Contact allergy and depigmentation from alstroemeria

Contact dermatitis caused by tulips: identification of contact sensitizers in tulip workers of Kashmir Valley in North India

BACKGROUND

Tulip, belonging to the genus Tulipa and family Liliaceae, is a spring-blooming perennial that grows from bulbs. Owing to manual handling, contact dermatitis can occur in professionals at any stage of the growth cycle of the tulip plant.

OBJECTIVES

To determine the clinical pattern of contact dermatitis resulting from tulip plant cultivation, and to assess contact allergy in workers coming into contact with this plant.

METHODS

One hundred and sixty-four tulip workers were screened, and 48 patients with suspected contact dermatitis were patch tested with 39 allergens, including haptens from the Indian baseline series, a plant series, and extracts from different parts of the tulip plant.

RESULTS

Thirty-nine positive patch test reactions were observed in 21 patients. Seventeen patients showed positive reactions to either α-methylene-γ-butyrolactone or to tulip plant extract. Clinical relevance was observed for 13 of 17 positive patch test reactions.

CONCLUSIONS

Contact dermatitis is an important health hazard in workers dealing with tulip bulbs. Further studies to identify and isolate other possible tulip allergens, and to quantify the amounts of allergens in different parts of the tulip plant, are recommended.

Tulipalin A induced phytotoxicity

Tulipalin A induced phytotoxicity is a persistent allergic contact dermatitides documented in floral workers exposed to Alstroemeria and its cultivars.[1] The causative allergen is tulipalin A, a toxic glycoside named for the tulip bulbs from which it was first isolated.[2] The condition is characterized by fissured acropulpitis, often accompanied by hyperpigmentation, onychorrhexis, and paronychia. More of the volar surface may be affected in sensitized florists. Dermatitis and paronychia are extremely common conditions and diagnostic errors may occur. A thorough patient history, in conjunction with confirmatory patch testing with a bulb sliver and tuliposide A exposure, can prevent misdiagnosis. We report a case of Tulipalin A induced phytotoxicity misdiagnosed as an unresolved tinea manuum infection in a patient evaluated for occupational exposure.

Quantification of α-methylene-λ-butyrolactone extracted from different parts ofAlstroemeria wilhelmina and evaluation of it's antigenicity using the guinea-pig maximization test

To detect the type of contact dermatitis caused due to the handling ofAlstroemeria wilhelmina, 1% α-methylene-λ-butyrolactone (α-MBL) dissolved in physiological alien and a five-fold diluted saline solution of original extracts of flowers, leaves and stems of the flower were applied to guinea-pigs for extracts were applied to the animals as the challenge treatment in compliance with the guinea-pig maximization test (GMT). As a consequence, not only primary irritant dermatitis was observed, but also delayed type allergic contact dermatitis due toAlstroemeria wilhelmina was observed. α-MBL determined in the extracts using high-performance liquid chromatography (HPLC) was found to be the biochemical material cause of the contact dermatitis. the flower region contained α-MBL in the highest concentrations compared with those of the leaves and stems. Therefore, the quantification of α-MBL in the extracts was concluded as being a useful evaluating method for contact dermatitis due to the handling ofAlstroemeria.

Allergic contact dermatitis to plants: understanding the chemistry will help our diagnostic approach

Allergic contact dermatitis due to plants is common. Potentially allergenic plants and plant products are found in many everyday environments, such as the home, the garden, the workplace, and recreational settings. By improving our knowledge of allergenic plant-derived chemical compounds, we will be better positioned to identify novel allergens. We review the most relevant chemical allergens that contribute to plant allergic contact dermatitis and propose a clinical classification system based on 5 major families of chemical sensitizers: α-methylene-γ-butyrolactones, quinones, phenol derivatives, terpenes, and miscellaneous structures (disulfides, isothiocyanates, and polyacetylenic derivates). We also describe the different clinical pictures of plant allergic contact dermatitis and review currently available patch test materials. A better understanding of the specific allergens involved in plant allergic contact dermatitis will help to predict cross-reactivity between different plant species or families.

Bulb dermatitis. Dermatological problems in the flower bulb industries

The irritant and allergenic properties of the most important flower bulbs are described, as well as the clinical symptoms they cause. The tulip contains the allergen tulipalin A; sensitization and irritation are responsible for the development of tulip fingers. The same clinical picture can be caused by Alliums like the onion and garlic. The narcissus causes lily rash, a dermatitis rarely caused by sensitization. The hyacinth evokes itching in practically everyone: an irritant reaction caused by calcium oxalate crystals. Patch testing is complicated as the allergens are not all identified.

A simple HPLC method for the isolation and quantification of the allergens tuliposide A and tulipalin A in Alstroemeria

A practical, rapid, reliable and sensitive method for the isolation and determination of the allergens tuliposide A and alpha-methylene-gamma-butyrolactone (tulipalin A), by reversed-phase high-performance liquid chromatography (RP-HPLC), has been developed in order to select Alstroemeria species for breeding purposes. From the aqueous extracts of flowers, stems and leaves, of several Alstroemeria species, the contents of 6-tuliposide A and tulipalin A were determined by isocratic RP-HPLC, using distilled water as mobile phase. The compounds were detected by an UV detector at 208 nm. Differences in 6-tuliposide A and tulipalin A content were found among the species investigated, with the highest concentrations in stems and flowers. The absence of other tuliposides (e.g., 1-tuliposide A, 1- and 6-tuliposide B) in extracts was proven by TLC, RP-HPLC, 1H- and 13C-NMR. 6-Tuliposide A and tulipalin A were identified by 1H- and 13C-NMR and comparison with authentic material, respectively. With this HPLC method, it is possible to investigate a large number of plants for their contents of tuliposide A and tulipalin A, within a minimum of time, and to isolate them directly from aqueous extracts.

Dermatoses among floral shop workers

Concern about the increasing incidence of hand dermatitis in floral shop workers in the United States and its possible association to the plant Alstroemeria, a flower that has become popular since its introduction in 1981, prompted investigation of the prevalence and cause of hand dermatitis in a sample of floral workers. Fifty-seven floral workers were surveyed, and 15 (26%) reported hand dermatitis within the previous 12 months. Sixteen floral workers (eight with dermatitis) volunteered to be patch tested to the North American Contact Dermatitis Group Standard and Perfume Trays, a series of eight pesticides and 20 plant allergens. Of four of seven floral designers and arrangers who reported hand dermatitis, three reacted positively to patch tests to tuliposide A, the allergen in Alstroemeria. Patch test readings for all other plant extracts were negative. A positive reading for a test to one pesticide, difolatan (Captafol), was noted, the relevance of which is unknown.

Hypopigmentation in dogs treated with an inhibitor of platelet aggregation

Hypopigmentation was the principal manifestation of systemic toxicity when the experimental platelet aggregation inhibitor, PD-89454, was orally administered to Beagle dogs for 28 days. Pigmentation changes were present in skin of nose, lips and eyelids and mucosa of hard palate. Fontana-Masson stain demonstrated decreased melanin within melanocytes and keratinocytes. Melanocytes were globoid with inconspicuous dendritic processes and had small, incompletely pigmented melanosomes that were quantitatively reduced relative to controls. Toxic mechanism of action of PD-89454, structurally distinct from known depigmenting compounds, was not established but ultrastructural findings suggest an interference in melanosome formation and/or melanization.

Contact dermatitis to Alstroemeria

A study was carried out on 50 workers in a floriculture centre to evaluate the incidence of contact dermatitis to Alstroemeria. 3 subjects gave positive reactions to aqueous and ethanolic extracts of cut flowers, stems and leaves. By column chromatography, the allergen was isolated and its chemical structure identified as 6-tuliposide A by proton magnetic resonance and carbon-13 magnetic resonance. Only 6-tuliposide A was isolated from cut flowers, and this gave positive reactions when patch tested at 0.01%; a-methylene-gamma-butyrolactone at 10(-5) (v/v) was positive in the same 3 subjects. Other lactones (gamma-methylene-gamma-butyrolactone, alantolactone, isoalantolactone) were negative at all concentrations used.

The sensitizing capacity of Alstroemeria cultivars in man and guinea pig. Remarks on the occurrence, quantity and irritant and sensitizing potency of their constituents tuliposide A and tulipalin A (alpha-methylene-gamma-butyrolactone)

Dermatitis in 8 female nursery workers handling Alstroemeria ligtu cultivars has been proven/proved in 6 cases to be of allergic origin. Epicutaneous tests with cut flower extracts as well as with the isolated and purified sensitizer were positive. Successful animal experiments corroborated the sensitising capacity of Alstroemeria cultivars. The responsible but unstable contact allergen, alpha-methylene-gamma-butyrolactone (tulipalin A), was found in short ether extracts of flower petals in concentrations up to 18%. Due to its instability, subsequent extractions were performed with methanol, yielding the sensitising constituent after purification in the glucosidic form (tuliposide A). This could be stored at room temperature for longer periods without loss of activity. Tuliposide A was determined in specimens of Alstroemeria ligtu cultivars of 14 different origins of various colours; its content varied between 1 and 2%. Direct testing of the plant material in human patients carries the risk of false positive reactions and active sensitisation, as the threshold for both forms of the allergen is very high. Only a concentration of 0.01% can be considered safe.