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Asteraceae
See also Herbal medicines
General information
There are about 600 genera in the family of Asteraceae (formerly Compositae), including various types of asters (daisies), arnica, chamomile, goldeneye, marigold, snakeroot, tansy, thistle, and wormwood.
Delayed hypersensitivity reactions to the Asteraceae (Compositae) can arise from sesquiterpene lactones. To detect contact allergy to sesquiterpene lactones, a mixture of lactones (alantolactone, costunolide, and dehydrocostus lactone) is used. However, Compositae contain other sensitizers, such as polyacetylenes and thiophenes. In a prospective study, the lactone mixture was complemented with a mixture of Compositae (containing ether extracts of arnica, German chamomile, yarrow, tansy, and feverfew) to detect contact allergy to Compositae [ ]. Of 346 patients tested, 15 (4.3%) reacted to the mixture of Compositae, compared with eight of 1076 patients (0.7%) who gave positive results with the lactone mixture, indicating the importance of the addition of Compositae allergens to the lactone mixture. However, the authors warned that patch-testing with these mixtures can cause active sensitization.
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Compositae dermatitis occurred in a 9-year-old boy with a strong personal and family history of atopy. Positive patch test reactions were 2 + for dandelion ( Taraxacum officinale ), false ragweed ( Ambrosia acanthicarpa ), giant ragweed ( Ambrosia trifida ), short ragweed ( Ambrosia artemisifolia ), sagebrush ( Artemisia tridentata ), wild feverfew ( Parthenium hysterophorus ), yarrow ( Achillea millifolium ), and tansy ( Tanacetum vulgare ), and 1 + for Dahlia species and English ivy ( Hedera helix ) [ ]. Patch tests were negative for another 30 plants, including cocklebur ( Xanthium strumarium ), dog fennel ( Anthemis cotula ), fleabane ( Erigeron strigosus ), sneezeweed ( Helenium autumnale ), and feverfew ( Tanacetum parthenium ).
An Austrian study has re-confirmed the importance of testing with not only a mixture of Compositae and a mixture of sesquiterpene lactones, but also with additional plant extracts when there is continuing clinical suspicion of allergy to one of the Compositae [ ]. By using additional short ether extracts, the authors found two of five patients who had otherwise been overlooked.
Achillea millefolium
Achillea millefolium (yarrow) can cause contact dermatitis [ ]; a generalized eruption following the drinking of yarrow tea has also been reported [ ].
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A female florist from North Germany, who ran a flower shop from 1954 to 1966 had to quit her job because of contact allergy to chrysanthemums and primrose. After a further 12 years she started to suffer occasionally from redness of the pharynx and stomachache after drinking tea prepared from yarrow and camomile. Skin tests were positive to chrysanthemum with cross-reactions to sunflower, arnica, camomile, yarrow, tansy, mugwort, and frullania (a lichen that does not occur in the Northern part of Germany). Patch-testing with primin showed high-grade hypersensitivity to Primula.
A. millefolium contains sesquiterpene lactones, polyacetylenes, coumarins, and flavonoids. Extracts have often been used in cosmetics in concentrations of 0.5–10%. A. millefolium was weakly genotoxic in Drosophila melanogaster . In provocative testing, patients reacted to a mix of Compositae that contained yarrow, as well as to yarrow itself. In clinical use, a formulation containing a 0.1% extract was not a sensitizer and alcoholic extracts of the dried leaves and stalks of the flower were not phototoxic [ ]. However, positive patch tests to A. millefolium have been reported [ ].
Anthemis species and Matricaria recutita (chamomile)
Chamomile is the vernacular name of Anthemis genus and Matricaria recutita (German chamomile, pinhead). The former are more potent skin sensitizers (delayed-type) than the latter, presumably because they can contain a higher concentration of the sesquiterpene lactone, anthecotullid. Cross-sensitivity with related allergenic sesquiterpene lactones in other plants is possible.
Internal use of chamomile tea has been associated with rare cases of anaphylactic reactions [ ] and its use in eye-washes can cause allergic conjunctivitis [ ].
Arnica montana
Arnica montana (arnica) contains a variety of terpenoids and has mostly been used in the treatment of sprains and bruises but is also used in cosmetics.
Ingestion of tea prepared from Arnica montana flowers can result in gastroenteritis.
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A 27-year-old woman presented with a rapidly enlarging necrotic lesion on her face and left leg together with malaise and high fever [ ]. She reported that she had applied a 1.5% arnica cream to her face before these symptoms had occurred. The diagnosis was Sweet’s syndrome elicited by pathergy to arnica. She was treated with prednisolone and her skin lesions disappeared within 3 weeks.
Of 443 individuals who were tested for contact sensitization, five had a positive reaction to A. montana and nine to Calendula officinalis (marigold); a mixture of the two was positive in 18 cases [ ]. Sensitization was often accompanied by reactions to nickel, Myroxylon pereirae resin, fragrance mix, propolis, and colophon.
Artemisia species
There are about 60 different species of Artemisia , of which the principal are Artemisia absinthium , Artemisia annua , Artemisia cina , and Artemisia vulgaris .
Artemisia absinthium
The volatile oil of A. absinthium (wormwood), which gives the alcoholic liqueur absinthe its flavor, can damage the nervous system and cause mental deterioration. This toxicity is attributed to thujones (alpha-thujone and beta-thujone), which constitute 0.25–1.32% in the whole herb and 3–12% of the oil. Alcoholic extracts and the essential oil are forbidden in most countries.
Artemisia annua
Artemisia annua , known in China as Qinghaosu, contains artemisinin, which has antimalarial activity. Several derivatives of the original compound have proved effective in the treatment of Plasmodium falciparum malaria and are currently available in a variety of formulations: artesunate (intravenous, rectal, oral), artelinate (oral), artemisinin (intravenous, rectal, oral), dihydroartemisinin (oral), artemether (intravenous, oral, rectal), and artemotil (intravenous). Artemisinic acid (qinghao acid), the precursor of artemisin, is present in the plant in a concentration up to ten times that of artemisinin. Several semisynthetic derivatives have been developed from dihydroartemisinin [ ].
Artemisia cina
Artemisia cina (wormseed) contains the toxic lactone, santonin, which was formerly used as an antihelminthic drug, but has now been superseded by other less toxic compounds.
Artemisia vulgaris
Artemisia vulgaris (common wormwood) contains the toxic lactone, santonin, which was formerly used as an antihelminthic drug, but has now been superseded by other less toxic compounds. Depending on the origin of the plant, 1,8-cineole, camphor, linalool, and thujone may all be major components. Allergic skin reactions [ ] and abortive activity have been described.
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