COD
Contact Dermatitis • Contact Points
Contact Dermatitis • CONTRIBUTIONS TO THIS SECTION MAY NOT UNDERGO PEER REVIEW, BUT WILL BE REVIEWED BY THE EDITOR •
Eucalyptus contact allergy Mette Gyldenløve1 , Torkil Menné1,2 and Jacob P. Thyssen1,2 1 Department
of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark and 2 Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
doi:10.1111/cod.12268
Key words: contact allergy; eucalyptol; eucalyptus.
Although most plants are harmless to the skin, allergic reactions to flora are occasionally seen in dermatology practice. Allergic contact dermatitis caused by plants can occur following airborne exposure to pollen, or after prolonged or repeated contact with the stem, leaves, or sap. Also, patients may react to organisms living on the plant, as the cure for allergic contact dermatitis is avoidance of the offending substance, the culprit allergen should be identified. We present a rare case of allergic contact dermatitis caused by the eucalyptus plant.
Case A 51-year-old female florist was referred to us with rhino-conjunctivitis and dermatitis located on her face and hands. She had a 4-month history of a burning sensation on her hands when working with eucalyptus plants. Examination showed diffuse, facial erythema and oedema of the eyelids, as well as discrete, interdigital erythema and vesicles. Patch testing was performed with the European baseline series and Gentofte extended patch test series. Finn Chambers® (8 mm; SmartPractice® , Phoenix, AZ, USA) on Scanpor® tape (Norgesplaster A/S, Vennesla, Norway) were used. The patch tests were applied to the upper back and occluded for 2 days. Readings were performed on D2, D3, D7, according to the recommendations of the ICDRG. Positive test reactions were observed to sesquiterpene lactone mix 0.1% (1+ on D3), chamomile (1+ on D3 and D7), parthenolide 0.1% (1+ on D3 and D7), and eucalyptus stem and leaf (1+ on D3). No reaction to eucalyptus oil 2% was observed, and
prick testing with the common aeroallergens gave negative results. Patch testing with eucalyptus was performed in 3 volunteers, and gave negative results. The patient responded well to topical treatment with corticosteroids and tacrolimus ointments, and was advised to reconsider her profession to avoid chronic disease.
Discussion The genus Eucalyptus is a large, diverse genus of flowering trees and shrubs in the Myrtaceae family. Eucalyptus plants originate from Australia, but now grow in most tropical and subtropical areas. Commercially, eucalyptus plants are used in flower arrangements (Fig. 1) and for timber, pulpwood and honey production. Furthermore, leaves of selected eucalyptus species are steam distilled to extract eucalyptus oil, which has a wide range of applications, including pharmaceutical (1–3), aromatic and industrial uses. The role of eucalyptus oil in medical therapy is controversial. Whereas IgE-mediated reactions to eucalyptus oil or pollen have been well documented, contact allergy to
Correspondence: Mette Gyldenløve, Department of Dermato-Allergology, Gentofte Hospital, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark. Tel: +45 39772781. E-mail: [email protected] Funding: None. Conflict of interest: The authors declare no conflict of interests.
Fig. 1. A typical eucalyptus species used in flower bouquets.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd • All rights reserved Contact Dermatitis, 71, 303–317
303
Contact Dermatitis • Contact Points BLEPHAROCONJUNCTIVITIS CAUSED BY TO PPD • VOGEL ET AL.
eucalyptus is rarely seen. According to the Botanical Dermatology Database, which is an updated free online version of Botanical Dermatology by Mitchell and Rook, the first case was described in 1909 (4, 5). To date, 4 cases have been reported on PubMed; contact urticaria caused by eucalyptus pollen (6) and contact dermatitis caused by Vicks VapoRub (7) or aromatherapy (8, 9). In the latter case, the authors noted that the patient had no known exposure to eucalyptus. It is worth noting that several of the constituents of eucalyptus oil are also well-known allergens found in tea tree oil, e.g. 1,8-cineole (eucalyptol), 𝛼-pinene, and limonene (10, 11). There is one report of allergic contact
dermatitis caused by eucalyptol in an anti-inflammatory cream (12), and, in a large, Australian survey from 2007, contact allergy to tea tree oil was observed in 2% of the study population. Here, the offending allergen was not further identified. No patch test reactivity to oxidized limonene was observed in our patient. Eucalyptus is used in everyday life, and it is thus important to identify allergic contact allergy to the eucalyptus plant and its related industrial products. Because of the large number of allergens shared between eucalyptus oil and tea tree oil, we believe that allergic contact allergy to eucalyptus might be more prevalent than currently described in the medical literature.
References 1 Worth H, Dethlefsen U. Patients with asthma benefit from concomitant therapy with cineole: a placebo-controlled, double-blind trial. J Asthma 2012: 49: 849–853. 2 Serafino A, Sinibaldi V P, Andreola F et al. Stimulatory effect of Eucalyptus essential oil on innate cell-mediated immune response. BMC Immunol 2008: 9: 17. 3 Nagata H, Inagaki Y, Tanaka M et al. Effect of eucalyptus extract chewing gum on periodontal health: a double-masked, randomized trial. J Periodontol 2008: 79: 1378–1385. 4 Botanical Dermatology Database. Available at: http://www.botanical-
304
5 6
7
8
dermatology-database.info/index.html (last accessed 30 April 2014). Mitchell J, Rook A. Botanical Dermatology: Vancouver, Greengrass Ltd, 1979. Vidal C, Cabeza N. Contact urticaria due to eucalyptus pollen. Contact Dermatitis 1992: 26: 265. Noiles K, Pratt M. Contact dermatitis to Vicks VapoRub. Dermatitis 2010: 21: 167–169. Dharmagunawardena B, Takwale A, Sanders K J, Cannan S, Rodger A, Ilchyshyn A. Gas chromatography: an investigative tool in multiple allergies to essential oils. Contact Dermatitis 2002: 47: 288–292.
9 Schaller M, Korting H C. Allergic airborne contact dermatitis from essential oils used in aromatherapy. Clin Exp Dermatol 1995: 20: 143–145. 10 International Organisation for Standardisation: Essential oils - oil of Melaleuca, terpinen-4-ol type (Tea Tree Oil). ISO-4730, 1996. Geneva, International Organization for Standardization. 11 Larson D, Jacob S E. Tea tree oil. Dermatitis 2012: 23: 48–49. 12 Vilaplana J, Romaguera C. Allergic contact dermatitis due to eucalyptol in an anti-inflammatory cream. Contact Dermatitis 2000: 43: 118.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 71, 303–317
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
Contact Dermatitis • Contact Points
Contact Dermatitis • CONTRIBUTIONS TO THIS SECTION MAY NOT UNDERGO PEER REVIEW, BUT WILL BE REVIEWED BY THE EDITOR •
Eucalyptus contact allergy Mette Gyldenløve1 , Torkil Menné1,2 and Jacob P. Thyssen1,2 1 Department
of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark and 2 Department of Dermato-Allergology, National Allergy Research Centre, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
doi:10.1111/cod.12268
Key words: contact allergy; eucalyptol; eucalyptus.
Although most plants are harmless to the skin, allergic reactions to flora are occasionally seen in dermatology practice. Allergic contact dermatitis caused by plants can occur following airborne exposure to pollen, or after prolonged or repeated contact with the stem, leaves, or sap. Also, patients may react to organisms living on the plant, as the cure for allergic contact dermatitis is avoidance of the offending substance, the culprit allergen should be identified. We present a rare case of allergic contact dermatitis caused by the eucalyptus plant.
Case A 51-year-old female florist was referred to us with rhino-conjunctivitis and dermatitis located on her face and hands. She had a 4-month history of a burning sensation on her hands when working with eucalyptus plants. Examination showed diffuse, facial erythema and oedema of the eyelids, as well as discrete, interdigital erythema and vesicles. Patch testing was performed with the European baseline series and Gentofte extended patch test series. Finn Chambers® (8 mm; SmartPractice® , Phoenix, AZ, USA) on Scanpor® tape (Norgesplaster A/S, Vennesla, Norway) were used. The patch tests were applied to the upper back and occluded for 2 days. Readings were performed on D2, D3, D7, according to the recommendations of the ICDRG. Positive test reactions were observed to sesquiterpene lactone mix 0.1% (1+ on D3), chamomile (1+ on D3 and D7), parthenolide 0.1% (1+ on D3 and D7), and eucalyptus stem and leaf (1+ on D3). No reaction to eucalyptus oil 2% was observed, and
prick testing with the common aeroallergens gave negative results. Patch testing with eucalyptus was performed in 3 volunteers, and gave negative results. The patient responded well to topical treatment with corticosteroids and tacrolimus ointments, and was advised to reconsider her profession to avoid chronic disease.
Discussion The genus Eucalyptus is a large, diverse genus of flowering trees and shrubs in the Myrtaceae family. Eucalyptus plants originate from Australia, but now grow in most tropical and subtropical areas. Commercially, eucalyptus plants are used in flower arrangements (Fig. 1) and for timber, pulpwood and honey production. Furthermore, leaves of selected eucalyptus species are steam distilled to extract eucalyptus oil, which has a wide range of applications, including pharmaceutical (1–3), aromatic and industrial uses. The role of eucalyptus oil in medical therapy is controversial. Whereas IgE-mediated reactions to eucalyptus oil or pollen have been well documented, contact allergy to
Correspondence: Mette Gyldenløve, Department of Dermato-Allergology, Gentofte Hospital, Niels Andersens Vej 65, DK-2900 Hellerup, Denmark. Tel: +45 39772781. E-mail: [email protected] Funding: None. Conflict of interest: The authors declare no conflict of interests.
Fig. 1. A typical eucalyptus species used in flower bouquets.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd • All rights reserved Contact Dermatitis, 71, 303–317
303
Contact Dermatitis • Contact Points BLEPHAROCONJUNCTIVITIS CAUSED BY TO PPD • VOGEL ET AL.
eucalyptus is rarely seen. According to the Botanical Dermatology Database, which is an updated free online version of Botanical Dermatology by Mitchell and Rook, the first case was described in 1909 (4, 5). To date, 4 cases have been reported on PubMed; contact urticaria caused by eucalyptus pollen (6) and contact dermatitis caused by Vicks VapoRub (7) or aromatherapy (8, 9). In the latter case, the authors noted that the patient had no known exposure to eucalyptus. It is worth noting that several of the constituents of eucalyptus oil are also well-known allergens found in tea tree oil, e.g. 1,8-cineole (eucalyptol), 𝛼-pinene, and limonene (10, 11). There is one report of allergic contact
dermatitis caused by eucalyptol in an anti-inflammatory cream (12), and, in a large, Australian survey from 2007, contact allergy to tea tree oil was observed in 2% of the study population. Here, the offending allergen was not further identified. No patch test reactivity to oxidized limonene was observed in our patient. Eucalyptus is used in everyday life, and it is thus important to identify allergic contact allergy to the eucalyptus plant and its related industrial products. Because of the large number of allergens shared between eucalyptus oil and tea tree oil, we believe that allergic contact allergy to eucalyptus might be more prevalent than currently described in the medical literature.
References 1 Worth H, Dethlefsen U. Patients with asthma benefit from concomitant therapy with cineole: a placebo-controlled, double-blind trial. J Asthma 2012: 49: 849–853. 2 Serafino A, Sinibaldi V P, Andreola F et al. Stimulatory effect of Eucalyptus essential oil on innate cell-mediated immune response. BMC Immunol 2008: 9: 17. 3 Nagata H, Inagaki Y, Tanaka M et al. Effect of eucalyptus extract chewing gum on periodontal health: a double-masked, randomized trial. J Periodontol 2008: 79: 1378–1385. 4 Botanical Dermatology Database. Available at: http://www.botanical-
304
5 6
7
8
dermatology-database.info/index.html (last accessed 30 April 2014). Mitchell J, Rook A. Botanical Dermatology: Vancouver, Greengrass Ltd, 1979. Vidal C, Cabeza N. Contact urticaria due to eucalyptus pollen. Contact Dermatitis 1992: 26: 265. Noiles K, Pratt M. Contact dermatitis to Vicks VapoRub. Dermatitis 2010: 21: 167–169. Dharmagunawardena B, Takwale A, Sanders K J, Cannan S, Rodger A, Ilchyshyn A. Gas chromatography: an investigative tool in multiple allergies to essential oils. Contact Dermatitis 2002: 47: 288–292.
9 Schaller M, Korting H C. Allergic airborne contact dermatitis from essential oils used in aromatherapy. Clin Exp Dermatol 1995: 20: 143–145. 10 International Organisation for Standardisation: Essential oils - oil of Melaleuca, terpinen-4-ol type (Tea Tree Oil). ISO-4730, 1996. Geneva, International Organization for Standardization. 11 Larson D, Jacob S E. Tea tree oil. Dermatitis 2012: 23: 48–49. 12 Vilaplana J, Romaguera C. Allergic contact dermatitis due to eucalyptol in an anti-inflammatory cream. Contact Dermatitis 2000: 43: 118.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Contact Dermatitis, 71, 303–317
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
