Australasian Journal of Dermatology (2000) 41, 262–263
VIGN ETTE I N CONTACT DERMATOLOGY
Contact dermatitis to Asparagus officinalis Marius Rademaker and Anthony Yung Contact Dermatitis Clinic, Waikato Hospital, Hamilton, New Zealand
SUMMARY A 53-year-old farm worker presented with a 3-year history of an occupational allergic contact dermatitis to asparagus. The dermatitis cleared quickly with courses of systemic corticosteroids but relapsed within days of further exposure to asparagus. The genera Asparagus is made up of some 300 species. It belongs to the family Liliaceae which includes tulips, onions and garlic. Asparagus contains asparagin, coniferin and the glucoside vanillin. The allergen may be a plant growth inhibitor, 1,2,3-Trithiane-5-carboxylic acid, which is present in young shoots. Key words: allergic contact dermatitis, occupational contact dermatitis, Liliaceae, vegetables.
CASE REPORT A 53-years Polynesian farm worker presented with a 3-year history of a recurrent hand dermatitis. She had been seen 4 years earlier with cutaneous discoid lupus erythematosus. The hand dermatitis appeared within 5 days of the start of each asparagus season. She had worked in the asparagus industry for 10 years, initially as a packer and then as a grader. She first developed mild dermatitis of the middle finger of her right hand when working in the grading shed 3 years previously. This grumbled on through the season and cleared completely when the season finished. The next year she worked as a picker. Within 5 days of the start of the season her dermatitis recurred. It progressed rapidly to involve both hands and arms. The dermatitis cleared quickly with courses of systemic corticosteroids but relapsed within days of returning to work. Once again it settled after the finish of the season. This year, the dermatitis appeared within 3 days of the start of the
Correspondence: Dr Marius Rademaker, Contact Dermatitis Clinic, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand. Email:
[email protected]. Marius Rademaker, FRACP, DM. Anthony Yung MB, ChB.
Manuscripts for this section should be submitted to Dr M Rademaker. Presented at the Annual Scientific Meeting of the Australasian College of Dermatologists, May 2000, Sydney, Australia.
season. It rapidly became generalized. Rubber gloves were initially of benefit, but not latterly. She was patch tested to the European standard series of allergens (Chemotechnique, Malmo, Sweden), and specific series of agricultural chemicals, pesticides, plants and woods as well as to various components of a freshly picked shoot of Asparagus officinalis. At both 48 hours and 96 hours she had a 1 + reaction to the leaf, tip, shaft and skin of the asparagus shoot. In addition, she had a 2 + reaction to thiuram mix and a 3 + reaction to nickel sulphate. The asparagus used for patch testing had not been treated with any fungicides.
COMMENT The genera Asparagus is made up of some 300 species.1,2 It belongs to the family Liliaceae (which includes tulips, onions and garlic). Several species of asparagus are of horticultural value, particularly as foliage for flower arranging (e.g., Asparagus spengeri, A. plumosus and A. medeoloides. The young shoots of A. officinalis are highly esteemed as a vegetable. The European preference is for white asparagus, while in New Zealand and Australia, new cultivars of green or red asparagus are more popular. Although the first report of possible contact dermatitis to asparagus was reported by Guntz in 1880,1 there appear very few case reports in the English literature.3,4 It is, however, apparently well recognized in Germany, particularly among pickers, canners and vegetable cooks. Asparagus contains asparagin, coniferin and the glucoside, vanillin.1 The allergen may be a plant growth inhibitor, 1,2,3-trithiane-5-carboxylic acid. In experimental studies this has a weak to moderate sensitizing capacity.3 1,2,3Trithiane-5-carboxylic acid is a sulfur-containing growth inhibitor which appears to be present mainly in the early phase of the growth season. This would explain why young shoots appear to be most allergenic. A further sensitizing constituent was also detected but has, as yet, not been fully identified.3 Contact urticaria,5 conjunctivitis, rhinitis and asthma6 have all been reported following exposure to asparagus, as has a case of acute urticaria following ingestion of asparagus.7 Contact dermatitis to asparagus seems to be relatively uncommon and takes a number of years to develop. Several local farmers have commented that packers and graders appear more susceptible to hand dermatitis than asparagus pickers. This may simply reflect that pickers are a more transient labour force and may not return for a further
Contact dermatitis to Asparagus officinalis season’s work if they had developed a hand dermatitis. Graders, on the other hand, are more skilled, slightly better paid, and may therefore be more likely to return every season, even if they have developed an allergic contact dermatitis. The patient’s thiuram sensitivity probably reflects sensitization to rubber chemicals from rubber gloves. When the hand dermatitis first developed, she wore rubber gloves with good effect. However, over time, rubber gloves became ineffective. Thiuram cross-reacts with the dithiocarbamate fungicide, tetramethylthiuram disulphide (Thiram), which is a well-recognized cause of contact dermatitis in farmers. However, no fungicides were used at the patient’s place of work. Her nickel allergy reflects sensitization to nickelcontaining jewellery.
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Lovell CR. Allergic contact dermatitis due to plants. In: Plants and the Skin. Oxford, Blackwell Scientific Publications, 1993: 96–254 (p. 216). Hausen BM, Wolf C. 1,2,3-Trithiane-5-carboxylic acid, a first contact allergen from Asparagus officinalis (Liliaceae). Am. J. Contact Derm. 1996; 7: 41–6. Cronin E. Dermatitis of the hands in caterers. Contact Dermatitis 1987; 17: 265–9. Sanchez MC, Hernandez M, Morena V et al. Immunologic contact urticaria caused by asparagus. Contact Dermatitis 1997; 37: 181–2. Lopez-Rubio A, Rodriguez J, Crespo JF et al. Occupational asthma caused by exposure to asparagus: Detection of allergens by immunoblotting. Allergy 1998; 53: 1216–20. Escribano MM, Munoz-Bellido FJ, Serrano P, de la Calle A, Conde J. Acute urticaria after ingestion of asparagus. Allergy 1998; 53: 622–3.
REFERENCES 1.
Mitchell JC, Rook A. Botanical Dermatology: Plants and Plant Products Injurious to The Skin. Vancouver: Greengrass, 1979; 439–41.
AN NOUNCEM ENTS
SIXTH ASIA/PACIFIC ENVIRONMENTAL AND OCCUPATIONAL DERMATOLOGY SYMPOSIUM The Sixth Asia/Pacific Environmental and Occupational Dermatology Symposium, APEODS 2001, will be held in Melbourne, Australia, 17–19 May 2001. For further information, please write to: APEODS Melbourne 2001, PO Box 1014, Darling, Victoria 3145, Australia; or email:
[email protected]
THE NIELS HJORTH PRIZE The International Contact Dermatitis Research Group encourages research by endowing a Niels Hjorth Prize
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(£2000). The submission of original, unpublished papers is invited; a committee will select the winner. The winning entry will be presented as a paper at the 13th International Symposium on Contact Dermatitis in Montevideo, Uruguay, in November 2001. The deadline for submission of papers for the prize is 1 May 2001. Please send six copies of the paper to the Chairman of the International Contact Dermatitis Research Group, Professor J.-M. Lachapelle, Department of Dermatology, Louvain University, UCL 3033, 30, Clos Chapelleaux-Champs, B-1200 Brussels, Belgium. Tel.: 322 7643 335; fax: 322 7643 334.
