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Avoidance of the plant is the best policy. Meticulously wash any clothing that
comes into contact with the plant resin. Carefully clean exposed tools and backpacks
with alcohol.
Numerous other plants can also cause reactions. It is vital to remember that some
individuals may have an anaphylactic reaction to a dermal exposure. Should this occur,
the first-line treatment is epinephrine (1:1000) 0.2-0.5 ml SQ or IM.
2. Contact Urticaria:
This reaction may be immunologic or nonimmunologic. It is characterized by a central
irregular raised wheal that is mildly blanched, surrounded by an irregular more
erythematous flare. The process is caused by the release of histamines and other
vasoactive agents. The reaction produces a sensation ranging from mildly itchy to
intensely painful such as those reactions caused by the Urticaceae (nettle) family.
Occasionally an ipsilateral self-limiting lymphadenopathy can develop. Generally, a good
cleansing of the area is all that is necessary as this process is self-limited. Administer pain
and itch medication.
3. Photodermatitis:
Some plant species contain psoralens that sensitize the skin to ultraviolet light. This is a
phototoxic reaction an exaggerated sunburn-like reaction. With sun exposure, more
severe, even blistering burns can occur. Areas exposed need to be protected from the sun
for approximately two weeks. Treatment is the same as for any sunburn. Cool compresses
and administration of non-steroidal anti-inflammatories such as ibuprofen or aspirin can
be helpful.
III. PLANT INGESTIONS
Between 1994-1999 one million people in the United States ingested potentially
dangerous plants: only 27 died, and major morbidity was rare. While the majority of
ingested toxins were from fungi (mushrooms), there are numerous deadly toxins such as
ricin and abrin from Ricinus and Abru, cicutoxin from Cicuta douglasii (water hemlock),
gyratoxins from the Rhododendron family, aconitine from the genus Acontium
(wolfsbane and monk's-hood) and numerous alkaloids that all tend to present with GI
symptoms. Toxicity is low with inadvertent exposures but can be fatal after a large dose
as often happens with a case of mistaken identity, "folk" remedies and ritualistic
ingestions. Later, more serious symptoms can develop with deadly consequences.
Diagnosis: A presumptive diagnosis can be made based upon the history and early
presenting signs and symptoms. To plan treatment, every effort should be made to note
the overall shape of the tree or shrub, and collect any available flowers, fruits and foliage.
Several highly toxic or fatal species look almost identical to other harmless and even
delicious plants. Toxicities within and among species can vary greatly depending upon
location and a poor correlation exists between taxonomy and toxicity. Consequently
clinical judgment and re-evaluation of the victim are of the utmost importance.
Mushroom Ingestions: If mushroom poisoning is suspected, urgently evacuate to
definitive medical care. Initiate seizure precautions. Vomiting is a common result of
