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To the Editor.— Skin disorders are a major contributor to lost productivity in the workplace, accounting for up to 45% of all occupationally related diseases. Hand dermatitis, in particular, may account for up to 75% of industrial-related skin disorders. 1 A wide variety of barrier creams have been developed in an effort to address this problem. We know of several anecdotal reports of Dermashield (Benchmark Lab Inc, Ft Lauderdale, Fla), a new topical barrier substance, being effective in preventing allergic contact dermatitis from poison ivy. This study was designed to study its efficacy in preventing rhus dermatitis. Prevention of rhus dermatitis as well as patch testing to toxicodendron antigen has been well described. 2,3 Subjects and Methods.— A random group of healthy adults between 18 and 60 years of age was selected and served as their own controls. All subjects were initially patch tested with six dilutions of poison ivy

POISON IVY EXTRACT, alum precipitated (Aqua Ivy, A.P.), the oral tablets in particular, has enjoyed popular appeal and widespread use for poison ivy hyposensitization primarily because of its reported effectiveness in very low dosage and its lack of side effects. 1-4 However, doubt has been raised as to its value, and the absence of adverse reactions has been attributed to its inertness. 5 Because of this conflict, a controlled double-blind study was undertaken, comparing various dosages of poison ivy extract, alum precipitated, with placebo. Method and Procedure.— Volunteers with history of poison-ivy dermatitis were divided randomly into groups receiving different dosages or placebo over a 50-day period. The total dosages were 120, 240, and 480 mg in 1961; 480 and 960 mg in 1962; and 1,920 mg in 1963. The subjectswere observed at five

• Allergic contact dermatitis was elicited with Toxicodendron antigen and the patch test site examined at various time intervals up to one week. The degree of inflammation was rather constant during the observation period. The mean erythema score at 168 hours was not significantly different from the score at 24 hours. These data support the use of a delayed (96-hour) patch test reading as a guide to discriminating between allergic and irritant patch test reactions. ( Arch Dermatol 1984;120:1022-1024)

To the Editor.— It is of interest to review the antiquity of plants that cause dermatitis. A specimen of fossilized poison sumac leaves was obtained that was similar to current poison sumac (Figure). This was identified by paleobotanists as Rhus merrilli Chaney found in central Oregon in the John Day Formation. It is from the early Oligocene period. This makes it approximately 37.5 million years old. So, this plant was present long before any form of man appeared on earth. It is hoped that other members of the famed Anacardiaceae family, such as R toxicodendron and R diversiloba , will be found as fossilized and unchanged markers of skin contactants.

In the summer of 1930 a patient came under my observation suffering from an extensive poison-ivy dermatitis, which had occurred during the three preceding summers. On his way home from the office he was in an automobile accident and sustained a fracture of the thigh, with extensive extravasation of blood at the site of injury. Within thirty-six hours the dermatitis disappeared. The question was, what had caused the serologic changes that led to the prompt disappearance of the dermatosis? The inference was, of course, that the extravasated blood had produced the phenomenon. That an individual's own whole blood outside its normal channels would obliterate this type of dermatitis seemed a reasonable hypothesis. This gave rise to the theory that in a case of poison-ivy dermatitis, the individual's own whole blood injected into the tissues would act as a curative agent. Acting on this theory, the treatment was

In 1866 Dr. J. W. Moorman of Hardinsburg, Ky.,1reported the cases of 2 children who each ate about 1 pint (550 cc.) of the fruit of Rhus toxicodendron, or poison ivy. In a few hours they became drowsy and stuporous, and in a short time vomiting commenced. The vomitus at first consisted of the partially digested fruit, and this was followed by a thick tenacious fluid the color of red wine. Generalized convulsions then appeared accompanied by delirium. The respiratory rate was hurried, the pulse weak and rapid and the pupils dilated. Emesis was induced, and a solution of sodium carbonate was freely administered. Both children recovered. In 1867 there was reported2the case of a boy who drank tea made from the root of R. toxicodendron. He became delirious, and there developed nervous twitchings, watery eyes, an intense burning sensation in his stomach and an intolerable

To the Editor:— A large vine of poison ivy is entwined about a tree surrounded by a ground cover of the same plant (Figure). The vine is darker than the rest of the trees, and it climbs to the full height of the supporting trees. This illustrates the full range of growth which may not be commonly appreciated. This growth is located at Watch Hill, part of the Fire Island National Seashore, off the South Shore of Long Island, NY.

This paper deals with immunologic prophylaxis of Rhus dermatitis due to Rhus radicans (poison ivy) and Rhus toxicodendron (poison oak). A comprehensive summary of the clinical biology of Rhus dermatitis has been given in a previous paper, which forms the prelude to the present theme.1 A striking feature of the literature on Rhus prophylaxis is the contradictory nature of many reports. Students of the subject hold diametrically opposed views. Some achieve remarkable results which are just as remarkably denied by others. Despite genuine advances in the basic knowledge of allergic contact dermatitis, the issue of hyposensitization is one in which there is no end of clinical testimony but relatively little in the way of objective research. Therapeutic ambitiousness has colored the picture with extravagant claims. The paramount aim of the present effort is to test the soundness of the concept of hyposensitization and

In reviewing the literature of poison ivy dermatitis one observes contradictory trends of opinion on various phases of the subject. The nature of the process is in question. Is it merely a contact dermatitis or a manifestation of allergy ? Vaughan 1 expressed the thought that poison ivy dermatitis is probably not allergic. Coca and Grove, 2 using the Prausnitz-Kustner test, failed to demonstrate sensitizing bodies in the blood of persons sensitive to poison ivy. Rostenberg and Sulzberger 3 stated that the result of a patch test is much more liable to be positive in contact dermatitis than in the atopic variety. Spain and Cooke 4 concluded that sensitization is transmitted from the original focus to other parts of the skin and mucous membranes by the blood and lymph. Recently Straus and Coca, 5 after experimentation on rhesus monkeys decided that sensitization develops only in connected skin by continuity, and hence

For reasons that are obscure at this time, certain dermatoses have racial or geographic peculiarities of distribution. The Negro is considered to be comparatively immune to basal-cell epitheliomas but particularly susceptible to the annular syphilid. Howard Fox, 1 after a study of 2200 Negroes and an equal number of whites, reached the conclusion that the Negro is less susceptible to external contacts. To quote his article of 1908: An example of lessened susceptibility to vegetable irritants is given by my statistics for poison by the Rhus toxicodendron, which showed 22 cases in the white against 8 in the black. While these figures show a much greater prevalence of ivy poisoning in the white, the disproportion in my opinion would have been much greater in a comparison of whites with full-blooded Negroes. In replying to the question, "Is the Negro immune to ivy poisoning?" the answer, "I have

The genus Rhus contains four species which are recognized as capable of producing toxic symptoms when applied to the skin of susceptible persons. These are Rhus venenata , swamp or poison sumac; Rhus toxicodendron ( Rhus radicans ), the ordinary poison ivy; Rhus diversaloba , the poison oak of the Pacific slope, closely allied to Rhus toxicodendron ; and Rhus vernicifera , the lacquer plant of Japan and China. The first of these, Rhus venenata , is confined to the eastern part of North America; the second, Rhus toxicodendron , is found over large parts of North America. So far as I know, it does not occur in western North America, its place there being taken by Rhus diversaloba . Rhus vernicifera occurs native only in eastern Asia, and with it is said to grow another poisonous species, but whether this is Rhus toxicodendron or Rhus diversaloba I do not know. The eruptions produced in susceptible persons by all

An orally administered poison ivy extract, Aqua Ivy, AP, is now being sold without prescription; each tablet contains 0.6 mg. of alum-precipitated poison ivy complex. Mass immunization of persons of varying sensitivities to poison ivy extract, without medical supervision, is hazardous, as shown by the following case summaries. A female, aged 14, took one tablet of Aqua Ivy, AP as directed, every other day, on April 3, 5, and 7, 1958. The patient, when seen on April 9, had swelling of right wrist and elbow joints, associated with a purpuric rash of the arms and the chest. This girl, for a number of years, has suffered from severe poison ivy attacks necessitating bed rest and a physician's attendance. The members of a family (consisting of husband and wife, both aged 41, and their sons, aged 15 and 11) each took one tablet of Aqua Ivy, AP on March 18, 20

In 1916, Schamberg1informally reported favorable results following treatment for dermatitis venenata due to ivy (Rhus toxicodendron) by means of oral administration of an alcoholic extract of the leaves of the plant. He made a formal report2in 1919, in which he advised two types of treatment: preseasonal prophylactic and seasonal curative. In both treatments, he began with the administration of very small doses (1 or 2 drops) of the alcoholic extract by mouth. In the preseasonal cases the extract was given three times daily, each dose being increased by 1 drop until 21 drops were reached, at which time the dosage was increased to 1 teaspoonful. This dosage was to be continued throughout the season. If dermatitis had already developed, the system of treatment was the same, except that each dose was increased by 2 drops. After the dosage reached 18 drops, it was increased to 1

In a review of the literature we have found reports of leukoderma following many dermatologic conditions, 1 but so far as we were able to search, there is no recorded case following dermatitis venenata. REPORT OF CASE H. W., a man, white, aged 30, a salesman, born in the United States, was referred to us on Aug. 20, 1924, for treatment of his skin condition. On June 15, the patient developed "ivy poisoning," at which time he consulted his family physician, Dr. Paul Baurberger, Yonkers, N. Y. At this time the patient had a characteristic eruption of dermatitis venenata involving the face, neck, arms and hands. He was treated with wet dressings for twelve hours. The following day the condition was so much improved that further treatment was suspended. In a short time all the lesions healed completely and left no visible traces. (The patient believed that he had had

In this contribution I present a statistical discussion of two problems. The first is a study of the relative value of the antigen method of treating dermatitis venenata due to poison ivy or poison oak, as compared with the older methods of local applications. The second phase of the discussion is whether or not this specific toxin (antigen) treatment is of value in the prevention of attacks of dermatitis venenata in those who are highly susceptible to it. The data represent the accumulated experiences, not only of myself, but of many other physicians throughout the country who have utilized this method of treatment. TREATMENT OF THE ATTACK OF DERMATITIS VENENATA The attack of dermatitis venenata represents a state of hypersensibility on the part of the person affected to this particular form of irritant. The old method of local application utilized remedies, in the treatment of dermatitis venenata due to poison

DEFINITION Rhus dermatitis caused by Rhus diversiloba and Rhus toxicodendron is an irritation of the skin caused, in the case of Rhus toxicodendron , by Pfaff's toxicodendrol and in the case of Rhus diversiloba by lobinol, a nonvolatile substance containing a polyhydrophenol with unsaturated side chains. 1 These toxic substances may or may not have the same chemical composition. ETIOLOGY I have shown in preceding papers 2 that the active principle lobinol is neither bacterial nor volatile, and that poisoning occurs from actual contact with the resinous sap of the plant. This contact, however, may result through an intermediary agent, which carries the sap, such as particles of soot in smoke, clothing, cordwood, croquet balls and shoes. AVENUES CF INFECTION A suitable channel must be present so that the pathogenic lobinol may enter the body and produce its specific disease. Such avenues of infection are the cutaneous surfaces, the respiratory, alimentary

THE STUDY of dermatitis venenata due to poison oak (Rhus diversiloba) was undertaken, while I was a member of the armed forces, with the assumption that the manifestations observed in the disease were probably due, as in other allergic states, to an overproduction of histamine and other such monoamines in the body tissues. The hypothesis was carried still further, based on the probability that the irritating factor in poison oak (lobinol, a volatile oil isolated by McNair 1 ) first decomposes the protein molecules in the cutaneous tissues into a-amino acids by a process similar to that of the proteolytic enzymes in digestion. These amino acids may further be decomposed not according to the normal method of deamination and oxidation but by losing carbon dioxide from the carboxyl group (decarboxylation) with the formation of a corresponding alkyl amine, as: CO 2 R-CH(NH 2 ) COOH→R-CH 2 NH 2 Various studies have shown

"The poisonous weed, being in shape but little different from our English ivie; but being touched causeth reddness, itchings, and lastly blysters, the which howsoever, after a while they pass away of themselves without further harme; yet because for the time they are somewhat painefull, and in aspect dangerous, it hath gotten itselfe an ill name, although questionless of noe very ill nature." The recorded history of poison ivy dermatitis begins with these words of Captain John Smith in 1609.* McNair's wonderful little book ``Rhus Dermatitis" is the most complete treatment of the subject; in it knowledge is summarized up to 1923.1The modern master is Bedford Shelmire; his original studies are impressive examples of biological research at the clinical level.2-7Exclusive of biochemical accomplishments, the remaining literature is excessively preoccupied with prophylaxis and therapy; the yield therefrom is not in proportion to the

Experiments show that the toxic principle of Rhus diversiloba while not volatile can poison at a distance by means of mechanical carriers. It is not destroyed by subjection for one hour to 100° C. and is carried, potent, by the smoke from burning Rhus plants. The dermatitis produced by this plant is a purely local affection and is not spread by the blood or lymph or by the serum of the blebs. The reaction of the sweat has no relation to individual susceptibility.Absolute immunity in man has been claimed but was not found to exist, on repeated attempts, in any of the individuals tried (6 persons). In spite of the work of Ford, the conclusion is arrived at that experimental immunity in animals to Rhus toxin has not been proved. The author, working with pure toxin (glucoside) produced by the method of Syme, was unable to intoxicate animals with any reasonable amount. Ford's work was done with a commercial fluid extract containing various impurities. A permanent aqueous suspension of the alcoholic solution of...

Since the introduction of specific immunologic measures for the treatment or prevention of poison ivy dermatitis, the more than one hundred year old controversy as to their usefulness has continued, and no decisive answer is at hand even today. It appears that desensitization was first suggested by the American Indian practice of chewing the leaves of the poison ivy plant. Dakin,1in 1829, was probably the first medical authority to report the beneficial effects of specific desensitization. He stated that laborers and other persons chewed the leaves to gain immunity and that physicians advised that the forbidden fruit be eaten. Alumbaugh,2in 1898, half filled a vial with the buds or leaves of Rhus toxicodendron, poured into the flask enough alcohol or whisky to fill it completely and allowed this to stand for one day. He then made a third decimal dilution. Twenty drops of this were placed

The mucous membranes are thought to be less sensitive than the skin to eczematogenous allergens. The skin is often found extremely sensitive to minute doses of a particular allergen while the mucous membrane of the same person remains unaffected by the identical allergen. This fact is responsible for the recent attempts to desensitize sufferers from eruptions caused by poison ivy by giving them drops of the tincture or extract of poison ivy leaves or asking them to chew the leaves. The reason for this profound difference in sensitivity of the skin and mucous membranes is not known. Nor is this difference as common as it is thought to be by many. There are persons whose skin and mucous membranes are equally sensitive to an allergen. A patient demonstrating this dual sensitivity came under my care recently. The following case is an illustration of the fact that the giving of poison

This report is made because Dictamnus albus is a rather commonly cultivated garden plant and we have been unable to find any mention of its irritating property in the literature. Furthermore, the requirement of the sun's rays to produce the irritation is of distinct interest. In July 1935 a man noticed an eruption on his forearms (fig. 1). Two days previously he had been working in his garden in the hot sun. Rhus toxicodendron was suspected as the cause, but the patient was certain that there was none in or near his garden. He remembered a similar outbreak on the skin which had appeared in the early summer two years previously. There was no eruption on the hands, but this was readily understood since gloves had been worn. Recalling a chance inquiry made some years previously as to whether or not the gas plant could irritate the skin (a question

During the past half-century numerous attempts have been made to isolate and identify the toxic principle of the various species of the three leaflet, white-fruited forms of the Rhus family, scientifically known as Rhus radicans (Rhus toxicodendron), Rhus quercifolia, Rhus microcarpa, Rhus rydbergii and Rhus diversiloba, etc., and commonly known as poison ivy or poison oak. Some botanists still contend that slight differences exist between these many forms, basing their contentions on whether the habit of growth of the plant is chiefly erect or climbing and on variances in the texture, pubescence and degree of lobing of the leaflets. Since all these variations can be observed in the same species under different climatic, soil and other field conditions, conservative toxonomists now agree that the numerous species of poison ivy are identical. I have patch tested ivy-sensitive persons with acetone-diluted oleoresins extracted from the many so-called species of ivy collected in

Iron salts have been used extensively in the treatment of ivy poisoning since White 1 in 1873 first called attention to their use. Ferric chloride is one of the chief means of combating the poison of Rhus toxicodendron. It was popularized by McNair 2 after Browning 3 advocated its use. This means of therapy has usually brought good results and no ill effects, as attested by numerous writers. 4 However, cases have been reported in which pigmentation of the skin occurred. This has always been considered permanent. Traub and Tennen 5 reported 2 cases, and Sutton 6 and Pusey 7 reported others. MacKee 8 observed 4 cases. In all, 8 cases have been recorded in the literature. These undesirable results, so far as can be determined, have not cooled the ardor with which ferric chloride has been employed in the treatment of ivy poisoning. The predominating impression that pigmentation is

ETIOLOGY Most cases of internal poisoning by rhus have been caused by chewing the leaves of the plants and swallowing the juice in order to attain immunity to the poison. One of these cases terminated fatally (Alumbaugh, 1 1903). Dakin 2 (1829) aptly commented on this procedure nearly a century ago: Some good meaning, mystical, marvellous physicians, or favored ladies with knowledge inherent, say the bane will prove the best antidote, and hence advise the forbidden leaves to be eaten, both as a preventive and cure to the external disease. I have known the experiment tried, which resulted in an eruption, swelling, redness and intolerable itching, around the verge of the anus. In 1907, Conner 3 reported one case caused by thoughtless chewing of a tender shoot of Rhus toxicodendron . Two cases are recorded in which children were poisoned by eating the fruit of Rhus toxicodendron (Mporman 4 1866). Root

To the Editor: —InThe Journal, June 2, p. 1588, is an article by Dr. Albert Strickler on "The Value of the Toxin (Antigen) of Rhus Toxicodendron and Rhus Venenata." This material is considered in its relation to treatment during the attack and to immunization. A table of cases treated by thirty-five physicians sets forth the records of 356 patients, though nineteen of the physicians reported less than five cases each. "In the vast majority of cases, improvement was noted twenty-four hours after the institution of this mode of treatment." In the second paragraph of the "comment," bearing on desensitization, occurs the statement, "It is incapable of doing harm." With this remark I beg to differ. In the early summer of 1921, a medical student came to the Jefferson Hospital Skin Dispensary with this history: He had had an attack of dermatitis venenata and had been treated by Dr. Strickler.