Compositae Allergy

Compositae (Asteraceae) allergy is a delayed contact allergy, mainly to Sesquiterpene Lactones, from plants of the daisy family. The family includes Chamomile, Calendula (marigold), Arnica, dandelion, sunflower and ragweed. People can be sensitised by touching the plants, by pollen, or by “natural” skincare products made from the plant extracts. The allergy usually lasts for life (DermNet). It matters for toddler eczema because sensitisation clusters in atopic children. All paediatric case reports involve atopic children (Paulsen 2008), 11 of 12 Compositae-sensitised Danish children had a personal history of atopy (Paulsen 2020), and dandelion should always be tested in children (Paulsen 2013).

Sesquiterpene Lactones [causes] Compositae Allergy Compositae Allergy [part-of] Allergic Contact Dermatitis Atopic Dermatitis [relates] Compositae Allergy

The sesquiterpene lactone mix and how it is tested. Patch Testing baseline series usually include an SL mix, often with parthenolide. Compositae mix and individual plant extracts (dandelion, tansy, yarrow, feverfew, chamomile, arnica, chrysanthemum) are added depending on exposure (DermNet). In 51 Compositae-allergic patients with current or past AD, SL mix plus parthenolide plus Compositae mix detected 96% (Paulsen & Andersen 2013). Paulsen 2008 recommends SL-mix screening supplemented with plant extracts chosen from the child’s exposure history. Plant extracts are needed because single mixes miss cases.

Conflict: [Paulsen & Andersen, Contact Dermatitis, 2020] say SL mix is “a suitable screening agent” in children (11 of 12 Compositae-sensitised children were SL-mix positive). [Reider et al., Contact Dermatitis, 2001] found the standard Compositae mix detected only 4 of 9 marigold-allergic patients. Unresolved — add to open_questions.

Patch Testing [defines] Compositae Allergy

Prevalence in paediatric patch-test series. Screening with SL mix found 0.5% and 1.8% positive in two paediatric studies. Two different Compositae mixes found 4.2% and 2.6% positive among children and adolescents (Paulsen 2008 review). In Denmark, 1.8% of consecutive patients under 18 with eczema were SL mix/parthenolide-positive in 1995–2006. From 2007 to 2019, 12 of 388 children tested (3%) were Compositae-sensitised (Paulsen & Andersen 2020). These children were older (mean 9–12 years) and 11 had hand eczema, so the data say little directly about 1–4-year-olds. The largest screening study found Compositae-mix sensitisation significantly more often in children with AD than in non-atopic children (Paulsen 2008). Across all ages, 3.1% of patients tested had Asteraceae allergy, and 56.5% of those were chamomile-allergic (Budzinski 2000, cited in Denisow-Pietrzyk 2019).

Compositae Allergy [relates] Atopic Dermatitis

Calendula, chamomile, arnica and herbal teas. These daisy-family remedies are the main ways a toddler meets Compositae allergens at home. They appear in nappy balms, “natural” eczema creams, bath infusions and teas. About 2% of allergic patients react to marigold allergens (Reider 2001; Denisow-Pietrzyk 2019). Chamomile has caused contact dermatitis from both cream and tea, and an 8-year-old had anaphylaxis after drinking chamomile tea (Denisow-Pietrzyk 2019). Echinacea taken by mouth has caused urticaria, angioedema and systemic contact dermatitis (DermNet). More than a third of Compositae-allergic patients are also allergic to fragrances, balsam of Peru and colophony, so the overlap with Fragrance Allergy is large (DermNet). Most affected people can still eat Compositae vegetables, but they should stop using cosmetics and creams made from these plants (DermNet).

Calendula [triggers] Compositae Allergy Chamomile [triggers] Compositae Allergy Arnica [triggers] Compositae Allergy Compositae Allergy [relates] Fragrance Allergy

Daisy-family "natural" remedies on eczema

Calendula, chamomile and arnica creams and infusions put sesquiterpene lactones onto broken skin, which is the route by which atopic children become sensitised. Standard patch-test mixes can miss calendula allergy. If a “natural” balm seems to make eczema worse, stop it and ask about patch testing with the product itself (Paulsen 2008; Reider 2001; DermNet).

Connections

• Calendula — marigold is a Compositae sensitiser (~2% patch-positive), source: Reider 2001
• Chamomile — chamomile is a Compositae sensitiser; atopic children at risk, source: DermNet; Paulsen 2008
• Atopic Dermatitis — risk factor for Compositae sensitisation in children, source: Paulsen 2008, 2020
• Sesquiterpene Lactones — main allergen class; SL mix screening, source: DermNet; Paulsen 2013
• Patch Testing — SL mix + parthenolide + Compositae mix + dandelion detect ~96%, source: Paulsen 2013, 2020
• Fragrance Allergy — >1/3 co-allergic to fragrance/balsam of Peru/colophony, source: DermNet
• Arnica — daisy-family remedy; Compositae allergen, source: DermNet
• Allergic Contact Dermatitis — Compositae allergy is a plant-derived form, source: DermNet
• Feverfew — Compositae herb; parthenolide patch-test allergen, source: DermNet