Absence of cross sensitivity between Toxicodendron (syn. Rhus) and Blepharocarya.
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Rhus dermatitis, experimentally induced in humans, was used as a model for determining the efficacy of various proprietary topical steroids. One-centimeter squares of vesicular dermatitis were induced by patch application of Rhus oleoresin. The steroids were then applied without occlusion once daily for four days, with readings of the therapeutic effect taken on the fifth day. Only potent steroids provided unequivocal suppression in this severe test. The rank order of efficacy corresponded to clinical experience. Cream and ointment formulations of the same steroid at the same strength did not differ. High strength preparations were more effective than regular strengths. Relief of pruritus was an important early effect of efficaceous steroids.
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Although it is well known that topically administered steroids can increase intraocular pressure systemically administered steroids are much less frequently implicated in episodes of ocular hypertension. In the case reported, a marked increase in intraocular pressure was apparently caused by seroids used in treating poison ivy dermatitis. Pressures returned to normal shortly after the drug was withdrawn.
The isolation and purification of poison ivy urushiol is described. The preparation of urushiol-ski protein and urushiol human serum albumin is also described. Lymphocytes from eleven donor naturally sensitized to poison ivy and from four non-sensitive individuals have been cultured for 5 days in the presence of urushiol-carrier conjugates. Lymphocytes from seven of the eleven sensitive donors responded with a stimulation index greater than 3.0 to urushiol-albumin conjugate. When urushiol-skin protein conjugate was used as a stimulant, lymphocytes from only three of the eleven sensitive donors responded. The results suggest that urushiol-protein conjugates can stimulate sensitive lymphocytes in vitro, although a response is not observed in every individual naturally sensitized to poison ivy.
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Allergies may cause gastrointestinal symptoms such as diarrhea, vomiting and pain, dermatologic manifestations, asthma and rhinitis. The most common offender among the foodstuffs is milk. Elimination diets are designed not only to remove the offending food but to identify it and to prevent new sensitizations. Canker sores, foul breath and even enuresis may occasionally be related to allergies.
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Renal damage associated with poison oak dermatitis is extremely rare in humans after exposure to urushiol antigen. Three renal lesions have been described: proliferative glomerulonephritis, arteritis, and membranous nephropathy. The present study reports on three patients who developed nephropathy after exposure to poison oak. One patient was studied by renal biopsy (including electron microscopy and immunofluorescence techniques) and another by autopsy findings. One of these patients had a typical membranous nephropathy, the other, proliferative glomerulonephritis with necrotizing arteritis and glomerulitis. In the patient with membranous nephropathy antibody to urushiol was discovered by passive cutaneous anaphylaxis in the guinea pig.
Six separate investigators following the methodology stipulated in a common protocol provided a data base of 124 patients with Rhus dermatitis, other contact dermatitis, or atopic dermatitis. In this double-blind study, one or two 1 ml (4.0 mg/ml) intramuscular injections of the new sodium phosphate ester of betamethasone was compared with dexamethasone sodium phosphate in the treatment of the signs and symptoms common to these disorders. The comparably balanced groups responded dramatically to both drugs. Within 24 hours the mean scores of all symptoms and patients' overall condition were reduced appreciable. Pruritus, burning, inflammation and other typical symptoms and signs each responded well. The significant beneficial differences were observed most often in patients on betamethasone. There were no treatment failures and no side effects in this short-term trial.
A case of microscopic hemorrhage into the anterior chamber is described. Slit-lamp examination disclosed a steady fine stream of blood issuing from a tiny grayish bulblike microhemangioma at the pupillary border. Fluorescein biomicroscopy revealed several similar microhemangiomas on the borders of each pupil. It is presumed that minor ocular irritation, due either to poison ivy or to a menthol (0.70%) cream which the patient applied to her face, precipitated the microhyphema.
Black patients readily acquire allergic contact dermatitis from such contactants as paraphenylenediamine, nickel, chromates, and mercaptobenzothiazole. Such dermatitis is often complicated by hyperpigmentation and lichenification unless treated early anf vigorously with systemic corticosteroids. Patch testing is reliable on black skin. In addition, acne veneate (pomade acne, Vaselinoderma), which is characterized by noninflammatory acneiform lesions, is very common in black persons. Finally, the old wives' tale that blacks do not get poison ivy may be laid to rest, along with the popular notion that Indians chewed poison ivy leaves in order to prevent poison ivy dermatitis. Several years ago, I interviewed an Indian Chief on a western reservation and inquired whether, to his knowledge, Indians did ever chew poison ivy leaves. The chief's immediate answer was, "You white men must be crazy to think that we would be that foolish!".
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