Airborne Contact Dermatitis (ABCD) Due to Congress Grass

The causative plant for airborne contact dermatitis is Parthenium hysterophorus (Congress Grass). This plant was accidentally introduced all over the world through contaminated wheat shipments and now it has spread to the nook and corner of the world. Thus, the cases of Parthenium dermatitis have been reported from all over the world.

Causes

The main allergen responsible for allergic contact dermatitis has been identified as sesquiterpene lactones. Upon entry into the skin, the parthenium antigen is taken up by the antigen presenting cells in the skin, which transport the allergen to regional lymph nodes where it is presented to T-lymphocytes. Subsequently, T-cell clonal proliferation takes place and it leads to infiltration of T-lymphocytes into re-exposed skin sites with resultant development of cutaneous inflammation.

Clinical Presentation

The allergens present in plant dust, debris and pollens may cause hay fever, allergic rhinitis, asthma or dermatitis. In most cases, Parthenium dermatitis initially involves the eyelids, suggesting that the airborne allergens lodge in the skin folds and cause dermatitis. A seasonal variation is observed, initially with exacerbation in the summer corresponding to the growing season and disappearance in winters. A spectrum of the clinical pattern ranging from airborne contact dermatitis (ABCD) to severe erythroderma (more than 90% body surface area involvement) may develop.

Treatment

Various measures aimed at markedly reducing the antigen or allergen load on the skin includes the following:

• Removing the plant from the surrounding environment of the patient or the sufferer.

• Use of sensible clothing, try to dry the clothes indoors and frequent washing of uncovered areas.

• A barrier cream should be used to slow down the penetration of the allergen into the skin and washing each time before reapplication.

• In case of photosensitivity, avoiding exposure to sunlight and use of sunscreen may be useful.

• Gloves may not offer protection since the sesquiterpene lactone permeates vinyl, polyethylene and latex gloves.

• Mild disease may be managed with topical steroids; acute, severe or extensive disease may require systemic steroids.

• Other immunosuppressive agents like Azathioprine, Cyclosporine, Mycophenolate mofetil and Methotrexate may have to be employed.

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