensitization and are in fact instances of true cross sensitivity.  This is corroborated by the observation that the TCH in this patient with both these plants was UD(undiluted plant extract) only, whereas in patients primarily sensitized with Parthenium and/or Xanthium the TCH is generally very high.  Unfortunately, the TCH with Chrysanthemum extract could not be tested because we did not have serial dilutions of the standardised extract of this plant, but the strongest patch test reaction with Chrysanthemum compared to other plants and a history of repeated exposures of the patient to this plant (to the exclusion of other plants) indicates that this patient had been primarily sensitized to Chrysathemum.
All the 3 plants (Parthenium hysterophorus, Xanthium strumarium and Chrysanthemum) belong to the same family Compositae  and the agents responsible for sensitization are known to be the sesquiterpene lactones , which resemble each other to a large extent. However, whereas Parthenium hysterophorus and Xanthium strumarium have shown a very high rate of cross sensitivity in Indian patients  the prevalence of cross reaction with Chrysanthemum is generally low.  It is also important to distinguish between true cross sensitivity and polysensitivity.  If a patient develops independent allergies to more than one agent which do not share any chemical groups (antigenic determinants), such a situation is appropriately called polysensitivity and not cross sensitivity.
| References|| |
|1.||Pasricha JS . Contact Dermatitis in India, 2nd edn. NewDelhi : Department of Science and Technoldgy, 1988. |
|2.||Pasricha J S, Sethi NC : Contact dermatitis in India, 1st edn. Bombay : Lyka Labs, 1981. |
|3.||Pasricha JS . Bhaumik P, Agarwal A . Contact dermatitis due to Xanthium strumarium, Ind J Dermatol Venereol Leprol 1990; 56 : 319-21. |
|4.||Pasricha JS, Singh SN Evaluation of the antigen-impregnated-discs for patch tests. Ind J Dermatol Venereol Leprol 1982; 48:327-9. |
|5.||Pasricha JS : Titre of contact hypersensitivity (TCH) as a means of determining the degree of hypersensitivity in contact dermatitis. Ind J Dermatol Venereol Leprol 1986; 52: 195-7. |
|6.||Benezra X, Maibach HI True crosssensitisation, false cross-sensitisation and otherwise. Contact Dermatitis 1984; 11: 65-9. |
|7.||Crounse RG . Plant dermatitis due to the Compositae (Asteraceae) family. J Acad Dermatol 1980; 2 : 417-424. [PUBMED] |
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