Phytodermatitis: Reactions in the Skin Caused by Plants

Safety & Health Assessment & Research for Prevention Report: 63-8-2001 Washington State Department of Labor and Industries August 2001 1-888-66-SHARP www.lni.wa.gov/sharp/derm

Numerous occupations are associated with the risk of developing reactions to plants and woods. These include food handlers, caterers, green grocers/market gardeners, farmers, agricultural workers, florists, nursery workers, landscapers, forestry workers and loggers. It is estimated that 50% of agricultural occupational skin disease is due to plants, trees and natural vegetation (OMalley et al 1988). Reactions to pesticides and chemicals account for less than 20% of skin reactions in agricultural workers. Plants harm skin in numerous ways. Dermatitis due to mechanical injury, irritant contact, allergic contact, photo reactions (phytophotodermatitis) and contact urticaria (pharmacologic injury) are some of the known reactions to plants. In many cases, it is only specific parts of the plants that cause the reaction such as the bulb of tulips or lilies or the pollen in tansy. Some plants can cause more than one type of skin reaction such as tulips causing hives and allergic contact dermatitis. Types of Plant Dermatitis Mechanical: Dermatitis can be caused by cuts, abrasions and punctures from thorns, spines and hairy appendages on the plants. These can become secondarily infected with bacteria, mycobacteria or fungi. Prickly pears, pineapples, barberry, bamboo and rose thorns are examples of plant material that can cause mechanical injury to the skin. This reaction can occur in anyone and does not require sensitization to a chemical. A reaction develops when the skin comes in contact with an irritating chemical present in the plant. If there is skin trauma from spines or hairy appendages on the plant, the reaction can be worse. Working in hot or wet working conditions can make the reaction intensified. Examples of chemical irritants from plants include acids, proteolytic enzymes and calcium oxylate crystals. This is the most common skin reaction to plants. Mustards, chile peppers, pineapple, mayweed, cowhage and yarrow are examples of plants that contain irritating chemicals that can injury the skin.
Irritant:

The reaction is caused by furocoumarin chemicals (psoralens) present in plants in combination with Ultraviolet A light. After exposure to the plant saps and sunlight, blisters form in a few hours. When the blisters resolve, there is dark, streaky hyperpigmentation that can last for months. Most common plants for causing this reaction are celery, carrots, parsnips, limes, figs, Queen Annes lace and giant hogweed.
Photo Dermatitis (Phytophotodermatitis):

Unlike irritant dermatitis, allergic contact dermatitis requires a sensitized immune system. Not everyone will have a reaction caused by low molecular weight compounds. This reaction requires previous sensitization to the compound. It may take up to 48 hours to develop a reaction. The rash may persist for a few weeks before healing. The most common plant causing this reaction is poison
Allergic Contact Dermatitis:

oak/ivy. The huge family of Compositae plants contain chemical compounds known as sesquiterpene lactones which are sensitizers and irritants. Chrysanthemums and numerous agricultural weeds such as dandelion, goldenrod, black-eyed Susan and tansy in this plant family cause allergic contact dermatitis. Instead of developing blisters like poison ivy, rashes from the Compositae family are usually chronic, dry, itchy, eczematous reactions on the hands. Florists who are allergic to tulips and Alstroemeria can develop severe reactions to these flowers. Except for poison oak/ivy rashes, this type of reaction is the least common form of dermatitis.
Contact Urticaria or Pharmacologic Injury:

Urticaria (hives) develop after contact with the plant or plant product. Irritant hairs on the surface of the plant can enhance penetration of the pharmacological chemicals into the skin. Development of urticaria may be a non-allergic or allergic reaction. In the non-allergic reaction, any person is susceptible to the reaction. Nettles with stinging hairs contain histamines, acetylcholine and serotonin and cause a burning reaction in the skin with development of hives. The reaction can last for a few hours. In the allergic type of urticaria, people with atopic eczema are more prone to serious reactions with swelling of the lips, eyes, throat and generalized hives. There is usually a pre-existing sensitization in the allergic type reaction. Proteins (such as latex) and pollen in plants cause the allergic reaction. Garlic, onions, tulips and lilies can cause this type of reaction in susceptible people. Burke, WA. Skin diseases in farmers. In: Langley, RL, McLymore, RL, Meggs, WJ and Roberson, GT, editors Safety and Health in Agriculture, Forestry, and Fisheries. Rockville, MD: Government Institutes; 1997. p. 321-352. Lovell, CR. Plants and the Skin. Oxford: Blackwell Scientific Publications, 1993. OMalley, M et al. Surveillance of occupational skin disease using the supplementary data system. Am J Indust Med 1988; 13: 291-299. Rietschel, RL and Fowler, Jr., JF. Toxicodendron, plants, and spices. In: Fishers Contact Dermatitis, 4th edition. Baltimore: Williams & Wilkins; 1995. p. 461-523. Sasseville, D. Phytodermatitis. J. Cutaneous Medicine and Surgery 1999; 3: 263-279. Zug, KA and Marks, JG. Plants and woods. In: Adams, RM, editor. Adams Occupational Skin Disease, 3rd edition. Philadelphia: W B Saunders Company; 1999. p. 567-596.

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Acacia African violet Alder, speckled Alfalfa Almond nut Anemone Angelica Anise Anise seed Anthurium Apples Apricot Arnica, wolf's bane, mountain tobacco Artichoke Ash Asparagus Aster Balsam fir Bamboo Banana Barberry Barley Beech, American Beech, European Beggar ticks Begonia Bergamot orange Bindweed Birch, European GENUS Acacia spp. Saintpaulia spp. Alnus rugosa Medicago sativa Prunis dulcis Anemone spp. Angelica archangelica Pimpinella anisum Pimpinella anisum Anthurium spp. Malus domestica Prunus armeniaca Arnica montana Cynara scolymus Fraxinus spp. Asparagus officinalis Aster spp. Abies balsamea Bambusa spp. Musa spp. Berberis spp. Hordeum vulgare Fagus grandifolia Fagus sylvatica Bidens frodosa Begonia rex Citrus aurantium v. bergamia Convolvulus arvensis Betula verrucosa ALLURT NALLURT No No No No No No Yes No Yes No No No No No No No No No No No Yes No Yes No No No No No No No No No No No No No No No Yes No No No Yes No No No No No No No No No No No No No Yes No ACD Yes No Yes No No No No No Yes No No No Yes Yes Yes Yes Yes Yes No No No No Yes Yes No No No No No MECH No Yes No No No No No No No No No No No No No No No No Yes No Yes Yes No No Yes No No No No IRR No No No No No Yes No No No Yes No No No No No Yes No No No No No No No No No Yes No Yes No PHOTO No No No No No No Yes Yes No No No No No No No No No No No No No No No No No No Yes No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 1 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Birch, paper Bishop's weed Bitter orange Bitterweed Black-eyed Susan Blackberry Blackthorn Bleeding heart Borage Bougainvillea Brazil nut Brazilian pepper, Florida holly Bur marigold Burdock Burning bush, gas plant Buttercup Cabbage Cactus Caladium California glory Calla lily Canola bean, rape seed Caraway Carnation, pink Carrot Carrot weed Cassia Castor bean Castor oil plant Cauliflower GENUS Betula papyrifera Ammi majus Citrus aurantium Helenium amarum Rudbeckia hirta Rubus spp. Prunus spinosus Dicentra spectabilis Borago officinailis Bougainvillea brasiliensis Bertholletia excelea Schinus terebinthifolius Bidens tripartita Arctium lappa Dictamus albus Ranunculus bulbuosus Brassica oleracea Cactaceae family Caladium bicolor Fremontodendron Zantedeschia aethiopica Brassica napus Carum carvi Dianthus carophyllus Daucus carota Parthenium hysterophorus Cinnamomum cassia Ricinus communis Ricinus communis Brassica oleracea botrytis ALLURT NALLURT No No No No No No No No No No No No No No No No No No Yes No Yes No No No No No No No No No No No Yes No No No No No No No No No Yes No Yes No No No Yes No No No Yes No No No Yes No Yes No ACD Yes No No Yes Yes No No Yes No No No Yes No Yes No No No No No No No No Yes Yes Yes Yes Yes Yes No Yes MECH No No No No No Yes Yes No No No No No Yes No No No No Yes No No No No No No No No No No No No IRR No No No No No No No No Yes No No No No No No Yes No No Yes Yes Yes No No No No No No No Yes Yes PHOTO No Yes Yes No No No No No No No No No No No Yes No No No No No No No No No Yes No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 2 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Cedar Celery Century plant, agave Chamomile, sweet Chervil Chestnut, horse Chicory Chile pepper Chinese rice paper plant Chives Chrysanthemum Chrysanthemum, florist Chrysanthemum, florist Cinnamon Citron Citronella oil Clematis Cocklebur Coffee bean Coleus Columbine Comfrey Coriander Corn Cornflower Cosmos Cotoneaster Cotton Cow parsley Cow parsnip GENUS Cedrus spp. Apium graveolens Agave americana Anthemis nobilis Anthriscus cereifolium Aesculus hipposcastanum Chicorium intybus Capsicum annuum longum Tetrapanax papyriferus Allium schoenoprasum Chrysanthemum spp. Chrysanthemum indicum Dendranthema grandiflora Cinnamomum zeylanicum Citrus medica Cymbopogon nardus Clematis vitalba Xanthium strumarium Coffea arabica Coleus blumei hybrids Aquilegia spp. Symphytum officinale Coriandrum sativum Zea mays Centaurea cyanus Codiaeum variegatum Cotoneaster spp. Gossypium spp. Heracleum sphondylium Heracleum lanatum ALLURT NALLURT No No Yes No No No No No No No No No No No Yes Yes No No Yes No Yes No Yes No Yes No Yes No No No No No No No No No Yes No No No No No No No Yes No Yes No No No No No Yes No Yes No No No No No ACD Yes Yes No Yes No Yes Yes No Yes Yes Yes Yes Yes Yes No Yes No No Yes Yes No No Yes Yes Yes Yes No No No No MECH No No Yes No No No No No No No No No No No No No No Yes No No No Yes No No No No No No No No IRR No No Yes No No No Yes Yes No No No No No No No No Yes No No No Yes No No No No No No No No No PHOTO No Yes No No Yes No No No No No No No No No Yes No No No No No No No No No No No No No Yes Yes

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 3 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Cowhage Creosote bush Croton bush Croton of florist's Crown of thorns Cucumber Cyclomen Daffodil Daffodil bulbs Daffodil, wild, Lent lily Dahlia Daisy Dandelion Desert heliotrope Devils walkingstick Dieffenbachia Dill Dog's tooth violet Dogwood, American Dogwood, bloodtwig Echinacea, coneflower Elephant ears Endive Eucalyptus False ragweed Fennel Fern, Boston or sword Fern, leather leaf Feverfew, bachelor's buttons Feverfew, wild GENUS Mucuna pruriens Larrea tridentata Croton tiglium Codiaeum variegatum v. pictum Euphorbia milii or E. splendens Cucumis sativus Cyclomen persicum Narcissus spp. Narcissus spp. Narcissus pseudo-narcissus Dahlia spp. Leucanthemum vulgare Taraxacum officinale Phacelia spp. Aralia spinosa Dieffenbachia picta or D. seguine Anethum graveolens Erythronium dens-canis Cornus spp. Cornus sanguineus Echinacea purpurea Alocasia macrorhiza Cichorium endivia Eucalyptus spp. Ambrosia acanthicarpa Foeniculum vulgare Nephrolepis exaltata Arachniodes adiantiformis Tenacetum parthenium Parthenium hysterophorus ALLURT NALLURT No Yes No No No No No No No No Yes No No No No No No No No No No No No No No No No No No No No No Yes No No No No No Yes No No No No No Yes No Yes No No No No No No No No No No No No No ACD No Yes No Yes No No Yes Yes No Yes Yes Yes Yes Yes No No Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes Yes Yes MECH No No No No No No No No No No No No No No Yes No No No Yes No No No No No No No No No No No IRR Yes No Yes No Yes Yes No No Yes No No Yes Yes No No Yes No No No No No Yes No No No No No No No No PHOTO No Yes No No No No No No No No No No No No No No Yes No No No No No No No No Yes No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 4 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Fig Fir, Douglas Fireweed Flax Fleabane Foxglove Foxtail barley, squirrel tail barley Garbanzo beans Garlic Geranium Geranium Giant hogweed Ginger Ginkgo tree (fruit), ginkyo Goldenrod Grape (stems) Grapefruit Green pepper Greenbrier Hawthorn Hazel nut Hellebore Hemp Hibiscus Hop Horseradish Horsetails Horseweed Hyacinth bulbs Hydrangea GENUS Ficus carica Pseudotsuga menziesii Epilobium latifolium Linum usitatissimum Erigeron spp. Digitalis purpurea Hordeum jubatum Cicer arietinum Allium sativum Pelargonium pellatum Pelargonium zonale Heracleum mantegazzianum Zingiber officanele Ginkgo biloba Solidago spp. Vitus vinifera Citrus paradisi Capsium annuum grossum Smilax rotundifolia Crataegus monogyna Corylus avellana Helleborus spp. Cannabis indica Hibiscus spp. Humulus lupulus Armoracia rusticana or A. Equisetum arvense Conyza spp.. Hyacinthus orientalis Hydrangea macrophylla ALLURT NALLURT No No No No No No Yes No No No No No No No Yes No Yes No No No No No No No No No No No No No No No Yes No Yes No No No Yes No Yes No No No Yes No No No Yes No No No Yes No No No No No No No ACD No Yes Yes No Yes No No No Yes Yes Yes No No Yes Yes No No No No No No No No Yes No No No Yes No Yes MECH No No No No No No Yes No No No No No No No No Yes No No Yes No No No No No No No No No No No IRR No No No No No Yes No No Yes No No No Yes No No No No No No No No Yes No No Yes Yes No No Yes No PHOTO Yes No No No No No No No No No No Yes No No No No Yes No No No No No No No No No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 5 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Iris (dried rhizome) Ivy, Algerian Ivy, English Jacaranda Jack-in-the-pulpit Jasmine Jonquil Jonquil bulbs Juniper Kiwi Knotweed Lady's slipper Lady's slipper Larch Larkspur Lavender Leeks Lemon Lemon grass Lettuce Lettuce, curled Lettuce, Romaine Lichens Lilies Lime Liverwort Lovage Magnolia tree Mahogony, American Mango GENUS Iris florentina Hedera canariensis Hedera helix Machaerium scleroxylon Arisaema triphyllum Jasminum officinale Narcissus jonquilla Narcissus spp. Juniperus spp. Actinidia chinensis Polygonum spp.. Cypripedium acaule Paphiopedilum insigne Latrix decidua Consolida ambigua Lavandula officinalis Allium porrum Citrus limon Cymbopogon citratus Lactuca sativa Lactuca crispa Lactuca sativa longifolia Lichens Lilium spp. Citrus aurantifolia Frullania Levasticum officinale Magnolia grandiflora Swietenia macrophylla Manifera indica ALLURT NALLURT No No No No No No No No No No No No No No No No Yes No Yes No No No No No No No Yes No No No No No Yes No Yes No No No Yes Yes No No No No No No Yes No Yes No No No No No No No No No Yes No ACD No Yes Yes Yes No Yes Yes No Yes No No Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No Yes Yes No MECH No No No No No No No No No No No No No No No No No No No No No No No No No No No No No No IRR Yes Yes Yes No Yes No No Yes Yes No Yes Yes Yes No Yes No No Yes No Yes No No No No No No No No No No PHOTO No No No No No No No No No No No No No No No No No Yes No No No No No No Yes No Yes No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 6 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Mango peel Maple Marigold May apple Mayweed, dog fennel Mesquite Millet Mint, peppermint Mint, spearmint Mole plant, caper spurge Mustard, black Mustard, white Narcissus bulbs Narcissus, bunch flowered Narcissus, florist Noseburn vine Nutmeg Oak Oak, white Oat Okra Oleander Onion Orange Ox-eye daisy, Marguerite Palmettos Palm Palm Palm Paprika GENUS Manigera indica Acer spp. Tagetes patula Podophyllum peltatum Anthemis cotula Prosopis juliflora var. glandulosa Pennisetum cereale Menth piperita Mentha spicata Euphorbia lathyrus Brassica nigra Brassica hirta Narcissus spp. Narcissus tazetta Narcissus poeticus Tragia involucra Myristica fragrans Quercus spp. Quercus alba Avena fatua Hibiscus esculentus Nerium oleander Allium cepa Citrus sinensis Chrysanthemum leucanthemum Sabal spp. Howea, Phoenix Livistona, Chamaedorea Chrysalidocarpus Capsicum anuum v. longum ALLURT NALLURT No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No Yes No No No No No No Yes No No No No No Yes No Yes No No No No No No No No No No No No No ACD Yes Yes Yes No Yes Yes No Yes Yes No No No No Yes Yes No Yes Yes Yes No Yes Yes Yes No Yes No No No No No MECH No No No No No No Yes No No No No No No No No No No No No No Yes No No No No Yes Yes Yes Yes No IRR No No No Yes Yes Yes No No No Yes Yes Yes Yes No No No No No No No Yes Yes Yes No No No No No No No PHOTO No No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 7 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Parlsey Parsnip Pasque flower Pencil tree Peony Peppergrass, pepperweed Periwinkle Peruvian lily Peruvian lily Petty spurge Philodendron Pine Pine, red Pineapple Poinsettia Poison ivy Poison oak Poison sumac Poplar Potatoes Pothos Prickly pear Primula Prune Queen Anne's lace Radish Ragweed Red clover Rhubarb Rice GENUS Petroselinum sativum Pastinaca sativa Pulsatilla vulgaris or P. patens Euphorbia tirucalli Paeonia lactiflora Lepidium spp. Vinca spp. Alstroemeria aurantiaca Alstroemeria ligtu Euphorbia peplus Philodendron scandens Pinus radiata, P. sylvestris Pinus resinosa Ananas comosus Euphorbia pulcherrima Toxicodendron radicans Toxicodendron diversilobum Toxicodendron vernix Populus spp. Solanum tuberosum Epipremnum pinnatum Opuntia ficus-indica, O. vulgaris Primula obconica Prunus spp. Daucus carota Raphanus sativus Ambrosia artemisiaefolia Trifolium pratensis Rheum rhaponticum Oryza sativa ALLURT NALLURT No No No No No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No No No No No Yes No No No No No No No No No No No No No No No Yes No No No No No ACD Yes Yes No No Yes No Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes No No No MECH No No No No No No No No No No No No No No No No No No No No No Yes No No No No No No No Yes IRR No No Yes Yes No Yes No Yes Yes Yes Yes No No Yes Yes No No No No No Yes No No No No Yes No No Yes No PHOTO Yes Yes No No No No No No No No No No No No No No No No No No No No No No Yes No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 8 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Rice starch Rose Rubber tree Rue Runner Bean Russian thistle Rye Safflower Scurf pea Sesame oil Sesame Seeds Shallot Sheperd's purse Shiso Silk oak Skunk cabbage Small head sneezeweed Sneezeweed Spider flower Spinach Spruce, Norway Spruce, white Spurge Spurge nettle, tread softly Stinging nettle Strawberry Strawflower Sun spurge Sunflower Sunflower seeds GENUS Oryza sativa Rosa spp. Helea brasiliensis Ruta graveolens Phaseolus coccineus Salsola kali Secale cereale Carthamnus tinctorius Psoralen corylifolia Sesamum indicum Sesamum indicum Allium cepa ascalonicum Capsella bursa-pastoris Perilla frutescens Grevillea robusta Symplocarpus foetidus Helenium microcephalum Helenium autamnale Grivillea hybrid Spinacia oleracea Picea albies Picea glauca Euphorbia franckiana Cnidoscolus stimulosis Urtica dioica Fragaria ananassa Helichrysum diosmifolium Euphorbia helioscopia Helianthus annuus Helianthus annuus ALLURT NALLURT No No No No Yes No No No Yes No No No Yes No No No No No No No Yes No Yes No No No No No No No No No No No No No No No Yes No No No No No No No No Yes No Yes Yes No No No No No No No Yes No ACD Yes No No No No No No Yes No Yes No No No Yes Yes No Yes Yes Yes No Yes Yes No No No No Yes No Yes No MECH No Yes No No No Yes No No No No No No No No No No No No No No No No No No No No No No No No IRR No No No No No No No No No No No No Yes No No Yes No No No No No No Yes No Yes No No Yes No No PHOTO No No No Yes No No No No Yes No No No No No No No No No No No No No No No No No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 9 of 10

Plants and Skin Reactions

Safety & Health Assessment & Research for Prevention (SHARP) Program Washington State Department of Labor and Industries PLANT Sweet bay Tansy Tarragon Tearthumb weed Thistle Thyme Timothy grass Tobacco Tomato Trumpet creeper vine, cow itch Tulip bulbs Tulip tree Tulips Tumbleweed Umbrella tree Vanilla Watercress Western red cedar Wheat Whitlow grass Wild chervil Wild parsnip Winged bean Wood nettle Wormwood Yarrow Yucca Zinnia GENUS Laurus nobilis Tenacteum vulgare Artemisia dracunculus Polygonum arifolium Salsola kali Thymus vulgaris Phleum pratense Nicotiana tobacum Lycopersicon esculentum Campsis radicans Tulipa spp. Liriodendron tulipifera Tulipa spp. Salsola kali Schefflera actinophylla Vanilla plantifolia Nasturtium officinale Thuja plicata Triticium vulgare Draba verna or Erophila verna Anthriscus sylvestris Pastinaca sativa Psophocarpus tetragonolobus Laportea canadensis Artemisia absinthum Achillea millefolium Yucca spp. Zinnia spp. ALLURT NALLURT No No No No No No No No No No Yes Yes Yes No No No Yes No No No No No No No Yes No Yes Yes No No No No Yes No Yes No Yes No No No No No No No Yes No No Yes No No No No No No No No ACD Yes Yes Yes No Yes No No No Yes Yes No Yes No No Yes Yes No Yes No No No No No No Yes Yes No Yes MECH No No No Yes No No No No No No No No No Yes No No No No No No No No No No No No Yes No IRR No No No No No Yes No Yes Yes No Yes No No No No No Yes No No Yes No No No No No Yes No No PHOTO No No No No No No No No No No No No No No No No No No No No Yes Yes No No No No No No

ALLURT=allergic urticaria; NALLURT=nonallergic urticaria; ACD=allergic contact dermatitis; MECH=mechanical; IRR=Irritant; PHOTO=Photodermatitis Christina Marino, MD, MPH 6/7/01 Page 10 of 10