Contact urticaria due to the common stinging nettle (Urtica dioica)--histological, ultrastructural and pharmacological studies

STRETCH: Stinging tree exposures to Cairns Hospital

OBJECTIVES

To evaluate the burden of disease, investigate the treatment and response to treatment caused by exposure to stinging tree plants presenting to Cairns Hospital over a 3-year period. Our secondary aim was to examine the benefit from treating such exposures with topical dilute hydrochloric acid (HCl).

METHODS

A retrospective chart review of all patients presenting to Cairns ED over a 3-year period because of stinging tree exposure. Symptoms, signs, treatment and outcomes were recorded.

RESULTS

There were 48 presentations, all having immediate pain after contact with the stinging tree, with 87% describing the pain as moderate or severe. Nearly all were stung on limbs (96%). There were 13 different treatments prior to presentation. In hospital, 60% needed opioid analgesia and a median oral morphine dose equivalent of 15 mg. Of the 29 receiving HCl nine patients reported good relief or complete relief.

CONCLUSIONS

Stinging tree exposure results in significant presentations to the Cairns ED each year. Pain is immediate and severe and there are no clear first aid or definitive treatment recommendations. Further work is needed to ascertain the best first aid and definitive treatment including a formal trial of dilute HCl.

Urtica dioica-Derived Phytochemicals for Pharmacological and Therapeutic Applications

Urtica dioica belongs to the Urticaceae family and is found in many countries around the world. This plant contains a broad range of phytochemicals, such as phenolic compounds, sterols, fatty acids, alkaloids, terpenoids, flavonoids, and lignans, that have been widely reported for their excellent pharmacological activities, including antiviral, antimicrobial, antihelmintic, anticancer, nephroprotective, hepatoprotective, cardioprotective, antiarthritis, antidiabetic, antiendometriosis, antioxidant, anti-inflammatory, and antiaging effects. In this regard, this review highlights fresh insight into the medicinal use, chemical composition, pharmacological properties, and safety profile of U. dioica to guide future works to thoroughly estimate their clinical value.

Distribution, Ecology, Chemistry and Toxicology of Plant Stinging Hairs

Plant stinging hairs have fascinated humans for time immemorial. True stinging hairs are highly specialized plant structures that are able to inject a physiologically active liquid into the skin and can be differentiated from irritant hairs (causing mechanical damage only). Stinging hairs can be classified into two basic types: Urtica-type stinging hairs with the classical "hypodermic syringe" mechanism expelling only liquid, and Tragia-type stinging hairs expelling a liquid together with a sharp crystal. In total, there are some 650 plant species with stinging hairs across five remotely related plant families (i.e., belonging to different plant orders). The family Urticaceae (order Rosales) includes a total of ca. 150 stinging representatives, amongst them the well-known stinging nettles (genus Urtica). There are also some 200 stinging species in Loasaceae (order Cornales), ca. 250 stinging species in Euphorbiaceae (order Malphigiales), a handful of species in Namaceae (order Boraginales), and one in Caricaceae (order Brassicales). Stinging hairs are commonly found on most aerial parts of the plants, especially the stem and leaves, but sometimes also on flowers and fruits. The ecological role of stinging hairs in plants seems to be essentially defense against mammalian herbivores, while they appear to be essentially inefficient against invertebrate pests. Stinging plants are therefore frequent pasture weeds across different taxa and geographical zones. Stinging hairs are usually combined with additional chemical and/or mechanical defenses in plants and are not a standalone mechanism. The physiological effects of stinging hairs on humans vary widely between stinging plants and range from a slight itch, skin rash (urticaria), and oedema to sharp pain and even serious neurological disorders such as neuropathy. Numerous studies have attempted to elucidate the chemical basis of the physiological effects. Since the middle of the 20th century, neurotransmitters (acetylcholine, histamine, serotonin) have been repeatedly detected in stinging hairs of Urticaceae, but recent analyses of Loasaceae stinging hair fluids revealed high variability in their composition and content of neurotransmitters. These substances can explain some of the physiological effects of stinging hairs, but fail to completely explain neuropathic effects, pointing to some yet unidentified neurotoxin. Inorganic ions (e.g., potassium) are detected in stinging hairs and could have synergistic effects. Very recently, ultrastable miniproteins dubbed "gympietides" have been reported from two species of Dendrocnide, arguably the most violently stinging plant. Gympietides are shown to be highly neurotoxic, providing a convincing explanation for Dendrocnide toxicity. For the roughly 648 remaining stinging plant species, similarly convincing data on toxicity are still lacking.

Neurotoxic peptides from the venom of the giant Australian stinging tree

Stinging trees from Australasia produce remarkably persistent and painful stings upon contact of their stiff epidermal hairs, called trichomes, with mammalian skin. Dendrocnide-induced acute pain typically lasts for several hours, and intermittent painful flares can persist for days and weeks. Pharmacological activity has been attributed to small-molecule neurotransmitters and inflammatory mediators, but these compounds alone cannot explain the observed sensory effects. We show here that the venoms of Australian Dendrocnide species contain heretofore unknown pain-inducing peptides that potently activate mouse sensory neurons and delay inactivation of voltage-gated sodium channels. These neurotoxins localize specifically to the stinging hairs and are miniproteins of 4 kDa, whose 3D structure is stabilized in an inhibitory cystine knot motif, a characteristic shared with neurotoxins found in spider and cone snail venoms. Our results provide an intriguing example of inter-kingdom convergent evolution of animal and plant venoms with shared modes of delivery, molecular structure, and pharmacology.

Therapeutic Perspectives of Molecules from Urtica dioica Extracts for Cancer Treatment

A large range of chronic and degenerative diseases can be prevented through the use of food products and food bioactives. This study reports the health benefits and biological activities of the Urtica dioica (U. dioica) edible plant, with particular focus on its cancer chemopreventive potential. Numerous studies have attempted to investigate the most efficient anti-cancer therapy with few side effects and high toxicity on cancer cells to overcome the chemoresistance of cancer cells and the adverse effects of current therapies. In this regard, natural products from edible plants have been assessed as sources of anti-cancer agents. In this article, we review current knowledge from studies that have examined the cytotoxic, anti-tumor and anti-metastatic effects of U. dioica plant on several human cancers. Special attention has been dedicated to the treatment of breast cancer, the most prevalent cancer among women and one of the main causes of death worldwide. The anti-proliferative and apoptotic effects of U. dioica have been demonstrated on different human cancers, investigating the properties of U. dioica at cellular and molecular levels. The potent cytotoxicity and anti-cancer activity of the U. dioica extracts are due to its bioactive natural products content, including polyphenols which reportedly possess anti-oxidant, anti-mutagenic and anti-proliferative properties. The efficacy of this edible plant to prevent or mitigate human cancers has been demonstrated in laboratory conditions as well as in experimental animal models, paving the way to the development of nutraceuticals for new anti-cancer therapies.

Highly potent radical scavenging-anti-oxidant activity of biologically reduced graphene oxide using Nettle extract as a green bio-genic amines-based reductants source instead of hazardous hydrazine hydrate

Reduced graphene oxide (rGO) is relied upon to be the most promising candidate for high-proficiency. Hydrazine is the most conventional efficient reducing agent that has been frequently used for reduction of graphene oxide, however, it is not environmentally safe due to its toxic nature, causing unsatisfactory defects on the basal plan of GO. Therefore, employing green and efficient reducing agents from natural sources like plant extracts has become the research interest for obtaining high quality reduced graphene oxide sheets in recent years. Here a one-step, easy, cost-effective and green synthesis method based on Nettle leaves' extract has been introduced as an effective reduction method of graphene oxide compared with the toxic and harmful Hydrazine hydrate substance. In this study, GO and rGO were obtained from various methods and characterized by Raman spectroscopy, field emission scanning electron microscope, high-resolution transmission electron microscope (HR-TEM), X-ray diffraction analysis (XRD) and X-ray photon spectroscopy (XPS) analysis. Results of different analytical techniques revealed that the Nettle leaves' extract could successfully reduce GO sheets to high performance reduced graphene oxide with 79% efficiency in comparison with conventional Hydrazine hydrate. On the other side the rGO obtained by Nettle solution could scavenge the free radicals with 70% inhibition capacity at least concentration. Existence of Histamine and Serotonin and many other polyphenols as a part of Nettle leaves composition by following anti-oxidants mechanisms (H donation or electron transfer) promote the anti-oxidant functionality of Nettle leaves. So the highlighted achievement of this paper is to obtain a highly anti-oxidant green reduced graphene oxide with a wide applications i.e medical and polymer composite with UV-shielding activity.

Effects of Sting Plant Extracts as Penetration Enhancers on Transdermal Delivery of Hypoglycemic Compounds

Background and objectives: The percutaneous route is an interesting and inventive investigation field of drug delivery. However, it is challenging for drug molecules to pass through the skins surface, which is a characterized by its permeability barrier. The purpose of this study is to look at the effect of some penetration enhancers on in vivo permeation of insulin and insulin sensitizers (curcumin and rutin) through diabetes-induced mouse skin. Materials and Methods: Sting crude extracts of Dendrocnide meyeniana, Urtica thunbergiana Sieb. and Zucc, and Alocasia odora (Lodd.) Spach were used as the penetration enhancers. Mouse skin irritation was tested by smearing the enhancers for the measurements at different time points and the cell viability of the HaCaT human skin keratinocytes, which was determined by Trypan blue exclusion and MTT assays to evaluate human biosafety for these extracts after the mouse skin permeation experiments. Results: All enhancers induced a slight erythema without edema on the mouse skin that completely recovered after 6 h from the enhancer smears as compared with normal mouse skin. Furthermore, no damaged cells were found in the HaCaT keratinocytes under sting crude extract treatments. The blood sugar level in the diabetic mice treated with the insulin or insulin sensitizers, decreased significantly (p < 0.05) in the presence of enhancers. The area under the curve (AUC) values of transdermal drug delivery (TDD) ranged from 42,000 ± 5000 mg/dL x min without enhancers, to 30,000 ± 2000 mg/dL x min in the presence of enhancers. Conclusions: This study exhibited that natural plant extracts could be preferred over the chemically synthesized molecules and are safe and potent penetration enhancers for stimulating the transdermal absorption of drugs.

Urtica spp.: Ordinary Plants with Extraordinary Properties

Nettles (genus Urtica, family Urticaceae) are of considerable interest as preservatives in foods for both human and animal consumption. They have also been used for centuries in traditional medicine. This paper reviews the properties of nettles that make them suitable for wider applications in the food and pharmaceutical industries. Nettles contain a significant number of biologically-active compounds. For example, the leaves are rich sources of terpenoids, carotenoids and fatty acids, as well as of various essential amino acids, chlorophyll, vitamins, tannins, carbohydrates, sterols, polysaccharides, isolectins and minerals. Extracts from the aerial parts of nettles are rich sources of polyphenols, while the roots contain oleanol acid, sterols and steryl glycosides. Due to the variety of phytochemicals and their proportions they contain, nettles show noticeable activity against both Gram-positive and Gram-negative bacteria. These properties make nettles suitable for a range of possible applications, including functional food, dietary supplements and pharmacological formulations. Despite these benefits, the nettle is still an underestimated plant source. This paper provides a unique overview of the latest research on nettle plants focusing on the possibilities for transforming a common weed into a commercial plant with a wide range of applications. Special attention is paid to the antimicrobial activity of the active compounds in nettles and to possible uses of these valuable plants in food and feed formulations.

Natural product modulators of human sensations and mood: molecular mechanisms and therapeutic potential

Humans perceive physical information about the surrounding environment through their senses. This physical information is registered by a collection of highly evolved and finely tuned molecular sensory receptors. A multitude of bioactive, structurally diverse ligands have evolved in nature that bind these molecular receptors. The complex, dynamic interactions between the ligands and the receptors lead to changes in our sensory perception or mood. Here, we review our current knowledge of natural products and their derived analogues that interact specifically with human G protein-coupled receptors, ion channels, and nuclear hormone receptors to modulate the sensations of taste, smell, temperature, pain, and itch, as well as mood and its associated behaviour. We discuss the molecular and structural mechanisms underlying such interactions and highlight cases where subtle differences in natural product chemistry produce drastic changes in functional outcome. We also discuss cases where a single compound triggers complex sensory or behavioural changes in humans through multiple mechanistic targets. Finally, we comment on the therapeutic potential of the reviewed area of research and draw attention to recent technological developments in genomics, metabolomics, and metabolic engineering that allow us to tap the medicinal properties of natural product chemistry without taxing nature.

The definition, diagnostic testing, and management of chronic inducible urticarias - The EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision

These recommendations for the definition, diagnosis and management of chronic inducible urticaria (CIndU) extend, revise and update our previous consensus report on physical urticarias and cholinergic urticaria (Allergy, 2009). The aim of these recommendations is to improve the diagnosis and management of patients with CIndU. Our recommendations acknowledge the latest changes in our understanding of CIndU, and the available therapeutic options, as well as the development of novel diagnostic tools.

Allergenic proteins in Urtica dioica, a member of the Urticaceae allergenic family

BACKGROUND

Allergy to the pollen of flowering plant species significantly affects the health of people in many parts of the world. Pollens of related genera usually share common antigens and are often, but not always, cross-reactive. Several studies have shown that Parietaria pollen is one of the most common causes of pollinosis in the Mediterranean area, whereas Urtica has no allergenic significance.

OBJECTIVES

To report on the localization of Parietaria judaica major allergen in Urtica dioica pollen grains and on the detection of allergenic proteins in U. dioica pollen grains during the hydration-activation process.

METHODS

A combination of transmission electron microscopy and immunocytochemical methods was used to locate allergenic proteins in U. dioica pollen grains after different periods of hydration-activation using the anti-Par j 1 (4.1.3.) monoclonal antibody and serum samples from allergic patients.

RESULTS

No significant labeling was noted for Parj 1 allergen after 10, 15, and 20 minutes in the walls and cytoplasm. Slight labeling was observed for allergic proteins in the walls of U. dioica after 10 minutes of hydration, and no significant labeling was found after 15 and 20 minutes of hydration.

CONCLUSIONS

Immunocytochemical methods confirmed the absence of cross-reactivity between 2 related genera, Parietaria and Urtica, and the lowest allergenic potential of U. dioica.

The inflammatory response in drug-induced acute urticaria: ultrastructural study of the dermal microvascular unit

BACKGROUND

Drug exposure is one of the main aetiologies of urticaria and represents the second most common cause in acute urticarias. Studies involving the ultrastructural aspects of urticaria are relatively rare in the literature. Most of the articles published report on skin biopsies of experimentally induced urticaria, and acute urticaria has been studied even less from a morphological point of view.

OBJECTIVES

The aims of this study were to observe ultrastructural cell characteristics in five patients with drug-induced acute urticaria and possible aspects of the inflammatory skin response.

METHODS

Clinical manifestations, light microscopy and transmission electron microscopy were evaluated.

RESULTS

With light microscopy, a mild perivascular lymphocyte-monocyte infiltrate was observed with few neutrophils and dermal oedema in skin biopsies of five patients. With electron microscopy, a mild vascular dilatation was observed, with platelets in the lumen and several lymphocytes and dendritic cells close to the superficial dermal vessels. Some mast cells appeared normal, whereas others were granule-depleted. In some areas, mast cells, lymphocytes and satellite dendritic cells were closely associated, as well as some macrophages. A significant number of plasma cells, eosinophils and polymorphonuclear neutrophils were not observed; however, the presence of lymphocytes and macrophages was significant. The epidermis and the dermal-epidermal junction were preserved, except for a discrete oedema in keratinocytes.

CONCLUSIONS

The ultrastructural aspect of drug-induced acute urticaria is similar to that observed in urticaria caused by Urtica dioica, intradermal histamine and cold urticaria. The presence of the cellular triad with mast cells, dendritic (or satellite) cells and lymphocytes suggests a functional interaction of these cells. These findings support the possible existence of mechanisms in the dermis that may participate in protective and/or injurious vasocentric immune reactions.

Identification of oxalic acid and tartaric acid as major persistent pain-inducing toxins in the stinging hairs of the nettle, Urtica thunbergiana

BACKGROUND AND AIMS

Once human skin contacts stinging hairs of Urtica spp. (stinging nettles), the irritant is released and produces pain, wheals or a stinging sensation which may last for >12 h. However, the existence of pain-inducing toxins in the stinging hairs of Urtica thunbergiana has never been systematically demonstrated. Experiments were therefore conducted to identify the persistent pain-inducing agents in the stinging hairs of U. thunbergiana.

METHODS

The stinging hairs of U. thunbergiana were removed and immersed in deionized water. After centrifugation, the clear supernatants were then subjected to high-performance liquid chromatography (HPLC), enzymatic analysis and/or behavioural bioassays.

KEY RESULTS

The HPLC results showed that the major constituents in the stinging hairs of U. thunbergiana were histamine, oxalic acid and tartaric acid. However, the well-recognized pain-inducing agents, serotonin and formic acid, existed at a low concentration as estimated by HPLC and/or enzymatic analyses. The behavioural tests showed that 2% oxalic acid and 10% tartaric acid dramatically elicited persistent pain sensations in rats. In contrast, 10% formic acid and 2% serotonin only elicited moderate pain sensation in the first 10 min. Moreover, no significant pain-related behavioural response was observed after injecting 10% acetylcholine and histamine in rats.

CONCLUSIONS

Oxalic acid and tartaric acid were identified, for the first time, as major long-lasting pain-inducing toxins in the stinging hairs of U. thunbergiana. The general view that formic acid, histamine and serotonin are the pain-inducing agents in the stinging hairs of U. dioica may require updating, since their concentrations in U. thunbergiana were too low to induce significant pain sensation in behavioural bioassays.

Molecular cloning and tissue-specific transcriptional regulation of the first peroxidase family member, Udp1, in stinging nettle (Urtica dioica)

A full-length cDNA clone, designated Udp1, was isolated from Urtica dioica (stinging nettle), using a polymerase chain reaction based strategy. The putative Udp1 protein is characterized by a cleavable N-terminal signal sequence, likely responsible for the rough endoplasmic reticulum entry and a 310 amino acids mature protein, containing all the important residues, which are evolutionary conserved among different members of the plant peroxidase family. A unique structural feature of the Udp1 peroxidase is defined into the short carboxyl-terminal extension, which could be associated with the vacuolar targeting process. Udp1 peroxidase is differentially regulated at the transcriptional level and is specifically expressed in the roots. Interestingly, wounding and ultraviolet radiation stress cause an ectopic induction of the Udp1 gene expression in the aerial parts of the plant. A genomic DNA fragment encoding the Udp1 peroxidase was also cloned and fully sequenced, revealing a structural organization of three exons and two introns. The phylogenetic relationships of the Udp1 protein to the Arabidopsis thaliana peroxidase family members were also examined and, in combination with the homology modelling approach, dictated the presence of distinct structural elements, which could be specifically involved in the determination of substrate recognition and subcellular localization of the Udp1 peroxidase.

Antihistamines in Dermatology

Along with antibiotics, antihistamines are the most widely used systemic drugs in dermatology. This is attributable to the major role played by histamine in common diseases such as urticaria and atopic eczema. Of the currently recognised four subtypes of G protein-coupled histamine receptors, only the H1 and H2 subtypes have been positively identified in human skin. Traditionally believed to be competitive antagonists of histamine, H1 and H2 antihistamines are now considered to behave as inverse agonists. By consensus, H1 antihistamines are classified as 'first generation' (associated with troublesome side-effects including somnolence, anti-adrenergic and atropine-like actions) and 'second-generation' compounds (in which these side-effects are reduced or absent). The main indications for H1 antihistamines in skin are suppression of pruritus in urticaria and atopic eczema, both of which are associated with increased mast cell numbers and tissue histamine levels. However the evidence basis for use in atopic eczema is ambiguous and controversial, even though these drugs are widely used in practice. Currently, significant side-effects are mainly confined to the first-generation compounds and are especially troublesome in the elderly. Psychomotor impairment may persist throughout the day following administration. Anti-cholinergic and anti-alpha-adrenergic blockade and cardiotoxicity (torsade de pointes) may also occur with first-generation antihistamines. Two early low-sedation second-generation antihistamines caused arrhythmias in a small number of patients but these compounds have now been withdrawn. Generally, the second-generation H1 antihistamines are well tolerated.

Complementary and alternative interventions in asthma, allergy, and immunology

OBJECTIVE

To review which herbs are most commonly used as complementary and alternative medicine (CAM) for treatment of asthma, allergy, and immunologic conditions.

DATA SOURCES

A review of the literature was performed using the PubMed and OVID databases searching the keywords asthma, allergy, and CAM to identify studies published between 1980 and 2003 that focused on Echinacea (Echinacea augustifolia, Echinacea pallida, and Echinacea purpurea); garlic (Allium); angelica; chamomile; ephedra; gingko; grape seed extract; licorice root (Glycyrrhiza); St. John's wort (Hypericum); kava kava (Piper); peppermint oil and leaf (Mentha); stinging nettle (Urtica); and ginseng (Panax) published in the English and German literature.

STUDY SELECTION

Studies included in vitro and in vivo clinical trials and case reports selected according to the expert opinion of the author.

RESULTS

Echinacea is one of the most common herbs used to treat symptoms of the "common cold" or upper respiratory tract allergies. Although no common drug interactions have been reported, there is a risk of hepatotoxicity, exacerbation of allergies and asthma, and anaphylactic reactions. Garlic is primarily used for cardiovascular health and relief of cough, colds, and rhinitis. Adverse effects commonly include gastrointestinal disturbances, change in body odor through the sweat and breath, and rarely allergic reactions or hypoglycemia. Other CAM agents, including angelica, German chamomile flower, ephedra, gingko, grape seed extract, licorice root, St. John's wort, kava kava rhizome, peppermint, stinging nettle, and ginseng, are also associated with significant adverse effects.

CONCLUSION

The specialty of allergy and immunology has seen the second largest increase in the popularity of CAM (second only to practitioners who treat lower back pain). Almost all of the CAM interventions have displayed adverse effects, usually in the form of a hypersensitivity reaction. Allergists and clinical immunologists need to become more knowledgeable about CAM so that they can inform patients about the use and possible abuse of these modalities.

Plant exposures: wilderness medicine

This article discusses poisonous plants, the symptoms that might arise if they are ingested, and the treatments that should be administered to patients.

Chemical stimulants of leaf-trenching by cabbage loopers: natural products, neurotransmitters, insecticides, and drugs

Larvae of the cabbage looper, Trichoplusia ni (Lepidoptera: Noctuidae), often transect leaves with a narrow trench before eating the distal section. The trench reduces larval exposure to exudates, such as latex, during feeding. Plant species that do not emit exudate, such as Plantago lanceolata, are not trenched. However, if exudate is applied to a looper's mouth during feeding on P. lanceolata, the larva will often stop and cut a trench. Dissolved chemicals can be similarly applied and tested for effectiveness at triggering trenching. With this assay, I have documented that lactucin from lettuce latex (Lactuca sativa), myristicin from parsley oil (Petroselinum crispum), and lobeline from cardinal flower (Lobelia cardinalis) elicit trenching. These compounds are the first trenching stimulants reported. Several other constituents of lettuce and parsley, including some phenylpropanoids, monoterpenes, and furanocoumarins had little or no activity. Cucurbitacin E glycoside found in cucurbits, another plant family trenched by cabbage loopers, also was inactive. Lactucin, myristicin, and lobeline all affect the nervous system of mammals, with lobeline acting specifically as an antagonist of nicotinic acetylcholine receptors. To determine if cabbage loopers respond selectively to compounds active at acetylcholine synapses, I tested several neurotransmitters, insecticides, and drugs with known neurological activity, many of which triggered trenching. Active compounds included dopamine, serotonin, the insecticide imidacloprid, and various drugs such as ipratropium, apomorphine, buspirone, and metoclopramide. These results document that noxious plant chemicals trigger trenching, that loopers respond to different trenching stimulants in different plants, that diverse neuroactive chemicals elicit the behavior, and that feeding deterrents are not all trenching stimulants. The trenching assay offers a novel approach for identifying defensive plant compounds with potential uses in agriculture or medicine. Cabbage loopers in the lab and field routinely trench and feed on plants in the Asteraceae and Apiaceae. However, first and third instar larvae enclosed on Lobelia cardinalis (Campanulaceae) failed to develop, even though the third instar larvae attempted to trench. Trenching ability does not guarantee effective feeding on plants with canal-borne exudates. Cabbage loopers must not only recognize and respond to trenching stimulants, they must also tolerate exudates during the trenching procedure to disable canalicular defenses.

Complementary and alternative medicine in children with asthma

BACKGROUND

The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children.

OBJECTIVE

To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma.

METHODS

The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM.

RESULTS

Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001).

CONCLUSIONS

Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

Study of two plants used in traditional medicine in Zimbabwe for skin problems and rheumatism: Dioscorea sylvatica and Urginea altissima

Two plants used in Zimbabwean traditional medicine, Dioscorea sylvatica (Dioscoreaceae) and Urginea altissima (Liliaceae), produce mild inflammation and itching when rubbed on the skin. Investigations of the causes of these cutaneous reactions showed that raphides of calcium oxalate are, at least in part, responsible for the effects. Histamine could not be detected.

Allergic responses to pollen of ornamental plants: high incidence in the general atopic population and especially among flower growers

BACKGROUND

The incidence of allergy to pollen of ornamental plants has not been deeply investigated, and its extent has remained obscure. Most of such studies have concentrated only on pollen of ornamental plants from the Asteraceae family (Compositae). In this study an attempt was made to clarify whether various other ornamental plants may also cause skin responses and allergic symptoms among allergic urban dwellers and among rural flower growers.

METHODS

Two hundred ninety-two patients were referred for allergic evaluation by their primary physicians; 75 flower growers and 44 university students were evaluated. For all participants, a detailed health record was obtained, and skin prick tests (SPTs) were performed. Extracts for SPTs included commercial common airborne allergens and autochthonous pollen extracts of 11 species of plants belonging to the Asteraceae, Ranunculaceae, Liliaceae, Scrophulariaceae, and Genetianaceae families.

RESULTS

Fifty-one of the 292 patients (17%) referred for allergic evaluation had positive SPT responses to pollen of various ornamental plants. A similar incidence was found among the students (23%). However, the incidence among flower growers was significantly higher, reaching 52%. Higher incidence (83%) of positive SPT responses to ornamental plants was found among flower growers also sensitive to the common allergens. All the tested plants, not only those belonging to the Asteraceae family, provoked positive SPT responses in all 3 groups of participants. None of the participants from the general population or the group of students reported exacerbation of allergic symptoms on exposure to the tested plants. In contrast, almost half of the flower growers (45%) described nasal, ocular, or respiratory symptoms associated with occupational exposure to the tested plants. Some 15% of the growers were eventually compelled to change their profession.

CONCLUSIONS

The incidence of positive SPT responses to ornamental plants was 17% to 23% among the general public but 52% among flower growers. Thus the effects of ornamental plant pollen on atopic patients should be seriously contemplated.