Erythema Multiforme, Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis

Breathnach, S.M.

doi:10.1002/9780470750520.ch74

Cited by 10 publications

(15 citation statements)

References 291 publications

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“…Incidentally, wormwood tea, from the same genus, elicted positive patch test reactions in 13 of 19 Compositae‐allergic patients . Erythema multiforme, in this context with laboratory test results within normal limits, is probably an expression of a delayed hypersensitivity reaction, as described previously .…”

Section: Methodssupporting

confidence: 68%

Systemic allergic dermatitis caused by sesquiterpene lactones

Paulsen

2016

Contact Dermatitis

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SummaryPatients with Compositae sensitization are routinely warned against the ingestion of vegetables, spices, teas and herbal remedies from this family of plants. The evidence for the occurrence of systemic allergic dermatitis caused by sesquiterpene lactone-containing plants is mostly anecdotal and based on statements from patients rather than scientific data. However, a few clinical reports on accidental sensitization and exposure and oral challenge prove the existence of this kind of reaction, most convincingly for strong contact allergens such as costunolide in bay leaves, and less so for weak allergens such as those of lettuce. Other Compositae species suspected of causing systemic reactions are artichoke, mugwort, yarrow, dandelion, feverfew, and elecampane. Some Compositae vegetables and teas, such as lettuce and chamomile tea, may induce systemic reactions through both humoral and cell-mediated mechanisms. It is difficult to disentangle the contribution of these reactions to both local and systemic symptoms of skin and mucous membranes in, for example, lettuce contact allergy. Further studies are needed to assess the prevalence of systemic allergic dermatitis caused by sesquiterpene lactones, and to clarify the pathogenesis for individual haptens.Key words: Asteraceae; challenge; Compositae; herbal tea; Lactuca sativa; Laurus nobilis; sesquiterpene lactones; systemic allergic dermatitis.Sesquiterpene lactones (SLs) constitute one of the largest groups of secondary plant metabolites, with > 5000 compounds (1, 2). They are reactive low molecular weight substances with antimicrobial, antifeedant, growth-modifying and allelopathic properties in general, and are thus important for plant survival (2). SLs occur in at least 17 plant families, but most abundantly in the sunflower family (Asteraceae or Compositae), where they are important taxonomic markers (3). The ability of SLs to bind covalently with biological macromolecules is also the basis of their allergenicity, and the reason why the sunflower family contains so many sensitizing species (1, 4).Contact sensitization to allergenic SLs may imply contact allergy to plants that are consumed either as vegetables, spices, teas, or herbal remedies. This may cause systemic allergic contact dermatitis, which is most frequently reported to be caused by metals, drugs, and plants/herbals (5-9). However, reports on Compositae-related systemic allergic dermatitis are often anecdotal (10-13).In contrast to immediate-type hypersensitivity reactions, which may be detected by serological and laboratory tests in addition to clinical tests, the diagnosis of systemic allergic dermatitis is based on clinical symptoms and signs, and possibly oral or other suitable challenges.The aim of this article is to review the evidence for the occurrence of systemic allergic contact dermatitis caused by Compositae and other SL-containing plants. MethodsThe older literature was searched via textbooks and references from both old and new articles. The newer literature was searched via the...

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Section: Methodssupporting

confidence: 68%

Systemic allergic dermatitis caused by sesquiterpene lactones

Paulsen

2016

Contact Dermatitis

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“…Although she had extensive blistering the Nikolsky sign was negative and she remained systemically well. The course was prolonged and her response to intravenous methylprednisolone was remarkably fast, which is atypical of classic TEN 4 …”

Section: Discussionmentioning

confidence: 96%

“…In this patient the histopathology directed the diagnosis to TEN‐like diseases. Table 1 highlights the distinguishing features of each of the potential diagnoses, although the differences can be subtle 1,2,4–6 …”

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis‐like subacute cutaneous lupus erythematosus

Ryan

Marshman²,

Astill

2011

Aust J Dermatology

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Toxic epidermal necrolysis (TEN)-like presentations have been described in non-drug-induced settings. We describe a case of subacute cutaneous lupus erythematosus (SCLE) in a 53-year old woman, which evolved into a TEN-like presentation over the course of 4 weeks. The patient responded rapidly to treatment with intravenous methylprednisolone. This article draws attention to features that may be used to differentiate classical TEN from TEN-like SCLE.

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“…Dear Editor, Erythema multiforme (EM) is triggered by several conditions including infections, medication and accompanying disorders such as carcinomas. 1 Regarding the infections, the herpes simplex virus (HSV) and species in the genus Mycoplasma are well-known relevant pathogens. However, bacterial infections that induce EM have seen little study.…”

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confidence: 99%