Airborne Contact Dermatitis (ABCD) Due to Congress Grass - An Overview

Introduction:

Parthenium hysterophorus, also known as congress grass, is one of the airborne allergens. It is a short herb known as a medical, agricultural, and environmental threat. Congress grass is a weed that has become the seventh most hazardous weed on many continents (Australia, Asia, and Africa). It is stated that this weed was accidentally introduced everywhere in the world through shipments of contaminated wheat, and now it is found almost everywhere. That is why the cases of airborne contact dermatitis because of Congress grass are documented worldwide. The congress grass is also known as carrot grass, bitter weed, white top, Santa Maria feverfew, Dhanura, and the “Scourge of India.”

What Is Airborne Contact Dermatitis (ABCD)?

Airborne contact dermatitis (ABCD) is a type of contact dermatitis (skin inflammation due to the contact of certain substances) that results from airborne allergens like pollens and dust particles. Airborne contact dermatitis is a dermatosis that affects especially the uncovered parts of the body and results from allergens or irritants in the atmosphere. Allergens can be found in various forms like dust, sprays, and pollens, which settle on our body's exposed parts. Patch test, prick test, or radio allergo sorbent test, patient history, and the lesions' distribution and morphology help diagnose airborne contact dermatitis. The revealed skin of the body is usually affected, such as the face, neck, dorsal part of hands, upper chest, and forearms, which are some of the areas of the body affected by airborne contact dermatitis. Parthenium hysterophorus is the most common cause of contact dermatitis. Also, the covered areas of the body get affected as the allergens can accumulate under the clothes.

What Is Congress Grass?

Parthenium hysterophorus is another name for the congress grass or congress weed. It is called a noxious weed in many continents of the world. Congress grass is a weed believed to be a reason for allergic respiratory problems, contact dermatitis, and mutagenicity in humans and livestock. It is a noxious weed that is often spotted on abandoned lands, developing residential colonies, railway tracks, roads, drainage, irrigation canals, etc. This weed is known for its growth luxuriantly in established gardens, plantations, and vegetable crops. As it has high fecundity, a single plant can produce 10,000 to 15,000 viable seeds, and these seeds can scatter and germinate to cover extensive areas.

In the 1950s, parthenium, which originated in tropical America, was brought to Asia via shipments of cereals from the USA (United States of America). Since then, the prevalence of allergic contact dermatitis has significantly increased, earning it the nickname "Scourge of India" and causing it to become a major issue throughout the country. Parthenium is an annual herb that can reach a height of two meters. It has spreading inflorescences with little white flowers and alternating, deeply divided leaves. This plant grows well in various soil types, but its ability to blossom is hampered in saline soils close to the coast. The transportation of grain, cattle, and fodder from regions where Parthenium hysterophorus is present has been connected to the spread of parthenium.

Due to allelopathy, crop production is affected worldwide. Allelopathy is known as a stimulatory or inhibitory effect on neighboring plants' growth due to the release of secondary compounds. This weed is also aggressive in nature and threatens biodiversity. It has no known economic importance until now. This is a comparatively short herb and is known for its ability to produce many offspring in a short time. This is why it spreads in a large area in a relatively short time.

Congress grass is stated to have numerous health hazards that have now reached an epidemic level. Dermatitis has been defined as T-cell-mediated immune injury, resulting in itchy erythematous papules and papulovesicular lesions on the revealed skin of the body. Such effects are related to the cytotoxicity of the Sesquiterpene Lactones (SQL), the allergen responsible for dermatitis and found in the pollen, leaves, and stem of congress grass. Clinical manifestations include skin inflammation, asthma (narrowing of the airway leading to difficult breathing), eczema (skin inflammation causing itchiness), allergic rhinitis (inflammation of the nasal passage causing sneezing and runny nose), black spots, blisters (fluid-filled sacs on the sling), etc. It is also the cause of diarrhea, breathlessness, choking, and severe papular erythematous eruptions (small and raised bumps on the skin). Allergic bronchitis (inflammation of the bronchial tubes due to allergy leading to mucus production) is also caused by it.

What Is the Pathogenesis of Airborne Contact Dermatitis Caused by Congress Grass?

Contact with the parthenium antigen can cause parthenium dermatitis, an immuno-inflammatory disorder that results in a cell-mediated hypersensitivity reaction (allergic reaction). This immune response has two phases: a sensitization phase at first and an elicitation phase if the antigen exposure continues.

During the sensitization phase, the allergen is taken up by epidermal Langerhans cells (skin cells) and dendritic cells, which then carry the allergens to local or nearby lymph nodes and deliver them to T-lymphocytes. This interaction produces effector and memory T-cells, which promote T-cell proliferation. When the allergen comes into contact again, these memory cells "remember" it.

When the skin comes into touch with the allergen again during the second stage, also called the elicitation phase, the memory T-cells identify it and migrate to the skin's afflicted area. This produces inflammation, which results in swelling, redness, and itching. The degree of immune cell activation and the time the antigen is exposed determine how severe the reaction will be.

What Are the Symptoms and Progression of Airborne Contact Dermatitis from Parthenium Congress Grass?

Parthenium-induced airborne contact dermatitis (ABCD) typically affects the face, neck, chest, and folds of the knees and elbows, with the eyelids particularly vulnerable. It begins as a spring or summer skin reaction and frequently gets better in the winter. Sensitive individuals may have symptoms 24 hours after exposure; in less severe situations, symptoms may take up to three days to manifest. Short-lived, transient redness and itching may accompany mild instances. In moderate cases, there may be blisters or red spots that itch and swelling. Severe cases might include swelling, seeping, and big blisters. Repeated exposure over time can result in thick, rough, and itchy skin that itches all year round.

What Are the Ways to Manage Airborne Contact Dermatitis Caused by Congress Grass?

The following ways can be practiced to manage the symptoms of airborne contact dermatitis:

• The degree of contact hypersensitivity and quantity of antigen should be decreased.

• The causative agent or the plant should be removed immediately.

• The patient should try to cover as much of the skin area as possible with clothing.

• The uncovered area should be washed properly with soap and water before the allergens penetrate the skin barrier.

• Barrier creams should be applied.

• Residents of such areas should consider relocating, which may help reduce exposure.

What Are the Treatment Options for Airborne Contact Dermatitis?

• Corticosteroids are one of the primary options for the treatment of airborne contact dermatitis. Mild to moderate levels of the disease can be cured by the topical use of corticosteroids.

• Azathioprine is one of the immunosuppressants that can be used to treat the condition. For severe conditions, systemic steroids like Prednisolone are needed in order to control the spread.

• Methotrexate and Cyclosporine can also be considered effective steroid-sparing agents. Cyclosporine may be used in the acute phase because of its faster response. Other treatment options can be discussed with the physician.

How Does Parthenium or Congress Grass Sensitivity Affect the Skin in the Long Term?

Parthenium sensitivity is a permanent condition that frequently progresses to a long-term with recurrences during summer. Dermatitis flare-ups that happen again and again can cause rough, thicker skin in places like the skin folds. Individuals who first suffer airborne contact dermatitis (ABCD) may later experience symptoms on exposed body areas that resemble those of chronic actinic dermatitis (CAD).

The body's inherent tolerance or improved treatment options may cause the disease's severity to lessen with time. There are no published studies demonstrating the development of tolerance in patients with parthenium-allergic contact dermatitis, despite the exploration of certain treatments such as oral hyposensitization. Some dermatologists think that because general practitioners have been diagnosing and treating the illness with corticosteroids earlier, the problem appears less severe now.

Conclusion:

Airborne contact dermatitis patients usually have active symptoms even many years after diagnosis. Avoidance of further antigen exposure should be emphasized. A few biological measures, such as exotic arthropods and opportunistic pathogens, various antagonistic plants and bioherbicides, and chemical herbicides, can help decrease congress grass. This condition can be challenging due to its clinical manifestations. Clinical manifestations can be managed in various ways. Some daily habits can be practiced to reduce the effect of the condition, such as washing the exposed skin properly as soon as possible, using barrier creams, and covering most of the body parts with clothes. Treatment ways can be discussed with the physician to control the condition. A few practices should be undertaken to eradicate the spread of the congress grass. People should be educated about the ill effects of the Congress grass and also be taught ways to eliminate its growth.