Allergic Contact Dermatitis to Plants: Understanding the Chemistry will Help our Diagnostic Approach

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Rozas-Muñoz, J.P. Lepoittevin, R.M. Pujol, A. Giménez-Arnau" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Rozas-Muñoz" "email" => array:1 [ 0 => "docrozas@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.P." "apellidos" => "Lepoittevin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "R.M." "apellidos" => "Pujol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Giménez-Arnau" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital del Mar. Parc de Salut Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatochemistry Laboratory, Institut of Chemistry, University of Strasbourg, Strasbourg, France" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica por contacto con plantas. Entender las bases químicas ayudará al enfoque diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 808 "Ancho" => 1837 "Tamanyo" => 93845 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of d-(+)- and l-(−)-frullanolide." ] ] ] "textoCompleto" => "IntroductionPlants are living organisms belonging to the kingdom of Plantae, which includes at least 300000 species of trees, herbs, bushes, grasses, vines, ferns, mosses and green algae. Although most plants are harmless on contact with the skin or ingestion, the possibility of mild to serious adverse events is well recognized. Several cutaneous adverse reactions to plants such as nonimmunological contact urticaria, irritant contact dermatitis, allergic contact dermatitis, phototoxic contact dermatitis and photoallergic contact dermatitis have been reported.Allergic contact dermatitis is one of the most frequent cutaneous side effects in individuals exposed to plants. Study of the pathogenic mechanisms implicated in the development of allergic contact dermatitis (ACD) to plants may be challenging because of the large number of species, the diversity of chemical compounds that they contain, and the simultaneous contact with more than one allergen.A wide range of plants and plant allergens responsible for ACD have been identified and the different contact dermatitis triggers have often been classified according botanical criteria. These classifications are useful but do not allow prediction of cross-reactivity among different species or families and require a botanical knowledge often cumbersome to physicians, dermatologists, and allergologists. A possible classification of plant contact dermatitis according to the main chemical structures acting as allergens could be useful and may help prevent future exposures to the responsible agent or its cross-reacting compounds present in other species or families.Our main objective is to review ACD to plants from a chemical point of view. The responsible plants are classified according their chemical allergens. Several families of chemical sensitizers causing different types of contact and photocontact allergic dermatitis are reviewed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Plant Contact Dermatitis Classified by its Responsible Chemical Allergenic Structureα-Methylene-γ-ButyrolactonesThe α-methylene-γ-butyrolactones are part of a large and varied group of bioactive natural products widely present in plants. Their high chemical reactivity arises because of an α,β-unsaturated carbonyl system which allows the formation of covalent adducts with nucleophilic residues on diverse biomolecules. Most of these chemicals are of the sesquiterpene type (15-carbon-atom molecule) with an α-methylene group directed exocyclically to the γ-lactone ring. They are classified into 6 main groups of sesquiterpene lactone (SQL) structures: guaianolide, pseudoguaianolide, xanthonolide, ermophilanolide, eudesmanolide, and germacranolide (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). They are the predominant allergens in the Compositae family as well as in other related plant families such as Jubulaceae, Magnoliaceae, Winteraceae, and Lauraceae.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> The α-methylene-γ-butyrolactones can also be found as more simple structures in the Liliaceae (tulipaline A) and Alstroemeraceae families.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Asteraceae or Compositae FamilyThe Asteraceae/Compositae family—also referred to as the aster, daisy, or sunflower family—comprises the second largest family of flowering plants in the world. It includes more than 22750 currently accepted species, spread across 1620 genera and 12 subfamilies. Over 200 species are important causes of contact dermatitis worldwide.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> This family presents a variety of edible plants, such as lettuce, chicory, dandelion, salsify, sunflower, scorzonera, artichoke and yacon. Many members are decorative flowers, such as chrysanthemums, gerbera, calendula, dendranthema, dahlias, and heleniums while many others are considered as common weeds. Species such as arnica, chamomile or feverfew are also used medicinally. Asteraceae/Compositae can be recognized by its inflorescence, consisting of many tiny flowers clustered to form a flower head and subtended by an involucre.SQLs are the predominant allergens although other compounds such as epoxythymol-diesters and polyacetylenes may also be involved.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> SQLs are usually lipophilic, and are often located in the liquid-soluble part (oleoresin fraction) of the leaf, stem flower, and possibly in polen.<a class="elsevierStyleCrossRefs" href="#bib0010">2,4,5</a> Although the mechanism of sensitization is unknown, several possibilities have been proposed: pollen or dry debris airborne transportation, direct and/or indirect contact with parts of the plant, and allergen inhalation or ingestion.<a class="elsevierStyleCrossRefs" href="#bib0020">4,6</a>Some peculiar cutaneous eruptions caused by the Asteraceae/Compositae family have been described. The pseudophotodermatitis pattern occurs almost exclusively in middle-aged men with a history of outdoor exposure but is rare in children and women, although some studies have suggested an equal sex distribution.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> Exposed areas of the face, V of the neck, hands, and forearms are typically involved. In addition, areas not clearly exposed to sunlight such as retroauricular regions (Wilkinson triangle), eyelids, nasolabial folds, and the area beneath the chin are also involved, allowing its differentiation from a true photo-related dermatitis.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In hot regions, during summer months dry dead plant material contributes to this airborne pattern of dermatitis. In the US, many Compositae weeds, including ragweed (Ambrosia species), induce this clinical pattern often called ragweed dermatitis<a class="elsevierStyleCrossRef" href="#bib0040">8</a> or weed dermatitis in regions where other composite weeds predominate, such as Ambrosia, Artemisia, Helenium, and Iva species.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> A similar pattern was described in Australia where it is known as bush dermatitis because it is caused by species such as Arctotheca, Cassini, Conyza, Cynara, and Dittrichi<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a> and also in India where it is called parthenium dermatitis, where the culprit plant is Parthenium hysterophorus L<a class="elsevierStyleCrossRefs" href="#bib0065">13,14</a> Although these environmental conditions are not normally encountered in the temperate regions of Europe, some isolated reports of airborne dermatitis (ragweed dermatitis) induced by feverfew (Tanacetum parthenium [L] Sch. Bip.), chicory and lettuce, liverworts of the genus Frullania, and chrysanthemums<a class="elsevierStyleCrossRefs" href="#bib0005">1,6,9</a> have exceptionally been reported.A second special clinical pattern has been described as atopic eczema-like eruption. Compositae allergy may be manifested as a generalized eczematous eruption with primarily flexural involvement. Although it most commonly occurs in elderly men in rural areas, cases in children have also been reported.<a class="elsevierStyleCrossRefs" href="#bib0020">4,15</a> An erythrodermic exfoliative pattern classically induced by the weed Parthenium hysterophorus L was also described. This plant was accidentally introduced to the west coast of India in contaminated seed wheat. Several thousands of cases of allergic contact dermatitis occurred, some of them fatal.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>Hand eczema is more frequent in women working in gardening after contact with weeds. A palmar distribution often predominates.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Hand dermatitis is also associated with handling lettuce.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a> Dermatitis confined to one or more localized areas such as facial dermatitis secondary to steaming chamomile tea or hand and arm dermatitis from herbal compresses<a class="elsevierStyleCrossRef" href="#bib0100">20</a> has rarely been reported. Oral swelling, perianal pruritus and dermatitis of the trunk and arms were described in a sensitized patient who drank chamomile tea.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Stomatitis and throat swelling have occurred in some patients after eating lettuce and endivia.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> In one single patient erythema multiforme was reported to develop after patch testing.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>A rare chronic and disabling eccematous photodermatosis known as chronic actinic dermatitis (CAD), photosensitive dermatitis, or actinic reticuloid, has been linked to the ACD to compositae. A high incidence of ACD to one or more allergens has been found among patients with CAD,<a class="elsevierStyleCrossRef" href="#bib0115">23</a> and sesquiterpene lactones are commonly identified as allergens. It is thought that about 20% to 75% of patients sensitized to Asteracea (Compositae) have some degree of photosensitivity. Thus, the progression of ACD to sesquiterpene lactones to CAD has been postulated, but its origin is still unknown.Patch TestNo ideal patch testing material to study Compositae-induced dermatitis exists. The Compositae family includes more than 1350 SQLs and almost 50% of them are potential contact allergens.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> SQLs with slight differences in molecular structure, may cause true cross-reactions, while identical SQLs from different species may be responsible of false cross-reactions. SQLs are not exclusive to the Compositae family and frequently show cross-reactivity with other plant families. Because the concentration of SQLs shows seasonal and geographic variations and as cross-reactions between different species are not complete, when a patient is not tested with the relevant plants, the diagnosis may be easily overlooked.Fresh plants or plant extracts should not be used for patch testing because they may cause severe contact reactions and can also elicit active sensitization. False positive irritant reactions or false negative results caused by low content of allergens (degradation products) can also occur.In 1986, Benezra and Epstein developed the sesquiterpene lactone mix (SL mix) a nonsensitizing and seldom irritant mixture of 3 of the 6 main structural groups of sesquiterpene lactones (alantolactone, costunolide and dehydrocostuslactone of eremophilanolide, germacranolide, and guaianolide group) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). This mixture can enable identification of about 60% of SQL sensitization cases<a class="elsevierStyleCrossRef" href="#bib0120">24</a> and was included in the European baseline series.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> Other studies<a class="elsevierStyleCrossRefs" href="#bib0095">19,25–27</a> reported different percentages, which can partly be explained by phytogeographical variations and the diversity of SQL structures.<a class="elsevierStyleCrossRef" href="#bib0140">28</a> An alternative preparation, the Compositae mix, based on a mixture of plant extracts (arnica, yarrow, tansy, German chamomile, and feverfew), detects a higher proportion of the cases; however, it may be irritant and cause patch test sensitization.<a class="elsevierStyleCrossRef" href="#bib0145">29</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Dandelion and feverfew extracts, together or individually, also appear to be more useful than the SL mix.<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a> Other blends have been proposed, such as a mixture of Achillea millefolium L, Chamaemelum nobile All, Helianthus anuus L, Tagetes minuta L, and Tanacetum vulgare L as well as extracts mixtures of arnica, German chamomile, feverfew, tansy, and yarrow.<a class="elsevierStyleCrossRef" href="#bib0135">27</a>Jubulaceae Family (Liverworts)Liverworts are nonvascular plants with a bryophyte life cycle. They comprise 4 genera: Frullania accounts for nearly 800 species and Jubula for 15, whereas Steerea and Neohattoria are both montypic. These plants are often epiphytes growing on trunks and branches of trees or shrubs. They are found throughout the world and are common in tropical and subtropical regions but rare in frigid climates. They are often resistant to desiccation and direct light. Jubula species are largely confined to damp shaded rock surfaces.At least 11 species of Frullania have been described as responsible for allergic contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0160">32</a>Frullania dilatata (L) Dum and Frulanina tamarisci (L) Dum have been frequently implicated in Europe. Cases of allergic contact dermatitis were also described in British Columbia (Canada), the Pacific North-West of the United States, and in the South-West of France.The most important allergen is frullanolide,<a class="elsevierStyleCrossRefs" href="#bib0165">33–35</a> an α-methylene-γ-butyrolactone sesquiterpene from the eudesmanolide structural group. Other α-methylene-γ-butyrolactones have been reported as sensitizers such as oxyfrullanolide 5, cis-b-cycloscotunolide 6, and eremofrullanolide 7.<a class="elsevierStyleCrossRefs" href="#bib0175">35–37</a>Frullania dilatata (L) Dum contains exclusively the d- or (+)-enantiomer of frullanolide while Frullania tamarisci (L) Dum exclusively yields the l- or (−)-enantiomer.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> Both enantiomers are sensitizers, and in guinea pigs the stereospecificity of sensitization to one enantiomer has been demonstrated<a class="elsevierStyleCrossRefs" href="#bib0180">36,37</a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Sensitization to Frullania can occur by direct handling of trees or by airborne contact through volatilization of its small particles, especially during warm weather or by the action of chainsaws.<a class="elsevierStyleCrossRefs" href="#bib0170">34,35</a> Forest workers often suffer from woodcutter's eczema and domestic allergy can present in individuals who use lobe-leaved trees as firewood. Exposed areas of skin are typically affected, with an airborne pattern on the face and the V of the neck. This clinical pattern can mimic a photosensitivity pattern but it involves areas with little photoexposure such as the eyelids and nasolabial folds. The hands may become edematous, with involvement of finger webs but often sparing of the palms. Exceptional involvement of the genitalia and intertriginous folds has also been reported.<a class="elsevierStyleCrossRef" href="#bib0190">38</a>Patch TestTesting the patient with small pieces of Frullania is associated with a high risk of active sensitization. The SQL mix only detects about 1% of allergic reactions to Frullania. The frullanolide mix, a racemic mixture of (+)- and (−)-frullanolide at 0.01%, 0.033% and 0.1% in petrolatum<a class="elsevierStyleCrossRef" href="#bib0195">39</a> is a safe and nonsensitizing test, but only shows 0.35% of positive reactions.Although testing the patient with small pieces of Frullania is associated with a high risk of active sensitization, it could be used if there is high clinical suspicion. Frullanolide mix, a racemic mixture of (+)- and (−)-frullanolide at 0.01%, 0.033% and 0.1% in petrolatum<a class="elsevierStyleCrossRef" href="#bib0195">39</a> has been used in several clinical trials proving to be a safe and nonsensitizing test, but with a lower sensitivity than the SQL mix. Therefore the allergen of choice in these cases is SQL mix, even though it only detects 1% of the allergic reactions to Frullania.Cross-reactions with botanically unrelated plants that contain similar allergens, eg Laurus nobilis L,<a class="elsevierStyleCrossRef" href="#bib0175">35</a>Magnolia grandiflora L,<a class="elsevierStyleCrossRef" href="#bib0200">40</a> and several Compositae may also occur.<a class="elsevierStyleCrossRefs" href="#bib0160">32,41,42</a>LiliaceaeThe tulip genus which comprises 109 species of showy flowers is the most important genus of the Liliaceae family. A number of species and many hybrid cultivars are grown in gardens, used as pot plants, or displayed as freshly cut flowers. Most cultivars of tulip are derived from Tulipa gesneriana. Professional bulb growers, bulb collectors, sorters, and packers are particularly at risk of contact dermatitis.Tulip bulbs contain several glucosides including tuliposides A and B, which are weakly allergenic but are rapidly hydrolysed to tulipalin A and B. Tulipalin A appears to be the main sensitizer in clinical practice<a class="elsevierStyleCrossRef" href="#bib0215">43</a> although tulipalin B also causes sensitization in guinea pigs<a class="elsevierStyleCrossRef" href="#bib0220">44</a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Flowers, leaves and stems possess higher concentrations of tuliposide A than the bulbs; but sensitivity can develop from contact with any portion of the plant, although most of the cases occur in bulb growers who are continuously handling the bulbs. Contact with airborne allergens, although infrequent has also been reported.<a class="elsevierStyleCrossRef" href="#bib0225">45</a><elsevierMultimedia ident="fig0020"></elsevierMultimedia>The most common presentation is a combined allergic and irritant hand dermatitis known as tulip fingers. It is characterized by painful, subungual and periungual erythematosquamous, sometimes erosive lesions involving the fingertips, particularly the first and second fingers of the dominant hand.<a class="elsevierStyleCrossRef" href="#bib0230">46</a> There may be fissures, suppuration, and hyperkeratosis. The dermatitis may extend to the adjacent skin and rarely may involve distant areas or even give rise to a diffuse dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0225">45,47</a> The dust in tulip sheds may induce conjunctivitis, rhinitis and asthma. Reaginic responses to tulip antigens can also occur.<a class="elsevierStyleCrossRef" href="#bib0235">47</a>AlstroemeriaceaeThese species have a cluster of tuberous roots and produce leafy stems, bearing one to several brightly colored flowers. Several species are found in special collections and only 2 species are widely distributed and produced: Alstroemeria aurantiaca D Don, with orange flowers, which grows as a border plant, particularly in cottage gardens, and Alstroemeria ligtu (Peruvian lilies) which give rise to numerous colors, mostly in shades of lilac and pink, with darker veins and mottling on the petals (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). They grow in Holland, South America, USA and Australia. Tulipalin A, the same allergen of the Liliaceae family, is the main responsible sensitizer and is found mainly in the petals and stem. The rate of sensitization for tulipalin A can exceed 50% in workers on Alstroemeria plantations.<a class="elsevierStyleCrossRef" href="#bib0240">48</a><elsevierMultimedia ident="fig0025"></elsevierMultimedia>Dermatitis most commonly affects florist who strip off the leaves manually and are therefore exposed to the broken plant with a high risk of allergic contact dermatitis. The lesions, in contrast to tulip finger dermatitis, can be more severe and tend to involve the fingertips of all digits of both hands. Occasionally, the clinical pattern can be very similar to that produced by the garlic clove (but in a bilateral and symmetric distribution).<a class="elsevierStyleCrossRef" href="#bib0245">49</a> Workers who cut the flowers often show palm eczema.<a class="elsevierStyleCrossRefs" href="#bib0250">50–55</a> Airborne dermatitis<a class="elsevierStyleCrossRef" href="#bib0280">56</a> and post-inflammatory depigmentation have rarely been reported.<a class="elsevierStyleCrossRef" href="#bib0285">57</a> False positive responses due to a primary irritant reactions may also occur.<a class="elsevierStyleCrossRef" href="#bib0290">58</a>Patch testing Liliaceae and AlstroemeriaceaePatch testing with short ether extract of the leaves and petals as well as direct testing with them is not recommended because of the high risk of active sensitization.<a class="elsevierStyleCrossRef" href="#bib0290">58</a> Since pure tulip allergen is not readily available, patch tests may be performed with outermost bulb scales, after removal of the brown skin. To obviate dependence on seasonal supplies, extracts may be prepared from bulbs which have been tested for allergenicity.<a class="elsevierStyleCrossRef" href="#bib0295">59</a>Several ways of performing patch testing have been recommended. A 96% ethanol extract of tulip bulbs or an extract prepared by shaking fresh bulbs for 90min in acetone (80% in water) using 1% of this extract in 70% ethanol was recommended by Hjorth et al.<a class="elsevierStyleCrossRef" href="#bib0295">59</a> A methanol extract of the fresh petal or leaf/stem material in petrolatum at a 0.001% concentration was recommended by Hausen et al.<a class="elsevierStyleCrossRef" href="#bib0290">58</a> A 6-tuliposide A at 0.01% or an α-methylene-γ-butyrolactone at 0.0001% in ethanol was proposed by Santucci et al.<a class="elsevierStyleCrossRef" href="#bib0255">51</a>Patients with allergic contact dermatitis to Alstroemeria generally cross-react with tulip extracts.<a class="elsevierStyleCrossRefs" href="#bib0285">57,60</a> No cross-reactions between the sesquiterpene lactones and tulipalin A have been reported (even though both contain an α-methylene-γ-butyrolactone in the lactone ring<a class="elsevierStyleCrossRef" href="#bib0305">61</a>).Phenol and DerivatesThis is a group of mono- or dihydroxybenzene derivatives of phenol, catechol, resorcinol, or salicylic acid with a long alkyl or alkenyl carbon side chain. Mixtures of catechols with alk(en)yl side chains are also known as urushiol and are the main allergens in the toxicodendron genus. Phenols, resorcinols, and salicylic acid with alk(en)yl side chains are called cardanol, grevillol, and ginkgolic acid, respectively and are the main allergic contact sensitizers in the Anacardiaceae, Gingkgoaceae and Proteaceae family respectively. They are very good examples of prohaptens, that is, nonelectrophilic substances which have to undergo a chemical transformation such as oxidation to yield the active substance. Thus, many phenolic derivatives are metabolized into ortho-quinones or para-quinones, which are strong electrophiles<a class="elsevierStyleCrossRef" href="#bib0310">62</a> (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).<elsevierMultimedia ident="fig0030"></elsevierMultimedia>AnacardiaceaeThe Anacardiaceae family also known as the cashew family or the sumac family is a very broad family of flowering plants. This family includes about 70 genera and 650 species of evergreen deciduous trees, shrubs, and woody vines. These plants are native to tropical and subtropical areas of the world, but some species are also found in temperate regions. Members of the Anacardiaceae plant family that are important in dermatology include: the Toxicoendron genus, (common poison ivy, poison oak, poison sumac), Mangifera indica L (mango), Toxicodendron vernicifluum (lacquer tree), and Anacardium occidentale L (cashew nut).Toxicodendron GenusToxicodendron is the most allergenic genus of this family. It includes poison ivy (Toxicodendron radicans Kuntze and subspecies such as T radicans Kuntze var, rydbergii Erskine), poison oak (Toxicodendron diversilobum Greene and Toxicodendron toxicarium Gillis), and poison sumac (Toxicodendron striatum Kuntze, T vernix Kuntze) complexes. These genera are the main causes of allergic contact dermatitis in the United States and approximately 50%–70% of the population seems to be sensitized.<a class="elsevierStyleCrossRef" href="#bib0315">63</a>Occupational contact dermatitis to poison ivy is an important cause of occupational disability and represents a significant cost for the health system in the United States. Wilderness, rural and outdoor activities as well as outdoor occupations related to agriculture, forestry, and fire fighting, bring with them a high risk of sensitization.<a class="elsevierStyleCrossRef" href="#bib0320">64</a>Poison ivy dermatitis is generally unknown in Europe. The plants can be recognized by their compound leaves, with 3 or more smaller leaflets. Flowers and fruit arise in the angle between the leaf and the twig. The leaf stalk also leaves a “U”- or “V”-shaped scar after it falls off.<a class="elsevierStyleCrossRef" href="#bib0325">65</a>The pentadecylcatechols, consisting of 1, 2-dihydroxy benzenes with a 15-atom side chain at position 3 (3-pentadecylcatechol), also called urushiols, are the sensitizers in Toxicodendron plants. Urushiols are colorless or slightly<a class="elsevierStyleCrossRef" href="#bib0320">64</a> yellow in their natural state, but they oxidize, polymerize and turn black when exposed to air. Urushiol is found in the stems, roots, leaves, and skin of the fruits of these plants and also on fomites, where it retains its antigenic potential in the dry state indefinitely.<a class="elsevierStyleCrossRef" href="#bib0330">66</a> Young leaves contain greater amounts of urushiol than the older ones.<a class="elsevierStyleCrossRef" href="#bib0335">67</a>Contact dermatitis primarily results from direct contact with the oleoresin obtained from a portion of a bruised or injured plant. However, contamination and re-exposure to the antigen may occur, with the most important reservoirs being the fingernails, clothing, animals, garden tools, or firewood.<a class="elsevierStyleCrossRefs" href="#bib0050">10,68</a> Contact dermatitis usually appears within 2–4 days; however it may appear as late as 2 weeks after the moment of contact. It is characterized by intense pruritus and an erythematous reaction followed by the appearance of multiple papules and vesiculo-bullous lesions in a linear distribution (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). The face, neck, and genitalia are commonly affected and usually show intense edema. The dermatitis has a self-limiting course, lasting approximately 1–2 weeks, but it can last up to 6 weeks.<a class="elsevierStyleCrossRef" href="#bib0320">64</a><elsevierMultimedia ident="fig0035"></elsevierMultimedia>Other clinical presentations include erythema multiforme-like reactions,<a class="elsevierStyleCrossRef" href="#bib0345">69</a> exanthematous and urticarial eruptions, and even renal damage that may occur after accidental, medicinal or alimentary ingestion.<a class="elsevierStyleCrossRefs" href="#bib0350">70,71</a> Stomatitis and anal itch have been described after chewing the leaves or secondary to hyposensitization treatments. Black spot poison ivy dermatitis is a rare and very special condition, consisting of asymptomatic black lesions on the skin that cannot be washed off. These lesions are followed by subsequent pruritic papules and have been mistaken for melanoma in several cases.<a class="elsevierStyleCrossRef" href="#bib0360">72</a>Patch TestPlant oleoresin diluted 1:10 in acetone may be used for patch testing. The pure synthetic antigen, 3-pentadecylcatechol, may also be used in various dilutions, but is not readily available and probably does not contain all the antigenic materials of the poison ivy oleoresin.<a class="elsevierStyleCrossRef" href="#bib0365">73</a>Mango (Mangifera indicaL) is a fruit found in eastern Asia, Burma and regions of India. It has been widely cultivated throughout the world, particularly in Hawaii, Florida, Mexico, and Central America.The responsible allergens are 3 resorcinols derivatives: heptadecadienylresorcinol, heptadecenylresorcinol and pentadecylresorcinol.<a class="elsevierStyleCrossRef" href="#bib0370">74</a> They are found in the stems, leaves, and peel, but not in fruit juice, which may be drunk by sensitized persons. Allergic contact dermatitis occurs after touching the fruit with the peel intact. Dermatitis can be limited to vesicles at the commissures of the mouth but it usually affects the entire perioral area, and it may affect the buccal mucosa and face. The hands can carry the allergen to the eyes and neck, and these eruptions sometimes become generalized. Some rare cases of systemic contact dermatitis have also been reported after ingestion by people previously sensitized by contact.<a class="elsevierStyleCrossRef" href="#bib0375">75</a> Climbing the tree can result in allergic dermatitis due to the content of urushiol in the leaves and bark of the tree. Symptoms of wheezing have also been reported, presumably due to an immediate hypersensitivity reaction.Patch test: Leaves and bark but not fruit extracts could be used to demonstrate contact allergy. There is no standardized procedure and a possible active sensitization should be taken into account. Cross hypersensitivity between the allergens of mango and the Anacardiaceae and Gingkoaceae families has been reported.<a class="elsevierStyleCrossRef" href="#bib0370">74</a>Cashew nut tree (Anacardium occidentaleL) is a small tree native to northeastern Brazil but it is now cultivated in most tropical countries. The tree produces a kidney shaped fruit (cashew nut) that grows at the end of the accessory fruit called the cashew apple. The cashew nuts are composed of an internal kernel and a double-layered outer shell. Between the 2 layers of the shell irritant and allergenic oil is found. The nuts are used in the food industry as a substitute for almonds. The oil obtained from the nut shells (cashew nut shell liquid) is used in manufacturing various products. Friction dust is used for brake linings and clutch facings, epoxy resins, paints, varnishes, and foundry core oil as well as insecticides to control mosquito larvae and schistosomiasis vectors.Anacardic acid (a mixture of 2-carboxyl-3-alkyl phenols) and cardol (a mixture of 5-alkyl resorcinols such as 5-pentadecadienylresorcinol), are the most important allergens.<a class="elsevierStyleCrossRef" href="#bib0180">36</a> Any part of the cashew tree, except the roasted nut, can induce dermatitis<a class="elsevierStyleCrossRef" href="#bib0380">76</a> although allergic contact dermatitis is generally caused by direct contact with the oil. Topical contact with the oil can induce the same type of reaction seen in individuals exposed to poison ivy.<a class="elsevierStyleCrossRef" href="#bib0385">77</a> Oral ingestion can lead to stomatitis and pruritus ani<a class="elsevierStyleCrossRef" href="#bib0390">78</a> and even to widespread dermatitis with flexural accentuation, typically distributed on the extremities, groin, and buttocks. This eruption occurs generally from 1 to 3 days after ingestion of raw cashew nuts contaminated with allergenic oil.<a class="elsevierStyleCrossRef" href="#bib0395">79</a> Dermatitis resulting from sensitized children handling and playing with the nuts has been reported.<a class="elsevierStyleCrossRef" href="#bib0400">80</a> Improperly shelled cashew nuts caused an outbreak of perioral and more generalized dermatitis in Pennsylvania.<a class="elsevierStyleCrossRef" href="#bib0405">81</a>Patch test: There is no standardized patch test recommendation for cashew nut oil, although a 30% concentration has been occasionally used.<a class="elsevierStyleCrossRef" href="#bib0410">82</a> The occurrence of cross-sensitivity between the urushiols of the poison ivy (Toxicodendron radicans Kuntze) and the cashew nut allergen has long been recognized.<a class="elsevierStyleCrossRefs" href="#bib0415">83,84</a>Toxicodendron vernicifluaStokes (Japanese lacquer tree) is an indigenous tree of Japan and China. Its trunk yields a milky juice, which on contact with air darkens and becomes a durable lacquer used as varnish on furniture, floors, tea pots, rifle stocks, canes, wooden toilet seats, and ornaments. All plant parts as well as lacquered objects can trigger an allergic phytodermatitis, even after many years.<a class="elsevierStyleCrossRef" href="#bib0425">85</a> The allergens are also urushiols, but they differ from poison ivy's by the positions of the double bonds, with the 15-carbon side chain at positions 8, 11 and 13 instead of at positions 8, 11 and 14 in poison ivy's urushiols.<a class="elsevierStyleCrossRef" href="#bib0430">86</a>Clinical features are variable depending on the mode and sites of contact, and the degree of sensitivity. The most common is an inflammatory reaction and erythema at the site of contact with the varnish; however more extensive persistent and severe cases have been described.<a class="elsevierStyleCrossRef" href="#bib0435">87</a> Dermatitis of the face induced by burning logs from lacquer trees has also been reported.<a class="elsevierStyleCrossRef" href="#bib0440">88</a>Patch test: Previous experience is scarce and there is no special protocol. General recommendation for plants should be followed. Patients allergic to poison ivy usually cross-react to Japanese lacquer tree urushiol.<a class="elsevierStyleCrossRef" href="#bib0430">86</a>Ginkgoaceae FamilyGinkgo biloba L, the ginkgo tree, is the only representative of this family and is regarded as one of the world's oldest surviving tree species. Originating in southeastern China 200 million years ago, it was introduced to Europe during the early 18th century, and it now grows in temperate regions throughout the world. Contact dermatitis from the ginkgo tree is not due to its leaves but to its malodorous fruit exclusively borne in female trees.The alkylphenols (anacardic or ginkgolic acids, cardols, and cardanols) have been identified as the potential allergens. Ginkgolic acid 1, the most important allergen, is found mainly in the fruit, but it can also be detected in Ginkgo leaves.<a class="elsevierStyleCrossRef" href="#bib0445">89</a> Allergic reactions seem to occur only with open fruit extruding pulp. Handling the intact fruit is not harmful to sensitized persons.<a class="elsevierStyleCrossRef" href="#bib0450">90</a>Contact dermatitis occurs especially in East Asians, who enjoy eating the nuts (seed kernels), and manipulate the seeds to remove the fleshy pulp and obtain the kernels. Pruritic, edematous and erythematous plaques with papules or vesicles appear on the hands, face, arms, and anywhere the seed pulp is spread. Ingestion may also cause stomatitis and anal pruritus.<a class="elsevierStyleCrossRef" href="#bib0455">91</a> While reactions are uncommon in the West, a small epidemic occurred among a group of schoolgirls who stomped upon fallen fruit. They developed a streaky, vesicular dermatitis on their legs, similar to that of poison ivy contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0460">92</a>Patch TestGinkgo fruit pulp 1–10 in acetone is recommended for patch testing<a class="elsevierStyleCrossRef" href="#bib0455">91</a> as it avoids irritation at this concentration, whereas the fruit pulp itself is strongly irritant.<a class="elsevierStyleCrossRefs" href="#bib0460">92,93</a>Proteaceae FamilyThe Proteaceae family comprises 1050 species in 62 genera and is found predominantly in the tropics. The most important genus of this family is the genus Grevillea which is made up of approximately 360 species, most native to Australia, where they range from low shrubs to forest trees. A number of different Grevillea species and hybrids, especially of the eugrevillea section, appear to cause allergic contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0470">94</a> The most important species are Grevillea robusta Cunn, also known as silky oak or silver oak and Grevillea x Robyn Gordon, a natural hybrid between Grevillea banksii R Br and Grevillea bipinnatifida R Br which is perhaps the most important plant in this genus from a human health perspective and probably represents the most common cause of plant-induced dermatitis in Australia.<a class="elsevierStyleCrossRef" href="#bib0475">95</a>The allergens appear to differ between the species and their hybrids. The allergens of G robusta are 5-tridecylresorcinol (grevillol), 5-pentadecylresorcinol and 5-pentadecenylyresorcinol. Grevillea banksii R Br shows the resorcinol derivative pentadecylresorcinol. Other long carbon chain alkenyl resorcinols include the haptens in Grevillea Robyn Gordon.<a class="elsevierStyleCrossRef" href="#bib0480">96</a>Contact with the wild and cultivated tree, and especially with the flowers, as well as with objects made with its wood, induces a bullous eruption similar to that caused by poison ivy and poison oak (Toxicodendron sp).<a class="elsevierStyleCrossRef" href="#bib0485">97</a> Grevillea poisoning was described among men who cut the fallen trees and developed a severe bullous contact reaction.<a class="elsevierStyleCrossRef" href="#bib0490">98</a>Patch TestThe 0.1% ethanol extract of the Grevillea flower in petrolatum has been used for patch testing. Because the allergens of Grevillea are related chemically to those of the Toxicodendron genus, cross-sensitivity can be seen. Patients who are known to be sensitive to Toxicodendron should avoid Grevillea species contact and vice versa.QuinonesThis is a group of (poly)cyclic organic compounds with at least one 6-membered unsaturated ring to which 2 oxygen atoms are bound as carbonyl groups (C=O). They represent oxidized forms of ortho- or para-diphenol. They are strong electrophilic substances that easily react with the nucleophilic groups of proteins, acting in this case as strong haptens.The most important allergens are benzoquinones or naphthoquinones. At high concentrations, they are primary irritants. They are the main sensitizers present in tropical woods as well as in some families of plants, of which the Primulaceae family is the most important.PrimulaceaePrimulaceae is a broad family of flowering plants with about 1000 species in 24 genera. Despite the large number of specimens and cosmopolitan distribution only Primula sp presents a common dermatological hazard. Primula was exported from China to England in the year 1880. Their beautiful flowers, long flowering period, and their ease of care led to a quick introduction into Europe although success was more limited in America. For a number of years Primula obconica Hanse was the most common cause of plant-induced contact dermatitis in Europe; however since the introduction of primin-free P obconica Hanse into the European market, its incidence has declined.<a class="elsevierStyleCrossRef" href="#bib0495">99</a> Other species of Primula are reported to be allergenic, such as P auricula L, P denticulata Sm and P vulgaris Huds, and vary widely in their allergen content.<a class="elsevierStyleCrossRefs" href="#bib0500">100–102</a>The primin (2-methoxy-6-n-pentyl-p-benzoquinone) is the major allergen of primrose dermatitis, a quinone formed by oxidation of its biosynthetic precursor miconidin (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>); however other allergens such as primetin (a flavone),<a class="elsevierStyleCrossRef" href="#bib0515">103</a> and miconidin (2-methoxy-6-pentyl-1,4-dihydroxybenzene)<a class="elsevierStyleCrossRef" href="#bib0520">104</a> have also been suggested. Primin is contained in the terminal cells of the microscopic glandular hairs on the surface of the leaves, stems, and flowers. The allergen content of the plant varies considerably, depending on season, the number hours of sunshine, the method of cultivation, and the horticultural variety, which explains the striking seasonal variation in its allergenicity, greatest in summer and lower in the winter months.<elsevierMultimedia ident="fig0040"></elsevierMultimedia>Sensitization to P obconica Hance can occur by direct contact with plants or by indirect contact, e.g. via hand-shakes, door handles, or paper fibers. Primin can be released through pollen or small dust particles, causing an airborne allergic contact dermatitis in some sensitized patients.<a class="elsevierStyleCrossRef" href="#bib0525">105</a>Dermatitis most commonly occurs in elderly women and a variety of cutaneous reactions have been described: facial dermatitis, alone or combined with limb dermatitis and hand dermatitis.<a class="elsevierStyleCrossRefs" href="#bib0210">42,106,107</a> Eruptions vary from linear to erythematous papules, vesicles and bullae, and to lesions resembling erythema-multiforme and lichen planus.<a class="elsevierStyleCrossRefs" href="#bib0540">108–113</a> A few cases of airborne dermatitis<a class="elsevierStyleCrossRefs" href="#bib0555">111,114,115</a> and facial eruption mimicking herpes simplex<a class="elsevierStyleCrossRef" href="#bib0580">116</a> as well as one case presenting as vitiligo<a class="elsevierStyleCrossRef" href="#bib0585">117</a> have also been reported.In order to reduce the incidence of allergic primin contact dermatitis, a primin-free Primula obconica Hance was developed.<a class="elsevierStyleCrossRef" href="#bib0590">118</a> Although its introduction reduced significantly the cases related to cultivars, it still remains as an important contact allergen, justifying its maintenance in the standard series.Patch TestPrimin 0.01% in petrolatum is included in the European baseline series.TerpenesThe terpenes represent a large class of hydrocarbon compounds, produced by a wide variety of plants, particularly conifers. They are the main components of most of the essential oils.The terpenes are composed biosynthetically of units of isoprene, which has the molecular formula C5H8. Chemically, terpenes are multiples of isoprene units, (C5H8)n where n is the number of linked units. The terpenes are classified by the number of isoprene units included in the complete molecule: hemiterpenes (a single isoprene unit), monoterpenes (2 isoprene units, e.g. limonene, pinene and 3-carene), sesquiterpenes (3 isoprene units), diterpenes (4 isoprene units), and so on. Terpenes by themselves are not sensitizers because they lack the electrophilic properties necessary to bind covalently to skin proteins. They act as prehaptens and need to undergo chemical transformation in order to become true haptens.Turpentine, a variable mixture of numerous terpenoid compounds, is one of the most important terpene representatives. Turpentine is obtained from the oleoresin of various pine species. Turpentine can easily auto oxidize into hydroperoxides (3-carene, α-pinene and β-pinene) which later yield ketones and aldehydes, both of which are excellent electrophilic substances. Another important example of sensitizing terpene is colophony. Colophony is the residue left after distilling off the volatile oil from the oleoresin obtained from Pinus sylvestris L and other species (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>).<elsevierMultimedia ident="fig0045"></elsevierMultimedia>RutaceaeThis family includes 900 species in 150 genera which are found in tropical and temperate regions especially in southern Africa and Australia. It is an important cause of phototoxic reactions although some cases of ACD to the citrus genus have also been reported.Citrus GenusTwelve species are native to southern China, south-east Asia and Indo-Malaysia; however, with the aim of achieving larger fruits, with more juice, better taste and lack of seeds, numerous other species have emerged from various artificial crosses. The most common species are Citrus sinensis L (orange), Citrus aurantium L (Bergamot), and Citrus Limon L Burm. Fil. (lemon). Besides its use in the food industry, citrus is used for aromatic oils in the flowers and fur, in perfumery, and in the manufacture of soaps and cosmetics.Allergic contact dermatitis to citrus fruits is unusual and hand dermatitis has been described in food handlers.<a class="elsevierStyleCrossRef" href="#bib0595">119</a> The potential sensitizers include geraniol, citral and the hydroperoxide derivative of d-limonene,<a class="elsevierStyleCrossRef" href="#bib0600">120</a> which are usually included in fragrances. The mechanism of sensitization is currently an object of research.Patch TestOxidized limonene is available as a commercial allergen for patch testing at 3% in petrolatum (from Chemotechnique). A multicenter study led by Ann Therese Karlberg from Gothenborg, Sweden, with oxidized limonene and linalol is currently being performed. A recommended patch test is still unavailable.Miscellaneous StructuresNatural products such as disulfides (Alliaceae), isothiocyanates (Cruciferae) and polyacetylenic derivates (Araliaceae, Apiaceae) are other types of natural products containing reactive functional groups which have been associated with skin allergies (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>).<elsevierMultimedia ident="fig0050"></elsevierMultimedia>DisulfidesAlliaceaeAlliaceae family members are widely distributed in temperate, subtropical and warm regions throughout the world. These species can be recognized easily by their characteristic garlic smell as well as their soft, fleshy leaves. The genus Allium is the most important genus in dermatology and includes many important vegetables such as garlic and onion. Garlic is the main species involved in cases of allergic contact dermatitis. Because of its multiple antibacterial, choleretic, spasmolytic, and in particular proven anti-atherosclerotic effect, the plant has been cultivated since ancient times in China, India and Egypt, and its healing effects are used as folk medicine nowadays in many countries.All parts of the plant, when damaged, release the potentially irritating and allergenic sap. Diallyl disulfide, allicin, and allyl propyl disulfide have been identified as the principal low molecular weight allergens.<a class="elsevierStyleCrossRef" href="#bib0605">121</a> Allergic contact dermatitis is generally considered as being caused by diallyl disulfide.<a class="elsevierStyleCrossRef" href="#bib0610">122</a>Occupational dermatitis has been frequently reported in the literature. The typical occupational gesture of cutting the bulb, which is held between the thumb and first/second finger of the nondominant hand, while the knife is held in the dominant hand leads to the characteristic distribution of hyperkeratotic eczema on the tips of the first 2 or 3 fingers of the nondominant hand and thumb of the dominant hand<a class="elsevierStyleCrossRefs" href="#bib0615">123–127</a> (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>). The hypersensitivity not always presents with this classical asymmetrical pulpitis, but frequently also as hand eczema (desquamation, fissuring and hyperkeratosis) involving the palm.<elsevierMultimedia ident="fig0055"></elsevierMultimedia>Lesions at different locations from those of typical hand eczema have also been described, reflecting a different pattern of exposure, especially after use for medicinal purposes.<a class="elsevierStyleCrossRef" href="#bib0640">128</a> Because of its sensitizing potential and the high degree of irritation (especially under occlusion), the use of garlic as a topical medicinal agent should be discouraged.Other less typical presentations attributed to garlic include a pemphigus vulgaris-like eruption,<a class="elsevierStyleCrossRef" href="#bib0615">123</a> cheilitis,<a class="elsevierStyleCrossRef" href="#bib0610">122</a> a garlic induced systemic contact dermatitis,<a class="elsevierStyleCrossRefs" href="#bib0630">126,129</a> cases of photodermatitis,<a class="elsevierStyleCrossRef" href="#bib0650">130</a> and an occupational airborne ACD from garlic with concurrent type I allergy.<a class="elsevierStyleCrossRef" href="#bib0655">131</a>Allergic contact dermatitis to onion is less widely reported. However, patients with allergic contact dermatitis to onion can be cross-reactive to garlic.<a class="elsevierStyleCrossRef" href="#bib0660">132</a>Patch TestPatch test has been performed either with 50% garlic/onion in arachis oil<a class="elsevierStyleCrossRef" href="#bib0665">133</a> or diallyl disulfide 5% pet<a class="elsevierStyleCrossRef" href="#bib0670">134</a> but actually 1% in petrolatum (Chemotechnique diagnostics®, Malmö, Sweden) is the recommended concentration to be used.IsocyanatesIsocyanates are a family of highly reactive, low molecular weight compounds identified by the number of NCO (nitrogen–carbon–oxygen) groups they contain. Mono-isocyanates contain 1 group; di-isocyanates (used in polyurethane) contain 2, and so on.Mono-isothiocyanates, otherwise known as mustard-oils because they are characteristic of and were indeed first isolated from mustard plants (Cruciferae family), occur in a wide variety of higher plants, but above all in the mustard family and its tropical counterpart, the caper family.Several species of this family yield in their leaves, fruits, seeds and root extracts glucosidic precursors (glucosinolates), which, through enzymatic hydrolysis by an enzyme named myrosinase, produce the isothiocyanates. Naturally occurring isothiocyanates can be either saturated or unsaturated.<a class="elsevierStyleCrossRef" href="#bib0675">135</a> Instauration of the β,γ carbons to the isothiocyanate nitrogen (allyl and benzyl isothiocyanate) may make the thiocayante more immunologically reactive. Compounds with instauration at the β,α positions, such as phenylisothiocyanate, are probably less immunologically reactive and have a greater potential for irritation.Cruciferae (Cabbage or Mustard Family, Brassicaceae) and Capparaceae FamilyThe Brassicacea family contains about 3200 species in 375 genera. It includes several important vegetables, such as cabbage (Brassica oleracea L), cauliflower (B oleracea L v botrytis), radish (Raphanus sativus L), horse radish (Armoracia rusticana P Gaertn, B Mey, and Scherb), turnip (Brassica campestris L) and mustrard (Brassica nigra [L] WDJ Koch). The Capparaceae, regarded as the tropical relative of the mustard family, comprises some 650 species of small trees and shrubs in 30 genera. The most important representative of this family is Capparis spinosa L, or caper bush, a shrub with grayish oval leaves and showy white-pink flowers with several prominent stamens. It is better known for the edible bud and fruit which are usually consumed pickled.Several species contain thioglucosides, which are broken down enzymatically, in the presence of water, to isothiocyanates, potent irritants, which appear to be also the most important allergens. Contact dermatitis from these plants can be both irritant and allergic,<a class="elsevierStyleCrossRefs" href="#bib0680">136,137</a> with a high potential irritant capacity. Allergic contact dermatitis is rare.Allergic contact dermatitis is more commonly seen in food handlers. Raphanus sativus L induced an acute vesiculo-bullous dermatitis of both palms in a waitress who chopped them.<a class="elsevierStyleCrossRef" href="#bib0675">135</a> Cabbages provoked occupational contact dermatitis<a class="elsevierStyleCrossRef" href="#bib0690">138</a> and cabbage juice can produce positive patch test reactions in patients with hand dermatitis suspected to have been caused by vegetables.<a class="elsevierStyleCrossRef" href="#bib0695">139</a>Brassica nigra induced an allergic contact dermatitis due to mustard powder in a salad maker<a class="elsevierStyleCrossRef" href="#bib0685">137</a> and Brassica oleracea v. Botrytis (cauliflower) induced a hand eczema in a plant grower.<a class="elsevierStyleCrossRef" href="#bib0700">140</a>Capparis spinosa L induced an acute vesiculo-bullous allergic contact dermatitis in a woman who applied a wet compress of the minced leaves and fruits to her arm.<a class="elsevierStyleCrossRef" href="#bib0705">141</a>Patch test: Isothiocyanates present in these plants are usually primary irritants, and they can be tested at a concentration of 0.05% in petrolatum. As the irritancy of mustard oil tends to overshadow its allergic potential, a positive patch test with mustard can be difficult to interpret.<a class="elsevierStyleCrossRef" href="#bib0675">135</a>Polyacetylenic DerivatesThe polyacetylenes are a group of chemically reactive and biologically active compounds with a carbon-carbon triple bond or alkynyl functional group. They can be found in 7 families of plants, and the majority has been isolated from the closely related plant families Araliaceae and Apiaceae. The polyacetylenic derivatives of the Araliaceae and Apiaceae are mostly the aliphatic C17-polyacetylenes of the falcarinol-type, derived from oleic acid.<a class="elsevierStyleCrossRef" href="#bib0710">142</a> They act as very reactive alkylating agents towards, for example, thiol groups in proteins, forming hapten-protein complexes (antigens).<a class="elsevierStyleCrossRefs" href="#bib0710">142,143</a>AraliaceaeThis family of some 700 species in 55 genera consists mostly of trees and shrubs, but includes some twiners. Most species occur in tropical regions, particularly in Indo-Malaysia and tropical America. Other species are native to temperate regions, and some species have become widely distributed by horticulture and as houseplants.Perhaps the best known temperate species is Hedera helix L, common ivy. The plants are native to Europe, North Africa, and Asia but are now grown in many other countries. Three main subspecies are found in Europe, namely helix (English ivy), canariensis (Canary Island ivy), and poetarum. They are a family of evergreen climbing plants usually found scrambling over rocks and through hedges or climbing up trees or walls (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).<elsevierMultimedia ident="fig0060"></elsevierMultimedia>Falcarinol (heptadeca-1,9-diene-4,6-diyne-3-ol) and didehydrofalcarinol are the most important allergens. They are detected in stalks, leaves, and roots and may cause both irritant and allergic contact dermatitis. Falcarinol seems to be the stronger sensitizer and concentration and the ratio didehydrofalcarinol:falcarinol seems to vary considerably, depending on climate and other conditions of growth.<a class="elsevierStyleCrossRef" href="#bib0720">144</a>Sensitization can occur through contact with plants on climbing trees covered by them or by pruning or handling the plants in an occupational setting. Any site in contact with the plant may be affected and dermatitis commonly begins with an itching and erythema that in a few days develops into a vesicular eczema (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 13</a>).<a class="elsevierStyleCrossRef" href="#bib0725">145</a> The most frequently affected sites are hands and forearms followed by involvement of the face and neck; however, involvement of trunk and legs as well as widespread dermatitis has also been reported.<a class="elsevierStyleCrossRefs" href="#bib0725">145,146</a> Urticarial-like dermatitis has also been reported.<a class="elsevierStyleCrossRef" href="#bib0735">147</a> Immediate, possibly allergic, reactions from common ivy causing rhinitis and asthma have rarely been reported, The majority of mucosal symptoms in gardeners are probably irritant, perhaps caused by hederin.<a class="elsevierStyleCrossRefs" href="#bib0740">148–150</a><elsevierMultimedia ident="fig0065"></elsevierMultimedia>Patch TestTesting the plant material as is as well as extracts of these carries the risk of false positive reactions. Falcarinol 0.03% and didehydrofalcarinol 0.3% in petrolatum can be used.ApiaceaeAlso known as Umbelliferae, this family of 2850 species in 275 genera is of cosmopolitan distribution but is found mainly in north temperate regions. Most of the species of dermatological importance are similar in floral structure, with cluster of flowers on stalks of roughly equal length arising from a single point as an umbrella structure. Most of the members of this family have been shown to be rich in psoralenes and therefore produced phototoxic reactions. Some ornamental plants and weeds as well as edible plants of this family have also been related to allergic contact dermatitis. Two important species in dermatology are Centella asiatica and Daucus carota vars.Centella asiaticaCentella asiatica, formerly named Hydrocotyle asiatica (L) Urban, is a small herbaceous annual plant of the subfamily Mackinlayoideae of the family Apiaceae. It is native to India, Sri Lanka, northern Australia, Indonesia, and other parts of Asia. The fresh and dried leaves as well as the stems of this species have been widely used topically in many medical and dermatological conditions for example on scars and keloids, in plastic surgery, scleroderma, phlebology, slow-healing wounds and chronic leg ulcers among others.<a class="elsevierStyleCrossRefs" href="#bib0755">151–155</a>Several commercial topical preparations have been formulated including Blastoestimulin, Centelas, Collaven, Emdecassol, Madecassol, Marticassol, and Trofolastin. Contact allergy to the Centella asiatica extract demonstrated by patch testing has been reported with the topical use of Madecassol,<a class="elsevierStyleCrossRef" href="#bib0780">156</a> Centelase,<a class="elsevierStyleCrossRefs" href="#bib0785">157–159</a> and Blastoestimulina.<a class="elsevierStyleCrossRefs" href="#bib0800">160–164</a> The potential allergens are madecassic acid, asiatic acid and, asiaticoside, 3 triterpenic acids of high molecular weight and low sensitizing capacity.<a class="elsevierStyleCrossRef" href="#bib0825">165</a>Daucus carota varsDaucus carota, the carrot, is a root vegetable of usually orange color, though purple, red, white, and yellow varieties exist. In early use, carrots were grown for their aromatic leaves and seeds, but they are now cultivated mainly for food.Allergic contact dermatitis from carrot is well recognized, particularly affecting employees working in canning factories.<a class="elsevierStyleCrossRefs" href="#bib0695">139,166–168</a> Leaves and fruits contain falcarinol, an allergen also present in celery (Apium graveolens L) and common ivy (Hedera helix L).<a class="elsevierStyleCrossRef" href="#bib0840">168</a> Hand or fingertip dermatitis is the typical clinical pattern, but involvement of the face has also been reported.<a class="elsevierStyleCrossRef" href="#bib0845">169</a>Patch test: If the oleoresin of carrots is not available for testing, patch testing may be performed with the external surface of an unpeeled raw carrot or with the surface of a slice of carrot.Available Resources to Patch Test PlantsCurrently we have a limited availability of commercial test materials for patch testing plants.The European baseline series includes sesquiterpene lactone mix at 0.1% in petrolatum for Compositae and Frullania and primin at 0.01% in petrolatum for Primulaceae. In contrast, the American baseline series includes the sesquiterpene lactone mix at 0.1% and the Compositae mix at 6% in petrolatum for Compositae and Frullania.Special plant series for testing Compositae, Frullania, Liliaceae, Alstroemeriacea, Alliaceae and the citrus genus can be purchased from different European and American suppliers. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the currently available allergens. Commercial patch test material for Anacardiaceae, Cruciferae, Capparaceae, Ginkgoaceae, Araliaceae, and Apiaceae are not available.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>We can confirm that often the study of a specific plant-induced contact dermatitis or photocontact dermatitis needs an accurate research into the published literature. The previous experience developed by our colleagues will help us to avoid unnecessary steps and allow more useful research protocols to be drawn up.Conclusions and Further ResearchThis review aimed to cover some of the essential aspects of the allergic contact dermatitis induced by plants. The intention of the chemical approach presented was to allow a more rational understanding of the presently confusing cross-reactions between apparently unrelated genera. Plant contact dermatitis tends to be underestimated and misdiagnosed. We lack definitive patch test material and often diagnosis requires an individualized approach using our own material. Plant-induced contact and photocontact dermatitis can be severe and the basis for the development of other inflammatory skin diseases such as chronic actinic dermatosis. Recognition of the problem will help to find the trigger and allow preventive measures to be taken.Conflict of InterestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:2 [ "identificador" => "xres96055" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec83215" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres96054" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec83216" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Plant Contact Dermatitis Classified by its Responsible Chemical Allergenic Structure" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "α-Methylene-γ-Butyrolactones" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "Asteraceae or Compositae Family" "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0025" "titulo" => "Patch Test" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Jubulaceae Family (Liverworts)" ] ] ] 1 => array:3 [ "identificador" => "sec0035" "titulo" => "Patch Test" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Liliaceae" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Alstroemeriaceae" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "sec0050" "titulo" => "Patch testing Liliaceae and Alstroemeriaceae" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Phenol and Derivates" ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Anacardiaceae" ] 2 => array:3 [ "identificador" => "sec0065" "titulo" => "Toxicodendron Genus" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Patch Test" ] ] ] 3 => array:3 [ "identificador" => "sec0075" "titulo" => "Ginkgoaceae Family" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Patch Test" ] ] ] 4 => array:3 [ "identificador" => "sec0085" "titulo" => "Proteaceae Family" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0090" "titulo" => "Patch Test" ] ] ] ] ] 7 => array:3 [ "identificador" => "sec0095" "titulo" => "Quinones" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0100" "titulo" => "Primulaceae" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0105" "titulo" => "Patch Test" ] ] ] ] ] 8 => array:3 [ "identificador" => "sec0110" "titulo" => "Terpenes" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0115" "titulo" => "Rutaceae" ] 1 => array:3 [ "identificador" => "sec0120" "titulo" => "Citrus Genus" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0125" "titulo" => "Patch Test" ] ] ] ] ] 9 => array:3 [ "identificador" => "sec0130" "titulo" => "Miscellaneous Structures" "secciones" => array:5 [ 0 => array:3 [ "identificador" => "sec0135" "titulo" => "Disulfides" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0140" "titulo" => "Alliaceae" ] 1 => array:3 [ "identificador" => "sec0145" "titulo" => "Patch Test" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0150" "titulo" => "Isocyanates" ] ] ] ] ] 1 => array:2 [ "identificador" => "sec0155" "titulo" => "Cruciferae (Cabbage or Mustard Family, Brassicaceae) and Capparaceae Family" ] 2 => array:2 [ "identificador" => "sec0160" "titulo" => "Polyacetylenic Derivates" ] 3 => array:3 [ "identificador" => "sec0165" "titulo" => "Araliaceae" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0170" "titulo" => "Patch Test" ] ] ] 4 => array:3 [ "identificador" => "sec0175" "titulo" => "Apiaceae" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0180" "titulo" => "Centella asiatica" ] 1 => array:2 [ "identificador" => "sec0185" "titulo" => "Daucus carota vars" ] ] ] ] ] 10 => array:2 [ "identificador" => "sec0190" "titulo" => "Available Resources to Patch Test Plants" ] 11 => array:2 [ "identificador" => "sec0195" "titulo" => "Conclusions and Further Research" ] 12 => array:2 [ "identificador" => "sec0200" "titulo" => "Conflict of Interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-04-12" "fechaAceptado" => "2011-07-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec83215" "palabras" => array:6 [ 0 => "Contact dermatitis" 1 => "Plants" 2 => "α-Methylene-γ-butyrolactone" 3 => "Quinones" 4 => "Terpenes" 5 => "Phenols" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec83216" "palabras" => array:6 [ 0 => "Dermatitis de contacto" 1 => "Plantas" 2 => "α-Metilen-γ-butirolactonas" 3 => "Quinonas" 4 => "Terpenos" 5 => "Fenoles" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Allergic contact dermatitis due to plants is common. Potentially allergenic plants and plant products are found in many everyday environments, such as the home, the garden, the workplace, and recreational settings. By improving our knowledge of allergenic plant-derived chemical compounds, we will be better positioned to identify novel allergens. We review the most relevant chemical allergens that contribute to plant allergic contact dermatitis and propose a clinical classification system based on 5 major families of chemical sensitizers: α-methylene-γ-butyrolactones, quinones, phenol derivatives, terpenes, and miscellaneous structures (disulfides, isothiocyanates, and polyacetylenic derivates). We also describe the different clinical pictures of plant allergic contact dermatitis and review currently available patch test materials. A better understanding of the specific allergens involved in plant allergic contact dermatitis will help to predict cross-reactivity between different plant species or families." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La dermatitis alérgica por contacto debida a plantas es común. Se pueden encontrar plantas y productos vegetales potencialmente alergénicos en muchos entornos habituales como el hogar, el jardín, el lugar de trabajo y ambientes recreativos. Mejorando nuestro conocimiento de los compuestos químicos alergénicos derivados de plantas estaremos en una mejor posición para identificar alérgenos nuevos. Revisamos los alérgenos químicos que contribuyen de manera más relevante a la dermatitis alérgica por contacto por plantas y proponemos un sistema de clasificación clínica basado en 5 principales familias de sensibilizadores químicos: α−metilen-γ-butirolactonas, quinonas, derivados fenólicos, terpenos y estructuras misceláneas (disulfuros, isotiocianatos y derivados poliacetilénicos). Describimos también los diferentes cuadros clínicos de dermatitis alérgica por contacto por plantas y revisamos los materiales de pruebas epicutáneas actualmente disponibles. Un mejor entendimiento de los alérgenos específicos involucrados en la dermatitis alérgica por contacto por plantas ayudará a predecir reacciones cruzadas entre diferentes especies o familias de plantas." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: E. Rozas-Muñoz, J.P. Lepoittevin, R.M. Pujol, A. Giménez-Arnau. Allergic Contact Dermatitis to Plants: Understanding the Chemistry will Help our Diagnostic Approach. Actas Dermosifiliogr.2012;103:456-477." ] ] "multimedia" => array:15 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1462 "Ancho" => 2503 "Tamanyo" => 171088 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of the main groups of sesquiterpene lactones." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 767 "Ancho" => 2337 "Tamanyo" => 126463 ] ] "descripcion" => array:1 [ "en" => "Structures of alantolactone, dehydrocostuslactone, and costunolide, constituents of the SL mix test material." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 808 "Ancho" => 1837 "Tamanyo" => 93845 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of d-(+)- and l-(−)-frullanolide." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 677 "Ancho" => 1670 "Tamanyo" => 64604 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of tulipalin A and B." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 629 "Ancho" => 950 "Tamanyo" => 100990 ] ] "descripcion" => array:1 [ "en" => "Alstroemeriaceae." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1503 "Ancho" => 3003 "Tamanyo" => 261299 ] ] "descripcion" => array:1 [ "en" => "General structures of sensitizing alk(en)yl aromatic derivatives." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 631 "Ancho" => 950 "Tamanyo" => 101401 ] ] "descripcion" => array:1 [ "en" => "Erythematous linear arrays and erythema multiforme-like lesions on the right elbow after contact with poison ivy." ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 707 "Ancho" => 1628 "Tamanyo" => 67428 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of primin and miconodin." ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1753 "Ancho" => 1587 "Tamanyo" => 126750 ] ] "descripcion" => array:1 [ "en" => "Chemical structures of some terpenes." ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 749 "Ancho" => 2337 "Tamanyo" => 115206 ] ] "descripcion" => array:1 [ "en" => "Miscellaneous chemical structures of plant sensitizers." ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 633 "Ancho" => 950 "Tamanyo" => 71713 ] ] "descripcion" => array:1 [ "en" => "Fingertip dermatitis after handling garlic." ] ] 11 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 712 "Ancho" => 950 "Tamanyo" => 210692 ] ] "descripcion" => array:1 [ "en" => "Hedera helix." ] ] 12 => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 1441 "Ancho" => 950 "Tamanyo" => 130140 ] ] "descripcion" => array:1 [ "en" => "Symmetrical erythematous patches after contact with Hedera helix." ] ] 13 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Abbreviation: SQL, sesquiterpene lactones." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Scientific Name \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Common Name \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Distribution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Allergen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Principal Use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Principal Affected Group \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lactuca sativa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lettuce \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Widely cultivated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hands and forearms dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (lactucin and lactucopicrin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: food handlers (salad makers, greengrocers and market gardeners) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cichorium endivia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Endivie \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mediterranean area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: salad makers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chicorium intybus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chicoriy, Escarole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Native to west and central Europe. Naturalized in South Africa, Australia, USA, and South America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (lactucin and lactucopicrin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: greengrocers and market gardeners \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Taraxacum officinale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dandelion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe. Temperate regions including South Africa, USA and Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis, face dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (taraxinic acid) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemums sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe, Asia, Africa and America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand and face dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (guaianolide) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental plants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: professional growers and florists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Helenium autumnale L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sneezeweed, Bitterweed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">North America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental plant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leucanthemum vulgare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Marguerites \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe, Asia, USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occcupational: gardeners and florists \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arnica montana L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Montain tobacco \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Northern hemisphere-temperate zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (helenalin and its esters) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic (used on wounds) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamomilla recutita \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamomile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral swelling, arm and trunk dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (desacetylmatricarin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tanacetum parthenium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Feverfew \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (parthenin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ambrosia sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ragweeds \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">North America. Naturalized in Australia and India. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male farmers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Artemisia sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mugwort, Wormwood \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Northern temperate regions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed/spice/medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arctotheca \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Capweed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cape province, South Africa. Naturalized in Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Conyza bonariensis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fleabane, Horseweed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">North and South America, Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cynara scolymus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Globe artichoke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Widely cultivated in Mediterranean regions and other temperate areas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (cynaropicrin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: pickers, market gardeners and flower arrangers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dittrichia viscosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sticky elecampane, Stinkwort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mediterranean regions, Australia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (inuviscolide and 2-deacetoxyxanthinin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic: farm workers and gardeners \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parthenium hysterophorus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Congress grass. Carrot weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central and south America. Southwest USA. India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (parthenin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adult male farmers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achillea millefolium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yarrow \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe (especially Britain) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized dermatitis, generalized dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamaemelum nobile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sweet chamomile \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Localized dermatitis, anaphylaxis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (nobilin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lawn plant, herbal tea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dahlia cvs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dahlia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Face, hand and arm dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental plant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: gardeners \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inula helenium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elecampane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Continental Europe, Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (alantolactone) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Jubulaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Frullania sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Worldwide, especially in temperate and subtopical forests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pseudophotodermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SQL (frullanolide) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liverworts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: forestry workers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liliaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tulipa sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tulip \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe, Mediterranean region; Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tulip fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">α-Methylene-γ-butyrolactones (tulipalin A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental plants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupatinal: bulb growers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alstroemeriaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alstromeria \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Peruvian lily \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Andean foothills esp Chile and Peru. Widely grown as a border perennial and for cut flowers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tulip fingers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">α-Methylene-γ-butyrolactones (tulipalin A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental plants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: florist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anacardiaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodendron radicans \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poison ivy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eastern Asia and North and South America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic and occupational (outdoor workers) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodendron diversilobum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Western poison oak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">West coast of North America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodendron toxicarium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eastern poison oak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">South-eastern USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodendron striatum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Poison sumac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central America and northern South America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mangifera indica L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mango \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Easterna Asia, Bruma and regions of India \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Face dermatitis, stomatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anacardium occidentale L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cashew nut tree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Northeastern Brazil. Tropical countries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis, stomatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anacardic acids and cardol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food, manufacturing of other products \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toxicodendron verniciflua Stokes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Japanese lacquer tree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Japan and China \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local eczema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urushiol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">varnish \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic and lacquer workers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ginkgoaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ginkgo biloba L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ginkgo tree \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">China, Europe and temperate regions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand, face, and arm dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ginkgolic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental and food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Proteacea family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grevillea sp \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Silk oak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Australia and southern USA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pentadecylresorcinol, tridecylresorcinol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primulaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primula obconica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">China and Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Facial dermatitis with limb or hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ornamental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: gardeners and florist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rutaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Citrus lemon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lemon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Widely cultivated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Geraniol, citral and d-limonene \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food handlers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Citrus sinensis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orange \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Widely cultivated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Geraniol, citral and d-limonene \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food handlers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Citrus aurantium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bergamot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Widely cultivated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Geraniol, citral and d-limonene \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food handlers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alliaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Allium sativum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Garlic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Worldwide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fingertip dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diallyl disulfide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupationa: food handlers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cruciferae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Raphanus sativus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radish \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Worldwide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isothiocyanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brassica oleracea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cabbage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Worldwide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isothiocyanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brassica nigra \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Black mustard \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Central and southern Europe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Variable, hand dermatitis, local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isothiocyanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food handler \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Brassica oleracea v botrytis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cauliflower \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Worldwide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isothiocyanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plant grower \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Capparaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Capparis spinosa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caper bush \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mediterranean, extending to Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isothiocyanate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Araliaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hedera helix \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common ivy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Europe, North Africa and Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Linear array dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Falcarinol and didehydrofalcarinol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Weed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apiaceae family</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Centella asiatica \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asian pennywort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Local dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Madecassic acid, asiatic acid and asiaticoside \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicinal herb \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Domestic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Daucus carota vars. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Carrot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Temperate areas \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Falcarinol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Food \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Occupational: canning factory workers \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182234.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main Plants Responsible for Allergic Contact Dermatitis." ] ] 14 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "aChemotetechnique.bMarti Tor.cAllergEAZE.dTROLAB." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Allergen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Family or Species \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">European baseline series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sesquiterpene lactone mix 0.1 pet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositea and Frullania \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primin 0.01 pet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primulaceae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">American baseline series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sesquiterpene lactone mix 0.1 pet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositae and Frullania \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositae mix 6 pet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositae and Frullania \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Special series</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamomilla romana \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamomilla Romana 1.0 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chamomilla romana \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Árnica montana \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Árnica montana 0.5 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Árnica Montana \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Taraxacum officinale \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Taraxacum Officinale 2.5 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Taraxacum officinale \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achillea millefolium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achillea Millefolium 1.0 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Achillea millefolium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum parthenium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum Parthenium 1.0 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum parthenium (Feverfew) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum cinerariaefolium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum Cinerariaefolium 1.0 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chrysanthemum cinerariaefolium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tanacetum vulgare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tanacetum Vulgare 1.0 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tanacetum vulgare \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alantolactone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alantolactone 0.033 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Compositae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parthenolide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parthenolide 0.1 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Feverfew several Compositae and Magnoliaceae \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dipentene (limonene) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dipentene (Limonene) 1.0 peta, 2%vasb, 2% petc, 2%e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Citrus genus \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diallyldisulfide 1.0 pet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diallyldisulfide 1.0 peta, vasb, petc,e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Garlic \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">α-Methylene-γ-butyrolactone (tulipalin A) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">α-Methylene-γ-butyrolactone 0.01 peta \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liliaceae and Alstroemeria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oil of bergamot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oil of bergamot 2% vasb, petc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bergamot \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oil of lemon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oil of lemon 2% vasb, petc,e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lemon \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orange oil \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orange oil 2%e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orange \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primin 0.01 peta, vasb, petc,e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Primula obconica \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Geraniol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Geraniol 1% peta, vasb, petc,e \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lemon, Orange, Bergamot \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab182233.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Available Allergens for Plant Patch Testing." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:169 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic contact dermatitis from sesquiterpenoids of the Compositae family of plants" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ …6] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airborne contact dermatitis" "autores" => array:1 [ …1] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ …7] ] ] ] ] ] 2 => array:3 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Review

Allergic Contact Dermatitis to Plants: Understanding the Chemistry will Help our Diagnostic Approach

Dermatitis alérgica por contacto con plantas. Entender las bases químicas ayudará al enfoque diagnóstico

E. Rozas-Muñoza,

Autor para correspondencia

docrozas@yahoo.com

Corresponding author.

, J.P. Lepoittevinb, R.M. Pujola, A. Giménez-Arnaua

a Department of Dermatology, Hospital del Mar. Parc de Salut Mar, Barcelona, Spain

b Dermatochemistry Laboratory, Institut of Chemistry, University of Strasbourg, Strasbourg, France

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        "titulo" => "Dermatitis al&#233;rgica por contacto con plantas&#46; Entender las bases qu&#237;micas ayudar&#225; al enfoque diagn&#243;stico"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Chemical structures of <span class="elsevierStyleSmallCaps">d</span>-&#40;&#43;&#41;- and <span class="elsevierStyleSmallCaps">l</span>-&#40;&#8722;&#41;-frullanolide&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Plants are living organisms belonging to the kingdom of <span class="elsevierStyleItalic">Plantae</span>&#44; which includes at least 300<span class="elsevierStyleHsp" style=""></span>000 species of trees&#44; herbs&#44; bushes&#44; grasses&#44; vines&#44; ferns&#44; mosses and green algae&#46; Although most plants are harmless on contact with the skin or ingestion&#44; the possibility of mild to serious adverse events is well recognized&#46; Several cutaneous adverse reactions to plants such as nonimmunological contact urticaria&#44; irritant contact dermatitis&#44; allergic contact dermatitis&#44; phototoxic contact dermatitis and photoallergic contact dermatitis have been reported&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis is one of the most frequent cutaneous side effects in individuals exposed to plants&#46; Study of the pathogenic mechanisms implicated in the development of allergic contact dermatitis &#40;ACD&#41; to plants may be challenging because of the large number of species&#44; the diversity of chemical compounds that they contain&#44; and the simultaneous contact with more than one allergen&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A wide range of plants and plant allergens responsible for ACD have been identified and the different contact dermatitis triggers have often been classified according botanical criteria&#46; These classifications are useful but do not allow prediction of cross-reactivity among different species or families and require a botanical knowledge often cumbersome to physicians&#44; dermatologists&#44; and allergologists&#46; A possible classification of plant contact dermatitis according to the main chemical structures acting as allergens could be useful and may help prevent future exposures to the responsible agent or its cross-reacting compounds present in other species or families&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our main objective is to review ACD to plants from a chemical point of view&#46; The responsible plants are classified according their chemical allergens&#46; Several families of chemical sensitizers causing different types of contact and photocontact allergic dermatitis are reviewed &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Plant Contact Dermatitis Classified by its Responsible Chemical Allergenic Structure</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#945;-Methylene-&#947;-Butyrolactones</span><p id="par0025" class="elsevierStylePara elsevierViewall">The &#945;-methylene-&#947;-butyrolactones are part of a large and varied group of bioactive natural products widely present in plants&#46; Their high chemical reactivity arises because of an &#945;&#44;&#946;-unsaturated carbonyl system which allows the formation of covalent adducts with nucleophilic residues on diverse biomolecules&#46; Most of these chemicals are of the sesquiterpene type &#40;15-carbon-atom molecule&#41; with an &#945;-methylene group directed exocyclically to the &#947;-lactone ring&#46; They are classified into 6 main groups of sesquiterpene lactone &#40;SQL&#41; structures&#58; guaianolide&#44; pseudoguaianolide&#44; xanthonolide&#44; ermophilanolide&#44; eudesmanolide&#44; and germacranolide &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; They are the predominant allergens in the <span class="elsevierStyleItalic">Compositae</span> family as well as in other related plant families such as <span class="elsevierStyleItalic">Jubulaceae</span>&#44; <span class="elsevierStyleItalic">Magnoliaceae</span>&#44; <span class="elsevierStyleItalic">Winteraceae</span>&#44; and <span class="elsevierStyleItalic">Lauraceae</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The &#945;-methylene-&#947;-butyrolactones can also be found as more simple structures in the <span class="elsevierStyleItalic">Liliaceae</span> &#40;tulipaline A&#41; and <span class="elsevierStyleItalic">Alstroemeraceae</span> families&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Asteraceae or Compositae Family</span><p id="par0030" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Asteraceae</span>&#47;<span class="elsevierStyleItalic">Compositae</span> family&#8212;also referred to as the aster&#44; daisy&#44; or sunflower family&#8212;comprises the second largest family of flowering plants in the world&#46; It includes more than 22<span class="elsevierStyleHsp" style=""></span>750 currently accepted species&#44; spread across 1620 genera and 12 subfamilies&#46; Over 200 species are important causes of contact dermatitis worldwide&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> This family presents a variety of edible plants&#44; such as lettuce&#44; chicory&#44; dandelion&#44; salsify&#44; sunflower&#44; scorzonera&#44; artichoke and yacon&#46; Many members are decorative flowers&#44; such as chrysanthemums&#44; gerbera&#44; calendula&#44; dendranthema&#44; dahlias&#44; and heleniums while many others are considered as common weeds&#46; Species such as arnica&#44; chamomile or feverfew are also used medicinally&#46; <span class="elsevierStyleItalic">Asteraceae</span>&#47;<span class="elsevierStyleItalic">Compositae</span> can be recognized by its inflorescence&#44; consisting of many tiny flowers clustered to form a flower head and subtended by an involucre&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">SQLs are the predominant allergens although other compounds such as epoxythymol-diesters and polyacetylenes may also be involved&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> SQLs are usually lipophilic&#44; and are often located in the liquid-soluble part &#40;oleoresin fraction&#41; of the leaf&#44; stem flower&#44; and possibly in polen&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4&#44;5</span></a> Although the mechanism of sensitization is unknown&#44; several possibilities have been proposed&#58; pollen or dry debris airborne transportation&#44; direct and&#47;or indirect contact with parts of the plant&#44; and allergen inhalation or ingestion&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Some peculiar cutaneous eruptions caused by the <span class="elsevierStyleItalic">Asteraceae</span>&#47;<span class="elsevierStyleItalic">Compositae</span> family have been described&#46; The pseudophotodermatitis pattern occurs almost exclusively in middle-aged men with a history of outdoor exposure but is rare in children and women&#44; although some studies have suggested an equal sex distribution&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Exposed areas of the face&#44; V of the neck&#44; hands&#44; and forearms are typically involved&#46; In addition&#44; areas not clearly exposed to sunlight such as retroauricular regions &#40;Wilkinson triangle&#41;&#44; eyelids&#44; nasolabial folds&#44; and the area beneath the chin are also involved&#44; allowing its differentiation from a true photo-related dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In hot regions&#44; during summer months dry dead plant material contributes to this airborne pattern of dermatitis&#46; In the US&#44; many <span class="elsevierStyleItalic">Compositae</span> weeds&#44; including ragweed &#40;<span class="elsevierStyleItalic">Ambrosia</span> species&#41;&#44; induce this clinical pattern often called <span class="elsevierStyleItalic">ragweed dermatitis</span><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or <span class="elsevierStyleItalic">weed dermatitis</span> in regions where other composite weeds predominate&#44; such as <span class="elsevierStyleItalic">Ambrosia</span>&#44; <span class="elsevierStyleItalic">Artemisia</span>&#44; <span class="elsevierStyleItalic">Helenium</span>&#44; and <span class="elsevierStyleItalic">Iva</span> species&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> A similar pattern was described in Australia where it is known as <span class="elsevierStyleItalic">bush dermatitis</span> because it is caused by species such as <span class="elsevierStyleItalic">Arctotheca</span>&#44; <span class="elsevierStyleItalic">Cassini</span>&#44; <span class="elsevierStyleItalic">Conyza</span>&#44; <span class="elsevierStyleItalic">Cynara</span>&#44; and <span class="elsevierStyleItalic">Dittrichi</span><a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> and also in India where it is called parthenium dermatitis&#44; where the culprit plant is <span class="elsevierStyleItalic">Parthenium hysterophorus</span> L<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Although these environmental conditions are not normally encountered in the temperate regions of Europe&#44; some isolated reports of airborne dermatitis &#40;<span class="elsevierStyleItalic">ragweed dermatitis</span>&#41; induced by feverfew &#40;<span class="elsevierStyleItalic">Tanacetum parthenium</span> &#91;<span class="elsevierStyleItalic">L</span>&#93; Sch&#46; Bip&#46;&#41;&#44; chicory and lettuce&#44; liverworts of the genus <span class="elsevierStyleItalic">Frullania</span>&#44; and chrysanthemums<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;6&#44;9</span></a> have exceptionally been reported&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">A second special clinical pattern has been described as atopic eczema-like eruption&#46; <span class="elsevierStyleItalic">Compositae</span> allergy may be manifested as a generalized eczematous eruption with primarily flexural involvement&#46; Although it most commonly occurs in elderly men in rural areas&#44; cases in children have also been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;15</span></a> An erythrodermic exfoliative pattern classically induced by the weed <span class="elsevierStyleItalic">Parthenium hysterophorus</span> L was also described&#46; This plant was accidentally introduced to the west coast of India in contaminated seed wheat&#46; Several thousands of cases of allergic contact dermatitis occurred&#44; some of them fatal&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Hand eczema is more frequent in women working in gardening after contact with weeds&#46; A palmar distribution often predominates&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Hand dermatitis is also associated with handling lettuce&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> Dermatitis confined to one or more localized areas such as facial dermatitis secondary to steaming chamomile tea or hand and arm dermatitis from herbal compresses<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> has rarely been reported&#46; Oral swelling&#44; perianal pruritus and dermatitis of the trunk and arms were described in a sensitized patient who drank chamomile tea&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Stomatitis and throat swelling have occurred in some patients after eating lettuce and endivia&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In one single patient erythema multiforme was reported to develop after patch testing&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A rare chronic and disabling eccematous photodermatosis known as chronic actinic dermatitis &#40;CAD&#41;&#44; photosensitive dermatitis&#44; or actinic reticuloid&#44; has been linked to the ACD to compositae&#46; A high incidence of ACD to one or more allergens has been found among patients with CAD&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and sesquiterpene lactones are commonly identified as allergens&#46; It is thought that about 20&#37; to 75&#37; of patients sensitized to <span class="elsevierStyleItalic">Asteracea</span> &#40;<span class="elsevierStyleItalic">Compositae</span>&#41; have some degree of photosensitivity&#46; Thus&#44; the progression of ACD to sesquiterpene lactones to CAD has been postulated&#44; but its origin is still unknown&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0060" class="elsevierStylePara elsevierViewall">No ideal patch testing material to study <span class="elsevierStyleItalic">Compositae</span>-induced dermatitis exists&#46; The <span class="elsevierStyleItalic">Compositae</span> family includes more than 1350 SQLs and almost 50&#37; of them are potential contact allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> SQLs with slight differences in molecular structure&#44; may cause true cross-reactions&#44; while identical SQLs from different species may be responsible of false cross-reactions&#46; SQLs are not exclusive to the Compositae family and frequently show cross-reactivity with other plant families&#46; Because the concentration of SQLs shows seasonal and geographic variations and as cross-reactions between different species are not complete&#44; when a patient is not tested with the relevant plants&#44; the diagnosis may be easily overlooked&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Fresh plants or plant extracts should not be used for patch testing because they may cause severe contact reactions and can also elicit active sensitization&#46; False positive irritant reactions or false negative results caused by low content of allergens &#40;degradation products&#41; can also occur&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In 1986&#44; Benezra and Epstein developed the sesquiterpene lactone mix &#40;SL mix&#41; a nonsensitizing and seldom irritant mixture of 3 of the 6 main structural groups of sesquiterpene lactones &#40;alantolactone&#44; costunolide and dehydrocostuslactone of eremophilanolide&#44; germacranolide&#44; and guaianolide group&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; This mixture can enable identification of about 60&#37; of SQL sensitization cases<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and was included in the European baseline series&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Other studies<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;25&#8211;27</span></a> reported different percentages&#44; which can partly be explained by phytogeographical variations and the diversity of SQL structures&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> An alternative preparation&#44; the Compositae mix&#44; based on a mixture of plant extracts &#40;arnica&#44; yarrow&#44; tansy&#44; German chamomile&#44; and feverfew&#41;&#44; detects a higher proportion of the cases&#59; however&#44; it may be irritant and cause patch test sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Dandelion and feverfew extracts&#44; together or individually&#44; also appear to be more useful than the SL mix&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> Other blends have been proposed&#44; such as a mixture of <span class="elsevierStyleItalic">Achillea millefolium</span> L&#44; <span class="elsevierStyleItalic">Chamaemelum nobile</span> All&#44; <span class="elsevierStyleItalic">Helianthus anuus</span> L&#44; <span class="elsevierStyleItalic">Tagetes minuta</span> L&#44; and <span class="elsevierStyleItalic">Tanacetum vulgare</span> L as well as extracts mixtures of arnica&#44; German chamomile&#44; feverfew&#44; tansy&#44; and yarrow&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Jubulaceae</span> Family &#40;Liverworts&#41;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Liverworts are nonvascular plants with a bryophyte life cycle&#46; They comprise 4 genera&#58; <span class="elsevierStyleItalic">Frullania</span> accounts for nearly 800 species and <span class="elsevierStyleItalic">Jubula</span> for 15&#44; whereas <span class="elsevierStyleItalic">Steerea</span> and <span class="elsevierStyleItalic">Neohattoria</span> are both montypic&#46; These plants are often epiphytes growing on trunks and branches of trees or shrubs&#46; They are found throughout the world and are common in tropical and subtropical regions but rare in frigid climates&#46; They are often resistant to desiccation and direct light&#46; <span class="elsevierStyleItalic">Jubula</span> species are largely confined to damp shaded rock surfaces&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">At least 11 species of <span class="elsevierStyleItalic">Frullania</span> have been described as responsible for allergic contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a><span class="elsevierStyleItalic">Frullania dilatata</span> &#40;L&#41; Dum and <span class="elsevierStyleItalic">Frulanina tamarisci</span> &#40;L&#41; Dum have been frequently implicated in Europe&#46; Cases of allergic contact dermatitis were also described in British Columbia &#40;Canada&#41;&#44; the Pacific North-West of the United States&#44; and in the South-West of France&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The most important allergen is frullanolide&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#8211;35</span></a> an &#945;-methylene-&#947;-butyrolactone sesquiterpene from the eudesmanolide structural group&#46; Other &#945;-methylene-&#947;-butyrolactones have been reported as sensitizers such as oxyfrullanolide 5&#44; <span class="elsevierStyleItalic">cis</span>-b-cycloscotunolide 6&#44; and eremofrullanolide 7&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#8211;37</span></a><span class="elsevierStyleItalic">Frullania dilatata</span> &#40;L&#41; Dum contains exclusively the <span class="elsevierStyleSmallCaps">d</span>- or &#40;&#43;&#41;-enantiomer of frullanolide while <span class="elsevierStyleItalic">Frullania tamarisci</span> &#40;L&#41; Dum exclusively yields the <span class="elsevierStyleSmallCaps">l</span>- or &#40;&#8722;&#41;-enantiomer&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Both enantiomers are sensitizers&#44; and in guinea pigs the stereospecificity of sensitization to one enantiomer has been demonstrated<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Sensitization to Frullania can occur by direct handling of trees or by airborne contact through volatilization of its small particles&#44; especially during warm weather or by the action of chainsaws&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;35</span></a> Forest workers often suffer from <span class="elsevierStyleItalic">woodcutter&#39;s eczema</span> and domestic allergy can present in individuals who use lobe-leaved trees as firewood&#46; Exposed areas of skin are typically affected&#44; with an <span class="elsevierStyleItalic">airborne</span> pattern on the face and the V of the neck&#46; This clinical pattern can mimic a photosensitivity pattern but it involves areas with little photoexposure such as the eyelids and nasolabial folds&#46; The hands may become edematous&#44; with involvement of finger webs but often sparing of the palms&#46; Exceptional involvement of the genitalia and intertriginous folds has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0100" class="elsevierStylePara elsevierViewall">Testing the patient with small pieces of <span class="elsevierStyleItalic">Frullania</span> is associated with a high risk of active sensitization&#46; The SQL mix only detects about 1&#37; of allergic reactions to <span class="elsevierStyleItalic">Frullania</span>&#46; The frullanolide mix&#44; a racemic mixture of &#40;&#43;&#41;- and &#40;&#8722;&#41;-frullanolide at 0&#46;01&#37;&#44; 0&#46;033&#37; and 0&#46;1&#37; in petrolatum<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> is a safe and nonsensitizing test&#44; but only shows 0&#46;35&#37; of positive reactions&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Although testing the patient with small pieces of <span class="elsevierStyleItalic">Frullania</span> is associated with a high risk of active sensitization&#44; it could be used if there is high clinical suspicion&#46; Frullanolide mix&#44; a racemic mixture of &#40;&#43;&#41;- and &#40;&#8722;&#41;-frullanolide at 0&#46;01&#37;&#44; 0&#46;033&#37; and 0&#46;1&#37; in petrolatum<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> has been used in several clinical trials proving to be a safe and nonsensitizing test&#44; but with a lower sensitivity than the SQL mix&#46; Therefore the allergen of choice in these cases is SQL mix&#44; even though it only detects 1&#37; of the allergic reactions to <span class="elsevierStyleItalic">Frullania</span>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cross-reactions with botanically unrelated plants that contain similar allergens&#44; eg <span class="elsevierStyleItalic">Laurus nobilis</span> L&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a><span class="elsevierStyleItalic">Magnolia grandiflora</span> L&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> and several <span class="elsevierStyleItalic">Compositae</span> may also occur&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">32&#44;41&#44;42</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Liliaceae</span><p id="par0115" class="elsevierStylePara elsevierViewall">The tulip genus which comprises 109 species of showy flowers is the most important genus of the <span class="elsevierStyleItalic">Liliaceae</span> family&#46; A number of species and many hybrid cultivars are grown in gardens&#44; used as pot plants&#44; or displayed as freshly cut flowers&#46; Most cultivars of tulip are derived from <span class="elsevierStyleItalic">Tulipa gesneriana</span>&#46; Professional bulb growers&#44; bulb collectors&#44; sorters&#44; and packers are particularly at risk of contact dermatitis&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Tulip bulbs contain several glucosides including tuliposides A and B&#44; which are weakly allergenic but are rapidly hydrolysed to tulipalin A and B&#46; Tulipalin A appears to be the main sensitizer in clinical practice<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> although tulipalin B also causes sensitization in guinea pigs<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Flowers&#44; leaves and stems possess higher concentrations of tuliposide A than the bulbs&#59; but sensitivity can develop from contact with any portion of the plant&#44; although most of the cases occur in bulb growers who are continuously handling the bulbs&#46; Contact with airborne allergens&#44; although infrequent has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The most common presentation is a combined allergic and irritant hand dermatitis known as <span class="elsevierStyleItalic">tulip fingers</span>&#46; It is characterized by painful&#44; subungual and periungual erythematosquamous&#44; sometimes erosive lesions involving the fingertips&#44; particularly the first and second fingers of the dominant hand&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> There may be fissures&#44; suppuration&#44; and hyperkeratosis&#46; The dermatitis may extend to the adjacent skin and rarely may involve distant areas or even give rise to a diffuse dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;47</span></a> The dust in tulip sheds may induce conjunctivitis&#44; rhinitis and asthma&#46; Reaginic responses to tulip antigens can also occur&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Alstroemeriaceae</span><p id="par0130" class="elsevierStylePara elsevierViewall">These species have a cluster of tuberous roots and produce leafy stems&#44; bearing one to several brightly colored flowers&#46; Several species are found in special collections and only 2 species are widely distributed and produced&#58; <span class="elsevierStyleItalic">Alstroemeria aurantiaca</span> D Don&#44; with orange flowers&#44; which grows as a border plant&#44; particularly in cottage gardens&#44; and <span class="elsevierStyleItalic">Alstroemeria ligtu</span> &#40;Peruvian lilies&#41; which give rise to numerous colors&#44; mostly in shades of lilac and pink&#44; with darker veins and mottling on the petals &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; They grow in Holland&#44; South America&#44; USA and Australia&#46; Tulipalin A&#44; the same allergen of the <span class="elsevierStyleItalic">Liliaceae</span> family&#44; is the main responsible sensitizer and is found mainly in the petals and stem&#46; The rate of sensitization for tulipalin A can exceed 50&#37; in workers on <span class="elsevierStyleItalic">Alstroemeria</span> plantations&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Dermatitis most commonly affects florist who strip off the leaves manually and are therefore exposed to the broken plant with a high risk of allergic contact dermatitis&#46; The lesions&#44; in contrast to tulip finger dermatitis&#44; can be more severe and tend to involve the fingertips of all digits of both hands&#46; Occasionally&#44; the clinical pattern can be very similar to that produced by the garlic clove &#40;but in a bilateral and symmetric distribution&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> Workers who cut the flowers often show palm eczema&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">50&#8211;55</span></a> Airborne dermatitis<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">56</span></a> and post-inflammatory depigmentation have rarely been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">57</span></a> False positive responses due to a primary irritant reactions may also occur&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a></p></span></span></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch testing Liliaceae and Alstroemeriaceae</span><p id="par0140" class="elsevierStylePara elsevierViewall">Patch testing with short ether extract of the leaves and petals as well as direct testing with them is not recommended because of the high risk of active sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> Since pure tulip allergen is not readily available&#44; patch tests may be performed with outermost bulb scales&#44; after removal of the brown skin&#46; To obviate dependence on seasonal supplies&#44; extracts may be prepared from bulbs which have been tested for allergenicity&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Several ways of performing patch testing have been recommended&#46; A 96&#37; ethanol extract of tulip bulbs or an extract prepared by shaking fresh bulbs for 90<span class="elsevierStyleHsp" style=""></span>min in acetone &#40;80&#37; in water&#41; using 1&#37; of this extract in 70&#37; ethanol was recommended by Hjorth et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> A methanol extract of the fresh petal or leaf&#47;stem material in petrolatum at a 0&#46;001&#37; concentration was recommended by Hausen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> A 6-tuliposide A at 0&#46;01&#37; or an &#945;-methylene-&#947;-butyrolactone at 0&#46;0001&#37; in ethanol was proposed by Santucci et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Patients with allergic contact dermatitis to <span class="elsevierStyleItalic">Alstroemeria</span> generally cross-react with tulip extracts&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">57&#44;60</span></a> No cross-reactions between the sesquiterpene lactones and tulipalin A have been reported &#40;even though both contain an &#945;-methylene-&#947;-butyrolactone in the lactone ring<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">61</span></a>&#41;&#46;</p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Phenol and Derivates</span><p id="par0155" class="elsevierStylePara elsevierViewall">This is a group of mono- or dihydroxybenzene derivatives of phenol&#44; catechol&#44; resorcinol&#44; or salicylic acid with a long alkyl or alkenyl carbon side chain&#46; Mixtures of catechols with alk&#40;en&#41;yl side chains are also known as urushiol and are the main allergens in the toxicodendron genus&#46; Phenols&#44; resorcinols&#44; and salicylic acid with alk&#40;en&#41;yl side chains are called cardanol&#44; grevillol&#44; and ginkgolic acid&#44; respectively and are the main allergic contact sensitizers in the <span class="elsevierStyleItalic">Anacardiaceae</span>&#44; <span class="elsevierStyleItalic">Gingkgoaceae</span> and <span class="elsevierStyleItalic">Proteaceae</span> family respectively&#46; They are very good examples of prohaptens&#44; that is&#44; nonelectrophilic substances which have to undergo a chemical transformation such as oxidation to yield the active substance&#46; Thus&#44; many phenolic derivatives are metabolized into ortho-quinones or para-quinones&#44; which are strong electrophiles<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">62</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Anacardiaceae</span><p id="par0160" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Anacardiaceae</span> family also known as the <span class="elsevierStyleItalic">cashew family</span> or the <span class="elsevierStyleItalic">sumac family</span> is a very broad family of flowering plants&#46; This family includes about 70 genera and 650 species of evergreen deciduous trees&#44; shrubs&#44; and woody vines&#46; These plants are native to tropical and subtropical areas of the world&#44; but some species are also found in temperate regions&#46; Members of the <span class="elsevierStyleItalic">Anacardiaceae</span> plant family that are important in dermatology include&#58; the <span class="elsevierStyleItalic">Toxicoendron</span> genus&#44; &#40;common poison ivy&#44; poison oak&#44; poison sumac&#41;&#44; <span class="elsevierStyleItalic">Mangifera indica</span> L &#40;mango&#41;&#44; <span class="elsevierStyleItalic">Toxicodendron vernicifluum</span> &#40;lacquer tree&#41;&#44; and <span class="elsevierStyleItalic">Anacardium occidentale</span> L &#40;cashew nut&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Toxicodendron Genus</span><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Toxicodendron</span> is the most allergenic genus of this family&#46; It includes poison ivy &#40;<span class="elsevierStyleItalic">Toxicodendron radicans</span> Kuntze and subspecies such as <span class="elsevierStyleItalic">T radicans</span> Kuntze var&#44; rydbergii Erskine&#41;&#44; poison oak &#40;<span class="elsevierStyleItalic">Toxicodendron diversilobum</span> Greene and <span class="elsevierStyleItalic">Toxicodendron toxicarium</span> Gillis&#41;&#44; and poison sumac &#40;<span class="elsevierStyleItalic">Toxicodendron striatum</span> Kuntze&#44; <span class="elsevierStyleItalic">T vernix</span> Kuntze&#41; complexes&#46; These genera are the main causes of allergic contact dermatitis in the United States and approximately 50&#37;&#8211;70&#37; of the population seems to be sensitized&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">63</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Occupational contact dermatitis to poison ivy is an important cause of occupational disability and represents a significant cost for the health system in the United States&#46; Wilderness&#44; rural and outdoor activities as well as outdoor occupations related to agriculture&#44; forestry&#44; and fire fighting&#44; bring with them a high risk of sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Poison ivy dermatitis is generally unknown in Europe&#46; The plants can be recognized by their compound leaves&#44; with 3 or more smaller leaflets&#46; Flowers and fruit arise in the angle between the leaf and the twig&#46; The leaf stalk also leaves a &#8220;U&#8221;- or &#8220;V&#8221;-shaped scar after it falls off&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">65</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">The pentadecylcatechols&#44; consisting of 1&#44; 2-dihydroxy benzenes with a 15-atom side chain at position 3 &#40;3-pentadecylcatechol&#41;&#44; also called urushiols&#44; are the sensitizers in <span class="elsevierStyleItalic">Toxicodendron</span> plants&#46; Urushiols are colorless or slightly<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a> yellow in their natural state&#44; but they oxidize&#44; polymerize and turn black when exposed to air&#46; Urushiol is found in the stems&#44; roots&#44; leaves&#44; and skin of the fruits of these plants and also on fomites&#44; where it retains its antigenic potential in the dry state indefinitely&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">66</span></a> Young leaves contain greater amounts of urushiol than the older ones&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">67</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Contact dermatitis primarily results from direct contact with the oleoresin obtained from a portion of a bruised or injured plant&#46; However&#44; contamination and re-exposure to the antigen may occur&#44; with the most important reservoirs being the fingernails&#44; clothing&#44; animals&#44; garden tools&#44; or firewood&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;68</span></a> Contact dermatitis usually appears within 2&#8211;4 days&#59; however it may appear as late as 2 weeks after the moment of contact&#46; It is characterized by intense pruritus and an erythematous reaction followed by the appearance of multiple papules and vesiculo-bullous lesions in a linear distribution &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; The face&#44; neck&#44; and genitalia are commonly affected and usually show intense edema&#46; The dermatitis has a self-limiting course&#44; lasting approximately 1&#8211;2 weeks&#44; but it can last up to 6 weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">64</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Other clinical presentations include erythema multiforme-like reactions&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">69</span></a> exanthematous and urticarial eruptions&#44; and even renal damage that may occur after accidental&#44; medicinal or alimentary ingestion&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">70&#44;71</span></a> Stomatitis and anal itch have been described after chewing the leaves or secondary to hyposensitization treatments&#46; <span class="elsevierStyleItalic">Black spot poison ivy dermatitis</span> is a rare and very special condition&#44; consisting of asymptomatic black lesions on the skin that cannot be washed off&#46; These lesions are followed by subsequent pruritic papules and have been mistaken for melanoma in several cases&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">72</span></a></p><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0195" class="elsevierStylePara elsevierViewall">Plant oleoresin diluted 1&#58;10 in acetone may be used for patch testing&#46; The pure synthetic antigen&#44; 3-pentadecylcatechol&#44; may also be used in various dilutions&#44; but is not readily available and probably does not contain all the antigenic materials of the poison ivy oleoresin&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">73</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Mango &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Mangifera indica</span></span><span class="elsevierStyleBold">L&#41;</span> is a fruit found in eastern Asia&#44; Burma and regions of India&#46; It has been widely cultivated throughout the world&#44; particularly in Hawaii&#44; Florida&#44; Mexico&#44; and Central America&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The responsible allergens are 3 resorcinols derivatives&#58; heptadecadienylresorcinol&#44; heptadecenylresorcinol and pentadecylresorcinol&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a> They are found in the stems&#44; leaves&#44; and peel&#44; but not in fruit juice&#44; which may be drunk by sensitized persons&#46; Allergic contact dermatitis occurs after touching the fruit with the peel intact&#46; Dermatitis can be limited to vesicles at the commissures of the mouth but it usually affects the entire perioral area&#44; and it may affect the buccal mucosa and face&#46; The hands can carry the allergen to the eyes and neck&#44; and these eruptions sometimes become generalized&#46; Some rare cases of systemic contact dermatitis have also been reported after ingestion by people previously sensitized by contact&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">75</span></a> Climbing the tree can result in allergic dermatitis due to the content of urushiol in the leaves and bark of the tree&#46; Symptoms of wheezing have also been reported&#44; presumably due to an immediate hypersensitivity reaction&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patch test&#58;</span></span> Leaves and bark but not fruit extracts could be used to demonstrate contact allergy&#46; There is no standardized procedure and a possible active sensitization should be taken into account&#46; Cross hypersensitivity between the allergens of mango and the <span class="elsevierStyleItalic">Anacardiaceae</span> and <span class="elsevierStyleItalic">Gingkoaceae</span> families has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">74</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Cashew nut tree &#40;</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Anacardium occidentale</span></span><span class="elsevierStyleBold">L&#41;</span> is a small tree native to northeastern Brazil but it is now cultivated in most tropical countries&#46; The tree produces a kidney shaped fruit &#40;cashew nut&#41; that grows at the end of the accessory fruit called the cashew apple&#46; The cashew nuts are composed of an internal kernel and a double-layered outer shell&#46; Between the 2 layers of the shell irritant and allergenic oil is found&#46; The nuts are used in the food industry as a substitute for almonds&#46; The oil obtained from the nut shells &#40;cashew nut shell liquid&#41; is used in manufacturing various products&#46; Friction dust is used for brake linings and clutch facings&#44; epoxy resins&#44; paints&#44; varnishes&#44; and foundry core oil as well as insecticides to control mosquito larvae and schistosomiasis vectors&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Anacardic acid &#40;a mixture of 2-carboxyl-3-alkyl phenols&#41; and cardol &#40;a mixture of 5-alkyl resorcinols such as 5-pentadecadienylresorcinol&#41;&#44; are the most important allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> Any part of the cashew tree&#44; except the roasted nut&#44; can induce dermatitis<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">76</span></a> although allergic contact dermatitis is generally caused by direct contact with the oil&#46; Topical contact with the oil can induce the same type of reaction seen in individuals exposed to poison ivy&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">77</span></a> Oral ingestion can lead to stomatitis and pruritus ani<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">78</span></a> and even to widespread dermatitis with flexural accentuation&#44; typically distributed on the extremities&#44; groin&#44; and buttocks&#46; This eruption occurs generally from 1 to 3 days after ingestion of raw cashew nuts contaminated with allergenic oil&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">79</span></a> Dermatitis resulting from sensitized children handling and playing with the nuts has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">80</span></a> Improperly shelled cashew nuts caused an outbreak of perioral and more generalized dermatitis in Pennsylvania&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">81</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patch test&#58;</span></span> There is no standardized patch test recommendation for cashew nut oil&#44; although a 30&#37; concentration has been occasionally used&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">82</span></a> The occurrence of cross-sensitivity between the urushiols of the poison ivy &#40;<span class="elsevierStyleItalic">Toxicodendron radicans</span> Kuntze&#41; and the cashew nut allergen has long been recognized&#46;<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">83&#44;84</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Toxicodendron verniciflua</span></span><span class="elsevierStyleBold">Stokes &#40;Japanese lacquer tree&#41;</span> is an indigenous tree of Japan and China&#46; Its trunk yields a milky juice&#44; which on contact with air darkens and becomes a durable lacquer used as varnish on furniture&#44; floors&#44; tea pots&#44; rifle stocks&#44; canes&#44; wooden toilet seats&#44; and ornaments&#46; All plant parts as well as lacquered objects can trigger an allergic phytodermatitis&#44; even after many years&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">85</span></a> The allergens are also urushiols&#44; but they differ from poison ivy&#39;s by the positions of the double bonds&#44; with the 15-carbon side chain at positions 8&#44; 11 and 13 instead of at positions 8&#44; 11 and 14 in poison ivy&#39;s urushiols&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Clinical features are variable depending on the mode and sites of contact&#44; and the degree of sensitivity&#46; The most common is an inflammatory reaction and erythema at the site of contact with the varnish&#59; however more extensive persistent and severe cases have been described&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">87</span></a> Dermatitis of the face induced by burning logs from lacquer trees has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">88</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patch test&#58;</span></span> Previous experience is scarce and there is no special protocol&#46; General recommendation for plants should be followed&#46; Patients allergic to poison ivy usually cross-react to Japanese lacquer tree urushiol&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">86</span></a></p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ginkgoaceae Family</span><p id="par0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ginkgo biloba</span> L&#44; the ginkgo tree&#44; is the only representative of this family and is regarded as one of the world&#39;s oldest surviving tree species&#46; Originating in southeastern China 200 million years ago&#44; it was introduced to Europe during the early 18th century&#44; and it now grows in temperate regions throughout the world&#46; Contact dermatitis from the ginkgo tree is not due to its leaves but to its malodorous fruit exclusively borne in female trees&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The alkylphenols &#40;anacardic or ginkgolic acids&#44; cardols&#44; and cardanols&#41; have been identified as the potential allergens&#46; Ginkgolic acid 1&#44; the most important allergen&#44; is found mainly in the fruit&#44; but it can also be detected in Ginkgo leaves&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">89</span></a> Allergic reactions seem to occur only with open fruit extruding pulp&#46; Handling the intact fruit is not harmful to sensitized persons&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">90</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Contact dermatitis occurs especially in East Asians&#44; who enjoy eating the <span class="elsevierStyleItalic">nuts</span> &#40;seed kernels&#41;&#44; and manipulate the seeds to remove the fleshy pulp and obtain the kernels&#46; Pruritic&#44; edematous and erythematous plaques with papules or vesicles appear on the hands&#44; face&#44; arms&#44; and anywhere the seed pulp is spread&#46; Ingestion may also cause stomatitis and anal pruritus&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a> While reactions are uncommon in the West&#44; a small epidemic occurred among a group of schoolgirls who stomped upon fallen fruit&#46; They developed a streaky&#44; vesicular dermatitis on their legs&#44; similar to that of poison ivy contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">92</span></a></p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0260" class="elsevierStylePara elsevierViewall">Ginkgo fruit pulp 1&#8211;10 in acetone is recommended for patch testing<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">91</span></a> as it avoids irritation at this concentration&#44; whereas the fruit pulp itself is strongly irritant&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">92&#44;93</span></a></p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Proteaceae Family</span><p id="par0265" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Proteaceae</span> family comprises 1050 species in 62 genera and is found predominantly in the tropics&#46; The most important genus of this family is the genus <span class="elsevierStyleItalic">Grevillea</span> which is made up of approximately 360 species&#44; most native to Australia&#44; where they range from low shrubs to forest trees&#46; A number of different <span class="elsevierStyleItalic">Grevillea</span> species and hybrids&#44; especially of the eugrevillea section&#44; appear to cause allergic contact dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">94</span></a> The most important species are <span class="elsevierStyleItalic">Grevillea robusta</span> Cunn&#44; also known as silky oak or silver oak and Grevillea x Robyn Gordon&#44; a natural hybrid between <span class="elsevierStyleItalic">Grevillea banksii</span> R Br and <span class="elsevierStyleItalic">Grevillea bipinnatifida</span> R Br which is perhaps the most important plant in this genus from a human health perspective and probably represents the most common cause of plant-induced dermatitis in Australia&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">95</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">The allergens appear to differ between the species and their hybrids&#46; The allergens of <span class="elsevierStyleItalic">G robusta</span> are 5-tridecylresorcinol &#40;grevillol&#41;&#44; 5-pentadecylresorcinol and 5-pentadecenylyresorcinol&#46; <span class="elsevierStyleItalic">Grevillea banksii</span> R Br shows the resorcinol derivative pentadecylresorcinol&#46; Other long carbon chain alkenyl resorcinols include the haptens in Grevillea Robyn Gordon&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">96</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Contact with the wild and cultivated tree&#44; and especially with the flowers&#44; as well as with objects made with its wood&#44; induces a bullous eruption similar to that caused by poison ivy and poison oak &#40;<span class="elsevierStyleItalic">Toxicodendron</span> sp&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">97</span></a> Grevillea poisoning was described among men who cut the fallen trees and developed a severe bullous contact reaction&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">98</span></a></p><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0280" class="elsevierStylePara elsevierViewall">The 0&#46;1&#37; ethanol extract of the <span class="elsevierStyleItalic">Grevillea</span> flower in petrolatum has been used for patch testing&#46; Because the allergens of Grevillea are related chemically to those of the <span class="elsevierStyleItalic">Toxicodendron</span> genus&#44; cross-sensitivity can be seen&#46; Patients who are known to be sensitive to <span class="elsevierStyleItalic">Toxicodendron</span> should avoid <span class="elsevierStyleItalic">Grevillea</span> species contact and vice versa&#46;</p></span></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Quinones</span><p id="par0285" class="elsevierStylePara elsevierViewall">This is a group of &#40;poly&#41;cyclic organic compounds with at least one 6-membered unsaturated ring to which 2 oxygen atoms are bound as carbonyl groups &#40;<span class="elsevierStyleGlyphsbnd"></span>C&#61;O&#41;&#46; They represent oxidized forms of ortho- or para-diphenol&#46; They are strong electrophilic substances that easily react with the nucleophilic groups of proteins&#44; acting in this case as strong haptens&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">The most important allergens are benzoquinones or naphthoquinones&#46; At high concentrations&#44; they are primary irritants&#46; They are the main sensitizers present in tropical woods as well as in some families of plants&#44; of which the <span class="elsevierStyleItalic">Primulaceae</span> family is the most important&#46;</p><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Primulaceae</span><p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Primulaceae</span> is a broad family of flowering plants with about 1000 species in 24 genera&#46; Despite the large number of specimens and cosmopolitan distribution only <span class="elsevierStyleItalic">Primula</span> sp presents a common dermatological hazard&#46; Primula was exported from China to England in the year 1880&#46; Their beautiful flowers&#44; long flowering period&#44; and their ease of care led to a quick introduction into Europe although success was more limited in America&#46; For a number of years <span class="elsevierStyleItalic">Primula obconica</span> Hanse was the most common cause of plant-induced contact dermatitis in Europe&#59; however since the introduction of primin-free <span class="elsevierStyleItalic">P obconica</span> Hanse into the European market&#44; its incidence has declined&#46;<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">99</span></a> Other species of Primula are reported to be allergenic&#44; such as <span class="elsevierStyleItalic">P auricula</span> L&#44; <span class="elsevierStyleItalic">P denticulata</span> Sm and <span class="elsevierStyleItalic">P vulgaris</span> Huds&#44; and vary widely in their allergen content&#46;<a class="elsevierStyleCrossRefs" href="#bib0500"><span class="elsevierStyleSup">100&#8211;102</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">The primin &#40;2-methoxy-6-<span class="elsevierStyleItalic">n</span>-pentyl-<span class="elsevierStyleItalic">p</span>-benzoquinone&#41; is the major allergen of primrose dermatitis&#44; a quinone formed by oxidation of its biosynthetic precursor miconidin &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#59; however other allergens such as primetin &#40;a flavone&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">103</span></a> and miconidin &#40;2-methoxy-6-pentyl-1&#44;4-dihydroxybenzene&#41;<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">104</span></a> have also been suggested&#46; Primin is contained in the terminal cells of the microscopic glandular hairs on the surface of the leaves&#44; stems&#44; and flowers&#46; The allergen content of the plant varies considerably&#44; depending on season&#44; the number hours of sunshine&#44; the method of cultivation&#44; and the horticultural variety&#44; which explains the striking seasonal variation in its allergenicity&#44; greatest in summer and lower in the winter months&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0305" class="elsevierStylePara elsevierViewall">Sensitization to <span class="elsevierStyleItalic">P obconica</span> Hance can occur by direct contact with plants or by indirect contact&#44; e&#46;g&#46; via hand-shakes&#44; door handles&#44; or paper fibers&#46; Primin can be released through pollen or small dust particles&#44; causing an airborne allergic contact dermatitis in some sensitized patients&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">105</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">Dermatitis most commonly occurs in elderly women and a variety of cutaneous reactions have been described&#58; facial dermatitis&#44; alone or combined with limb dermatitis and hand dermatitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">42&#44;106&#44;107</span></a> Eruptions vary from linear to erythematous papules&#44; vesicles and bullae&#44; and to lesions resembling erythema-multiforme and lichen planus&#46;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">108&#8211;113</span></a> A few cases of airborne dermatitis<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">111&#44;114&#44;115</span></a> and facial eruption mimicking herpes simplex<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">116</span></a> as well as one case presenting as vitiligo<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">117</span></a> have also been reported&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">In order to reduce the incidence of allergic primin contact dermatitis&#44; a primin-free <span class="elsevierStyleItalic">Primula obconica</span> Hance was developed&#46;<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">118</span></a> Although its introduction reduced significantly the cases related to cultivars&#44; it still remains as an important contact allergen&#44; justifying its maintenance in the standard series&#46;</p><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0320" class="elsevierStylePara elsevierViewall">Primin 0&#46;01&#37; in petrolatum is included in the European baseline series&#46;</p></span></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Terpenes</span><p id="par0325" class="elsevierStylePara elsevierViewall">The terpenes represent a large class of hydrocarbon compounds&#44; produced by a wide variety of plants&#44; particularly conifers&#46; They are the main components of most of the essential oils&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">The terpenes are composed biosynthetically of units of isoprene&#44; which has the molecular formula C<span class="elsevierStyleInf">5</span>H<span class="elsevierStyleInf">8</span>&#46; Chemically&#44; terpenes are multiples of isoprene units&#44; &#40;C<span class="elsevierStyleInf">5</span>H<span class="elsevierStyleInf">8</span>&#41;<span class="elsevierStyleInf"><span class="elsevierStyleItalic">n</span></span> where <span class="elsevierStyleItalic">n</span> is the number of linked units&#46; The terpenes are classified by the number of isoprene units included in the complete molecule&#58; hemiterpenes &#40;a single isoprene unit&#41;&#44; monoterpenes &#40;2 isoprene units&#44; e&#46;g&#46; limonene&#44; pinene and 3-carene&#41;&#44; sesquiterpenes &#40;3 isoprene units&#41;&#44; diterpenes &#40;4 isoprene units&#41;&#44; and so on&#46; Terpenes by themselves are not sensitizers because they lack the electrophilic properties necessary to bind covalently to skin proteins&#46; They act as prehaptens and need to undergo chemical transformation in order to become true haptens&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">Turpentine&#44; a variable mixture of numerous terpenoid compounds&#44; is one of the most important terpene representatives&#46; Turpentine is obtained from the oleoresin of various pine species&#46; Turpentine can easily auto oxidize into hydroperoxides &#40;3-carene&#44; &#945;-pinene and &#946;-pinene&#41; which later yield ketones and aldehydes&#44; both of which are excellent electrophilic substances&#46; Another important example of sensitizing terpene is colophony&#46; Colophony is the residue left after distilling off the volatile oil from the oleoresin obtained from <span class="elsevierStyleItalic">Pinus sylvestris</span> L and other species &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Rutaceae</span><p id="par0340" class="elsevierStylePara elsevierViewall">This family includes 900 species in 150 genera which are found in tropical and temperate regions especially in southern Africa and Australia&#46; It is an important cause of phototoxic reactions although some cases of ACD to the citrus genus have also been reported&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Citrus Genus</span><p id="par0345" class="elsevierStylePara elsevierViewall">Twelve species are native to southern China&#44; south-east Asia and Indo-Malaysia&#59; however&#44; with the aim of achieving larger fruits&#44; with more juice&#44; better taste and lack of seeds&#44; numerous other species have emerged from various artificial crosses&#46; The most common species are <span class="elsevierStyleItalic">Citrus sinensis</span> L &#40;orange&#41;&#44; <span class="elsevierStyleItalic">Citrus aurantium</span> L &#40;Bergamot&#41;&#44; and <span class="elsevierStyleItalic">Citrus Limon</span> L Burm&#46; Fil&#46; &#40;lemon&#41;&#46; Besides its use in the food industry&#44; citrus is used for aromatic oils in the flowers and fur&#44; in perfumery&#44; and in the manufacture of soaps and cosmetics&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis to citrus fruits is unusual and hand dermatitis has been described in food handlers&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">119</span></a> The potential sensitizers include geraniol&#44; citral and the hydroperoxide derivative of <span class="elsevierStyleSmallCaps">d</span>-limonene&#44;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">120</span></a> which are usually included in fragrances&#46; The mechanism of sensitization is currently an object of research&#46;</p><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0355" class="elsevierStylePara elsevierViewall">Oxidized limonene is available as a commercial allergen for patch testing at 3&#37; in petrolatum &#40;from Chemotechnique&#41;&#46; A multicenter study led by Ann Therese Karlberg from Gothenborg&#44; Sweden&#44; with oxidized limonene and linalol is currently being performed&#46; A recommended patch test is still unavailable&#46;</p></span></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Miscellaneous Structures</span><p id="par0360" class="elsevierStylePara elsevierViewall">Natural products such as disulfides &#40;<span class="elsevierStyleItalic">Alliaceae</span>&#41;&#44; isothiocyanates &#40;<span class="elsevierStyleItalic">Cruciferae</span>&#41; and polyacetylenic derivates &#40;<span class="elsevierStyleItalic">Araliaceae</span>&#44; <span class="elsevierStyleItalic">Apiaceae</span>&#41; are other types of natural products containing reactive functional groups which have been associated with skin allergies &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Disulfides</span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Alliaceae</span><p id="par0365" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Alliaceae</span> family members are widely distributed in temperate&#44; subtropical and warm regions throughout the world&#46; These species can be recognized easily by their characteristic garlic smell as well as their soft&#44; fleshy leaves&#46; The genus <span class="elsevierStyleItalic">Allium</span> is the most important genus in dermatology and includes many important vegetables such as garlic and onion&#46; Garlic is the main species involved in cases of allergic contact dermatitis&#46; Because of its multiple antibacterial&#44; choleretic&#44; spasmolytic&#44; and in particular proven anti-atherosclerotic effect&#44; the plant has been cultivated since ancient times in China&#44; India and Egypt&#44; and its healing effects are used as folk medicine nowadays in many countries&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">All parts of the plant&#44; when damaged&#44; release the potentially irritating and allergenic sap&#46; Diallyl disulfide&#44; allicin&#44; and allyl propyl disulfide have been identified as the principal low molecular weight allergens&#46;<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">121</span></a> Allergic contact dermatitis is generally considered as being caused by diallyl disulfide&#46;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">122</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">Occupational dermatitis has been frequently reported in the literature&#46; The typical occupational gesture of cutting the bulb&#44; which is held between the thumb and first&#47;second finger of the nondominant hand&#44; while the knife is held in the dominant hand leads to the characteristic distribution of hyperkeratotic eczema on the tips of the first 2 or 3 fingers of the nondominant hand and thumb of the dominant hand<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">123&#8211;127</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41;&#46; The hypersensitivity not always presents with this classical asymmetrical pulpitis&#44; but frequently also as hand eczema &#40;desquamation&#44; fissuring and hyperkeratosis&#41; involving the palm&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0380" class="elsevierStylePara elsevierViewall">Lesions at different locations from those of typical hand eczema have also been described&#44; reflecting a different pattern of exposure&#44; especially after use for medicinal purposes&#46;<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">128</span></a> Because of its sensitizing potential and the high degree of irritation &#40;especially under occlusion&#41;&#44; the use of garlic as a topical medicinal agent should be discouraged&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">Other less typical presentations attributed to garlic include a pemphigus vulgaris-like eruption&#44;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">123</span></a> cheilitis&#44;<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">122</span></a> a garlic induced systemic contact dermatitis&#44;<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">126&#44;129</span></a> cases of photodermatitis&#44;<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">130</span></a> and an occupational airborne ACD from garlic with concurrent type I allergy&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">131</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis to onion is less widely reported&#46; However&#44; patients with allergic contact dermatitis to onion can be cross-reactive to garlic&#46;<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">132</span></a></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0395" class="elsevierStylePara elsevierViewall">Patch test has been performed either with 50&#37; garlic&#47;onion in arachis oil<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">133</span></a> or diallyl disulfide 5&#37; pet<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">134</span></a> but actually 1&#37; in petrolatum &#40;Chemotechnique diagnostics<span class="elsevierStyleSup">&#174;</span>&#44; Malm&#246;&#44; Sweden&#41; is the recommended concentration to be used&#46;</p><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Isocyanates</span><p id="par0400" class="elsevierStylePara elsevierViewall">Isocyanates are a family of highly reactive&#44; low molecular weight compounds identified by the number of <span class="elsevierStyleGlyphsbnd"></span>NCO &#40;nitrogen&#8211;carbon&#8211;oxygen&#41; groups they contain&#46; Mono-isocyanates contain 1 group&#59; di-isocyanates &#40;used in polyurethane&#41; contain 2&#44; and so on&#46;</p><p id="par0405" class="elsevierStylePara elsevierViewall">Mono-isothiocyanates&#44; otherwise known as mustard-oils because they are characteristic of and were indeed first isolated from mustard plants &#40;<span class="elsevierStyleItalic">Cruciferae</span> family&#41;&#44; occur in a wide variety of higher plants&#44; but above all in the mustard family and its tropical counterpart&#44; the caper family&#46;</p><p id="par0410" class="elsevierStylePara elsevierViewall">Several species of this family yield in their leaves&#44; fruits&#44; seeds and root extracts glucosidic precursors &#40;glucosinolates&#41;&#44; which&#44; through enzymatic hydrolysis by an enzyme named myrosinase&#44; produce the isothiocyanates&#46; Naturally occurring isothiocyanates can be either saturated or unsaturated&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">135</span></a> Instauration of the &#946;&#44;&#947; carbons to the isothiocyanate nitrogen &#40;allyl and benzyl isothiocyanate&#41; may make the thiocayante more immunologically reactive&#46; Compounds with instauration at the &#946;&#44;&#945; positions&#44; such as phenylisothiocyanate&#44; are probably less immunologically reactive and have a greater potential for irritation&#46;</p></span></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Cruciferae</span> &#40;Cabbage or Mustard Family&#44; <span class="elsevierStyleItalic">Brassicaceae</span>&#41; and <span class="elsevierStyleItalic">Capparaceae</span> Family</span><p id="par0415" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Brassicacea</span> family contains about 3200 species in 375 genera&#46; It includes several important vegetables&#44; such as cabbage &#40;<span class="elsevierStyleItalic">Brassica oleracea</span> L&#41;&#44; cauliflower &#40;<span class="elsevierStyleItalic">B oleracea</span> L v botrytis&#41;&#44; radish &#40;<span class="elsevierStyleItalic">Raphanus sativus</span> L&#41;&#44; horse radish &#40;<span class="elsevierStyleItalic">Armoracia rusticana</span> P Gaertn&#44; B Mey&#44; and Scherb&#41;&#44; turnip &#40;<span class="elsevierStyleItalic">Brassica campestris</span> L&#41; and mustrard &#40;<span class="elsevierStyleItalic">Brassica nigra</span> &#91;L&#93; WDJ Koch&#41;&#46; The <span class="elsevierStyleItalic">Capparaceae</span>&#44; regarded as the tropical relative of the mustard family&#44; comprises some 650 species of small trees and shrubs in 30 genera&#46; The most important representative of this family is <span class="elsevierStyleItalic">Capparis spinosa</span> L&#44; or caper bush&#44; a shrub with grayish oval leaves and showy white-pink flowers with several prominent stamens&#46; It is better known for the edible bud and fruit which are usually consumed pickled&#46;</p><p id="par0420" class="elsevierStylePara elsevierViewall">Several species contain thioglucosides&#44; which are broken down enzymatically&#44; in the presence of water&#44; to isothiocyanates&#44; potent irritants&#44; which appear to be also the most important allergens&#46; Contact dermatitis from these plants can be both irritant and allergic&#44;<a class="elsevierStyleCrossRefs" href="#bib0680"><span class="elsevierStyleSup">136&#44;137</span></a> with a high potential irritant capacity&#46; Allergic contact dermatitis is rare&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis is more commonly seen in food handlers&#46; <span class="elsevierStyleItalic">Raphanus sativus</span> L induced an acute vesiculo-bullous dermatitis of both palms in a waitress who chopped them&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">135</span></a> Cabbages provoked occupational contact dermatitis<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">138</span></a> and cabbage juice can produce positive patch test reactions in patients with hand dermatitis suspected to have been caused by vegetables&#46;<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">139</span></a><span class="elsevierStyleItalic">Brassica nigra</span> induced an allergic contact dermatitis due to mustard powder in a salad maker<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">137</span></a> and <span class="elsevierStyleItalic">Brassica oleracea</span> v&#46; Botrytis &#40;cauliflower&#41; induced a hand eczema in a plant grower&#46;<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">140</span></a><span class="elsevierStyleItalic">Capparis spinosa</span> L induced an acute vesiculo-bullous allergic contact dermatitis in a woman who applied a wet compress of the minced leaves and fruits to her arm&#46;<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">141</span></a></p><p id="par0430" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patch test&#58;</span></span> Isothiocyanates present in these plants are usually primary irritants&#44; and they can be tested at a concentration of 0&#46;05&#37; in petrolatum&#46; As the irritancy of mustard oil tends to overshadow its allergic potential&#44; a positive patch test with mustard can be difficult to interpret&#46;<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">135</span></a></p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Polyacetylenic Derivates</span><p id="par0435" class="elsevierStylePara elsevierViewall">The polyacetylenes are a group of chemically reactive and biologically active compounds with a carbon-carbon triple bond or alkynyl functional group&#46; They can be found in 7 families of plants&#44; and the majority has been isolated from the closely related plant families <span class="elsevierStyleItalic">Araliaceae</span> and <span class="elsevierStyleItalic">Apiaceae</span>&#46; The polyacetylenic derivatives of the <span class="elsevierStyleItalic">Araliaceae</span> and <span class="elsevierStyleItalic">Apiaceae</span> are mostly the aliphatic C17-polyacetylenes of the falcarinol-type&#44; derived from oleic acid&#46;<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">142</span></a> They act as very reactive alkylating agents towards&#44; for example&#44; thiol groups in proteins&#44; forming hapten-protein complexes &#40;antigens&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0710"><span class="elsevierStyleSup">142&#44;143</span></a></p></span><span id="sec0165" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Araliaceae</span><p id="par0440" class="elsevierStylePara elsevierViewall">This family of some 700 species in 55 genera consists mostly of trees and shrubs&#44; but includes some twiners&#46; Most species occur in tropical regions&#44; particularly in Indo-Malaysia and tropical America&#46; Other species are native to temperate regions&#44; and some species have become widely distributed by horticulture and as houseplants&#46;</p><p id="par0445" class="elsevierStylePara elsevierViewall">Perhaps the best known temperate species is <span class="elsevierStyleItalic">Hedera helix</span> L&#44; common ivy&#46; The plants are native to Europe&#44; North Africa&#44; and Asia but are now grown in many other countries&#46; Three main subspecies are found in Europe&#44; namely helix &#40;English ivy&#41;&#44; canariensis &#40;Canary Island ivy&#41;&#44; and poetarum&#46; They are a family of evergreen climbing plants usually found scrambling over rocks and through hedges or climbing up trees or walls &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46;</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia><p id="par0450" class="elsevierStylePara elsevierViewall">Falcarinol &#40;heptadeca-1&#44;9-diene-4&#44;6-diyne-3-ol&#41; and didehydrofalcarinol are the most important allergens&#46; They are detected in stalks&#44; leaves&#44; and roots and may cause both irritant and allergic contact dermatitis&#46; Falcarinol seems to be the stronger sensitizer and concentration and the ratio didehydrofalcarinol&#58;falcarinol seems to vary considerably&#44; depending on climate and other conditions of growth&#46;<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">144</span></a>Sensitization can occur through contact with plants on climbing trees covered by them or by pruning or handling the plants in an occupational setting&#46; Any site in contact with the plant may be affected and dermatitis commonly begins with an itching and erythema that in a few days develops into a vesicular eczema &#40;<a class="elsevierStyleCrossRef" href="#fig0065">Fig&#46; 13</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">145</span></a> The most frequently affected sites are hands and forearms followed by involvement of the face and neck&#59; however&#44; involvement of trunk and legs as well as widespread dermatitis has also been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0725"><span class="elsevierStyleSup">145&#44;146</span></a> Urticarial-like dermatitis has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">147</span></a> Immediate&#44; possibly allergic&#44; reactions from common ivy causing rhinitis and asthma have rarely been reported&#44; The majority of mucosal symptoms in gardeners are probably irritant&#44; perhaps caused by hederin&#46;<a class="elsevierStyleCrossRefs" href="#bib0740"><span class="elsevierStyleSup">148&#8211;150</span></a></p><elsevierMultimedia ident="fig0065"></elsevierMultimedia><span id="sec0170" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Patch Test</span><p id="par0455" class="elsevierStylePara elsevierViewall">Testing the plant material <span class="elsevierStyleItalic">as is</span> as well as extracts of these carries the risk of false positive reactions&#46; Falcarinol 0&#46;03&#37; and didehydrofalcarinol 0&#46;3&#37; in petrolatum can be used&#46;</p></span></span><span id="sec0175" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Apiaceae</span><p id="par0460" class="elsevierStylePara elsevierViewall">Also known as <span class="elsevierStyleItalic">Umbelliferae</span>&#44; this family of 2850 species in 275 genera is of cosmopolitan distribution but is found mainly in north temperate regions&#46; Most of the species of dermatological importance are similar in floral structure&#44; with cluster of flowers on stalks of roughly equal length arising from a single point as an umbrella structure&#46; Most of the members of this family have been shown to be rich in psoralenes and therefore produced phototoxic reactions&#46; Some ornamental plants and weeds as well as edible plants of this family have also been related to allergic contact dermatitis&#46; Two important species in dermatology are <span class="elsevierStyleItalic">Centella asiatica</span> and <span class="elsevierStyleItalic">Daucus carota</span> vars&#46;</p><span id="sec0180" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Centella asiatica</span><p id="par0465" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Centella asiatica</span>&#44; formerly named <span class="elsevierStyleItalic">Hydrocotyle asiatica</span> &#40;L&#41; Urban&#44; is a small herbaceous annual plant of the subfamily <span class="elsevierStyleItalic">Mackinlayoideae</span> of the family <span class="elsevierStyleItalic">Apiaceae</span>&#46; It is native to India&#44; Sri Lanka&#44; northern Australia&#44; Indonesia&#44; and other parts of Asia&#46; The fresh and dried leaves as well as the stems of this species have been widely used topically in many medical and dermatological conditions for example on scars and keloids&#44; in plastic surgery&#44; scleroderma&#44; phlebology&#44; slow-healing wounds and chronic leg ulcers among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0755"><span class="elsevierStyleSup">151&#8211;155</span></a></p><p id="par0470" class="elsevierStylePara elsevierViewall">Several commercial topical preparations have been formulated including Blastoestimulin&#44; Centelas&#44; Collaven&#44; Emdecassol&#44; Madecassol&#44; Marticassol&#44; and Trofolastin&#46; Contact allergy to the <span class="elsevierStyleItalic">Centella asiatica</span> extract demonstrated by patch testing has been reported with the topical use of Madecassol&#44;<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">156</span></a> Centelase&#44;<a class="elsevierStyleCrossRefs" href="#bib0785"><span class="elsevierStyleSup">157&#8211;159</span></a> and Blastoestimulina&#46;<a class="elsevierStyleCrossRefs" href="#bib0800"><span class="elsevierStyleSup">160&#8211;164</span></a> The potential allergens are madecassic acid&#44; asiatic acid and&#44; asiaticoside&#44; 3 triterpenic acids of high molecular weight and low sensitizing capacity&#46;<a class="elsevierStyleCrossRef" href="#bib0825"><span class="elsevierStyleSup">165</span></a></p></span><span id="sec0185" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Daucus carota vars</span><p id="par0475" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Daucus carota</span>&#44; the carrot&#44; is a root vegetable of usually orange color&#44; though purple&#44; red&#44; white&#44; and yellow varieties exist&#46; In early use&#44; carrots were grown for their aromatic leaves and seeds&#44; but they are now cultivated mainly for food&#46;</p><p id="par0480" class="elsevierStylePara elsevierViewall">Allergic contact dermatitis from carrot is well recognized&#44; particularly affecting employees working in canning factories&#46;<a class="elsevierStyleCrossRefs" href="#bib0695"><span class="elsevierStyleSup">139&#44;166&#8211;168</span></a> Leaves and fruits contain falcarinol&#44; an allergen also present in celery &#40;<span class="elsevierStyleItalic">Apium graveolens</span> L&#41; and common ivy &#40;<span class="elsevierStyleItalic">Hedera helix</span> L&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0840"><span class="elsevierStyleSup">168</span></a> Hand or fingertip dermatitis is the typical clinical pattern&#44; but involvement of the face has also been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0845"><span class="elsevierStyleSup">169</span></a></p><p id="par0485" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Patch test&#58;</span></span> If the oleoresin of carrots is not available for testing&#44; patch testing may be performed with the external surface of an unpeeled raw carrot or with the surface of a slice of carrot&#46;</p></span></span></span><span id="sec0190" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Available Resources to Patch Test Plants</span><p id="par0490" class="elsevierStylePara elsevierViewall">Currently we have a limited availability of commercial test materials for patch testing plants&#46;</p><p id="par0495" class="elsevierStylePara elsevierViewall">The European baseline series includes sesquiterpene lactone mix at 0&#46;1&#37; in petrolatum for <span class="elsevierStyleItalic">Compositae</span> and <span class="elsevierStyleItalic">Frullania</span> and primin at 0&#46;01&#37; in petrolatum for <span class="elsevierStyleItalic">Primulaceae</span>&#46; In contrast&#44; the American baseline series includes the sesquiterpene lactone mix at 0&#46;1&#37; and the <span class="elsevierStyleItalic">Compositae</span> mix at 6&#37; in petrolatum for <span class="elsevierStyleItalic">Compositae</span> and <span class="elsevierStyleItalic">Frullania</span>&#46;</p><p id="par0500" class="elsevierStylePara elsevierViewall">Special plant series for testing <span class="elsevierStyleItalic">Compositae</span>&#44; <span class="elsevierStyleItalic">Frullania</span>&#44; <span class="elsevierStyleItalic">Liliaceae</span>&#44; <span class="elsevierStyleItalic">Alstroemeriacea</span>&#44; <span class="elsevierStyleItalic">Alliaceae</span> and the citrus genus can be purchased from different European and American suppliers&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the currently available allergens&#46; Commercial patch test material for <span class="elsevierStyleItalic">Anacardiaceae</span>&#44; <span class="elsevierStyleItalic">Cruciferae</span>&#44; <span class="elsevierStyleItalic">Capparaceae</span>&#44; <span class="elsevierStyleItalic">Ginkgoaceae</span>&#44; <span class="elsevierStyleItalic">Araliaceae</span>&#44; and <span class="elsevierStyleItalic">Apiaceae</span> are not available&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0505" class="elsevierStylePara elsevierViewall">We can confirm that often the study of a specific plant-induced contact dermatitis or photocontact dermatitis needs an accurate research into the published literature&#46; The previous experience developed by our colleagues will help us to avoid unnecessary steps and allow more useful research protocols to be drawn up&#46;</p></span><span id="sec0195" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions and Further Research</span><p id="par0510" class="elsevierStylePara elsevierViewall">This review aimed to cover some of the essential aspects of the allergic contact dermatitis induced by plants&#46; The intention of the chemical approach presented was to allow a more rational understanding of the presently confusing cross-reactions between apparently unrelated genera&#46; Plant contact dermatitis tends to be underestimated and misdiagnosed&#46; We lack definitive patch test material and often diagnosis requires an individualized approach using our own material&#46; Plant-induced contact and photocontact dermatitis can be severe and the basis for the development of other inflammatory skin diseases such as chronic actinic dermatosis&#46; Recognition of the problem will help to find the trigger and allow preventive measures to be taken&#46;</p></span><span id="sec0200" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0515" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        4 => array:2 [
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          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Plant Contact Dermatitis Classified by its Responsible Chemical Allergenic Structure"
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              "identificador" => "sec0015"
              "titulo" => "&#945;-Methylene-&#947;-Butyrolactones"
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            1 => array:3 [
              "identificador" => "sec0020"
              "titulo" => "Asteraceae or Compositae Family"
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                  "titulo" => "Patch Test"
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                      "identificador" => "sec0030"
                      "titulo" => "Jubulaceae Family &#40;Liverworts&#41;"
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                  "titulo" => "Patch Test"
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                      "identificador" => "sec0040"
                      "titulo" => "Liliaceae"
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                      "titulo" => "Alstroemeriaceae"
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          "titulo" => "Patch testing Liliaceae and Alstroemeriaceae"
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              "identificador" => "sec0055"
              "titulo" => "Phenol and Derivates"
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              "titulo" => "Anacardiaceae"
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              "titulo" => "Toxicodendron Genus"
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              "titulo" => "Ginkgoaceae Family"
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              "titulo" => "Proteaceae Family"
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                0 => array:2 [
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                  "titulo" => "Patch Test"
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          "titulo" => "Quinones"
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              "identificador" => "sec0100"
              "titulo" => "Primulaceae"
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                  "titulo" => "Patch Test"
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          "titulo" => "Terpenes"
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              "titulo" => "Rutaceae"
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              "titulo" => "Citrus Genus"
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                  "titulo" => "Patch Test"
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          "titulo" => "Miscellaneous Structures"
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              "titulo" => "Disulfides"
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                  "titulo" => "Alliaceae"
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                  "titulo" => "Patch Test"
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                      "titulo" => "Isocyanates"
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              "titulo" => "Cruciferae &#40;Cabbage or Mustard Family&#44; Brassicaceae&#41; and Capparaceae Family"
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              "identificador" => "sec0160"
              "titulo" => "Polyacetylenic Derivates"
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              "titulo" => "Araliaceae"
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                  "titulo" => "Patch Test"
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              "titulo" => "Apiaceae"
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                0 => array:2 [
                  "identificador" => "sec0180"
                  "titulo" => "Centella asiatica"
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                  "titulo" => "Daucus carota vars"
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          "identificador" => "sec0190"
          "titulo" => "Available Resources to Patch Test Plants"
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          "titulo" => "Conclusions and Further Research"
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          "titulo" => "Conflict of Interest"
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    "fechaRecibido" => "2011-04-12"
    "fechaAceptado" => "2011-07-29"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec83215"
          "palabras" => array:6 [
            0 => "Contact dermatitis"
            1 => "Plants"
            2 => "&#945;-Methylene-&#947;-butyrolactone"
            3 => "Quinones"
            4 => "Terpenes"
            5 => "Phenols"
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          "titulo" => "Palabras clave"
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          "palabras" => array:6 [
            0 => "Dermatitis de contacto"
            1 => "Plantas"
            2 => "&#945;-Metilen-&#947;-butirolactonas"
            3 => "Quinonas"
            4 => "Terpenos"
            5 => "Fenoles"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Allergic contact dermatitis due to plants is common&#46; Potentially allergenic plants and plant products are found in many everyday environments&#44; such as the home&#44; the garden&#44; the workplace&#44; and recreational settings&#46; By improving our knowledge of allergenic plant-derived chemical compounds&#44; we will be better positioned to identify novel allergens&#46; We review the most relevant chemical allergens that contribute to plant allergic contact dermatitis and propose a clinical classification system based on 5 major families of chemical sensitizers&#58; &#945;-methylene-&#947;-butyrolactones&#44; quinones&#44; phenol derivatives&#44; terpenes&#44; and miscellaneous structures &#40;disulfides&#44; isothiocyanates&#44; and polyacetylenic derivates&#41;&#46; We also describe the different clinical pictures of plant allergic contact dermatitis and review currently available patch test materials&#46; A better understanding of the specific allergens involved in plant allergic contact dermatitis will help to predict cross-reactivity between different plant species or families&#46;</p>"
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      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La dermatitis al&#233;rgica por contacto debida a plantas es com&#250;n&#46; Se pueden encontrar plantas y productos vegetales potencialmente alerg&#233;nicos en muchos entornos habituales como el hogar&#44; el jard&#237;n&#44; el lugar de trabajo y ambientes recreativos&#46; Mejorando nuestro conocimiento de los compuestos qu&#237;micos alerg&#233;nicos derivados de plantas estaremos en una mejor posici&#243;n para identificar al&#233;rgenos nuevos&#46; Revisamos los al&#233;rgenos qu&#237;micos que contribuyen de manera m&#225;s relevante a la dermatitis al&#233;rgica por contacto por plantas y proponemos un sistema de clasificaci&#243;n cl&#237;nica basado en 5 principales familias de sensibilizadores qu&#237;micos&#58; &#945;&#8722;metilen-&#947;-butirolactonas&#44; quinonas&#44; derivados fen&#243;licos&#44; terpenos y estructuras miscel&#225;neas &#40;disulfuros&#44; isotiocianatos y derivados poliacetil&#233;nicos&#41;&#46; Describimos tambi&#233;n los diferentes cuadros cl&#237;nicos de dermatitis al&#233;rgica por contacto por plantas y revisamos los materiales de pruebas epicut&#225;neas actualmente disponibles&#46; Un mejor entendimiento de los al&#233;rgenos espec&#237;ficos involucrados en la dermatitis al&#233;rgica por contacto por plantas ayudar&#225; a predecir reacciones cruzadas entre diferentes especies o familias de plantas&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; SQL&#44; sesquiterpene lactones&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Scientific Name&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Common Name&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Distribution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Clinical Pattern&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Allergen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Principal Use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Principal Affected Group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Compositae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lactuca sativa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lettuce&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely cultivated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hands and forearms dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;lactucin and lactucopicrin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; food handlers &#40;salad makers&#44; greengrocers and market gardeners&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cichorium endivia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Endivie&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediterranean area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; salad makers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chicorium intybus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chicoriy&#44; Escarole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Native to west and central Europe&#46; Naturalized in South Africa&#44; Australia&#44; USA&#44; and South America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;lactucin and lactucopicrin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; greengrocers and market gardeners&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Taraxacum officinale</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dandelion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&#46; Temperate regions including South Africa&#44; USA and Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&#44; face dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;taraxinic acid&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chrysanthemum</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chrysanthemums sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&#44; Asia&#44; Africa and America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand and face dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;guaianolide&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental plants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; professional growers and florists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Helenium autumnale</span> L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sneezeweed&#44; Bitterweed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">North America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental plant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Leucanthemum vulgare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Marguerites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&#44; Asia&#44; USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occcupational&#58; gardeners and florists&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Arnica montana</span> L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Montain tobacco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Northern hemisphere-temperate zone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;helenalin and its esters&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic &#40;used on wounds&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chamomilla recutita</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chamomile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral swelling&#44; arm and trunk dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;desacetylmatricarin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tanacetum parthenium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feverfew&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;parthenin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ambrosia</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ragweeds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">North America&#46; Naturalized in Australia and India&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Male farmers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Artemisia</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mugwort&#44; Wormwood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Northern temperate regions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&#47;spice&#47;medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Arctotheca</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Capweed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cape province&#44; South Africa&#46; Naturalized in Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Conyza bonariensis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fleabane&#44; Horseweed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">North and South America&#44; Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cynara scolymus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Globe artichoke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely cultivated in Mediterranean regions and other temperate areas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;cynaropicrin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; pickers&#44; market gardeners and flower arrangers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dittrichia viscosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sticky elecampane&#44; Stinkwort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediterranean regions&#44; Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;inuviscolide and 2-deacetoxyxanthinin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&#58; farm workers and gardeners&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Parthenium hysterophorus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Congress grass&#46; Carrot weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central and south America&#46; Southwest USA&#46; India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;parthenin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult male farmers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Achillea millefolium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yarrow&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe &#40;especially Britain&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localized dermatitis&#44; generalized dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chamaemelum nobile</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sweet chamomile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Localized dermatitis&#44; anaphylaxis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;nobilin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lawn plant&#44; herbal tea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dahlia</span> cvs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dahlia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face&#44; hand and arm dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental plant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; gardeners&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Inula helenium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elecampane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Continental Europe&#44; Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;alantolactone&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Jubulaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Frullania</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide&#44; especially in temperate and subtopical forests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pseudophotodermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SQL &#40;frullanolide&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liverworts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; forestry workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Liliaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tulipa</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tulip&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&#44; Mediterranean region&#59; Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tulip fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#945;-Methylene-&#947;-butyrolactones &#40;tulipalin A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental plants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupatinal&#58; bulb growers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Alstroemeriaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Alstromeria</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peruvian lily&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Andean foothills esp Chile and Peru&#46; Widely grown as a border perennial and for cut flowers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tulip fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#945;-Methylene-&#947;-butyrolactones &#40;tulipalin A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental plants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; florist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anacardiaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Toxicodendron radicans</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poison ivy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eastern Asia and North and South America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic and occupational &#40;outdoor workers&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Toxicodendron diversilobum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Western poison oak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">West coast of North America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Toxicodendron toxicarium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Eastern poison oak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">South-eastern USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Toxicodendron striatum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Poison sumac&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central America and northern South America&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mangifera indica</span> L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mango&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Easterna Asia&#44; Bruma and regions of India&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Face dermatitis&#44; stomatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anacardium occidentale</span> L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cashew nut tree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Northeastern Brazil&#46; Tropical countries&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&#44; stomatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anacardic acids and cardol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&#44; manufacturing of other products&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Toxicodendron verniciflua</span> Stokes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Japanese lacquer tree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Japan and China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urushiol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">varnish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic and lacquer workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ginkgoaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Ginkgo biloba</span> L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ginkgo tree&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&#44; Europe and temperate regions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand&#44; face&#44; and arm dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ginkgolic acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental and food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Proteacea family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Grevillea</span> sp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Silk oak&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Australia and southern USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pentadecylresorcinol&#44; tridecylresorcinol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Primulaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Primula obconica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China and Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Facial dermatitis with limb or hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ornamental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; gardeners and florist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Rutaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Citrus lemon</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lemon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely cultivated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geraniol&#44; citral and <span class="elsevierStyleSmallCaps">d</span>-limonene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food handlers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Citrus sinensis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orange&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely cultivated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geraniol&#44; citral and <span class="elsevierStyleSmallCaps">d</span>-limonene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food handlers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Citrus aurantium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bergamot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Widely cultivated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geraniol&#44; citral and <span class="elsevierStyleSmallCaps">d</span>-limonene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food handlers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Alliaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Allium sativum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garlic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fingertip dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diallyl disulfide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupationa&#58; food handlers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cruciferae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Raphanus sativus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radish&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isothiocyanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Brassica oleracea</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cabbage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isothiocyanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Brassica nigra</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Black mustard&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Central and southern Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variable&#44; hand dermatitis&#44; local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isothiocyanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food handler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Brassica oleracea v botrytis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cauliflower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Worldwide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isothiocyanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Plant grower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Capparaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Capparis spinosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caper bush&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mediterranean&#44; extending to Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Isothiocyanate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Araliaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hedera helix</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Common ivy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Europe&#44; North Africa and Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Linear array dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falcarinol and didehydrofalcarinol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Weed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Apiaceae family</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Centella asiatica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asian pennywort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Asia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Local dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Madecassic acid&#44; asiatic acid and asiaticoside&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medicinal herb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Domestic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Daucus carota</span> vars&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Carrot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Temperate areas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hand dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falcarinol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Food&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Occupational&#58; canning factory workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab182234.png"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>Chemotetechnique&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span>Marti Tor&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">c</span>AllergEAZE&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">d</span>TROLAB&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Allergen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Family or Species&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">European baseline series</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sesquiterpene lactone mix 0&#46;1 pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compositea and Frullania&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primin 0&#46;01 pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primulaceae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">American baseline series</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sesquiterpene lactone mix 0&#46;1 pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compositae and Frullania&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compositae mix 6 pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compositae and Frullania&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Special series</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chamomilla romana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chamomilla Romana 1&#46;0 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chamomilla romana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#193;rnica montana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;rnica montana 0&#46;5 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#193;rnica Montana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Taraxacum officinale</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taraxacum Officinale 2&#46;5 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Taraxacum officinale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Achillea millefolium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Achillea Millefolium 1&#46;0 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Achillea millefolium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chrysanthemum parthenium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chrysanthemum Parthenium 1&#46;0 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chrysanthemum parthenium &#40;Feverfew&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chrysanthemum cinerariaefolium</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chrysanthemum Cinerariaefolium 1&#46;0 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chrysanthemum cinerariaefolium&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tanacetum vulgare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tanacetum Vulgare 1&#46;0 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tanacetum vulgare&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alantolactone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Alantolactone 0&#46;033 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Compositae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Parthenolide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Parthenolide 0&#46;1 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feverfew several Compositae and Magnoliaceae&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dipentene &#40;limonene&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dipentene &#40;Limonene&#41; 1&#46;0 pet<span class="elsevierStyleSup">a</span>&#44; 2&#37;vas<span class="elsevierStyleSup">b</span>&#44; 2&#37; pet<span class="elsevierStyleSup">c</span>&#44; 2&#37;<span class="elsevierStyleSup">e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Citrus genus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diallyldisulfide 1&#46;0 pet&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diallyldisulfide 1&#46;0 pet<span class="elsevierStyleSup">a</span>&#44; vas<span class="elsevierStyleSup">b</span>&#44; pet<span class="elsevierStyleSup">c&#44;e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Garlic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#945;-Methylene-&#947;-butyrolactone &#40;tulipalin A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#945;-Methylene-&#947;-butyrolactone 0&#46;01 pet<span class="elsevierStyleSup">a</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liliaceae and Alstroemeria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oil of bergamot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oil of bergamot 2&#37; vas<span class="elsevierStyleSup">b</span>&#44; pet<span class="elsevierStyleSup">c</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bergamot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oil of lemon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oil of lemon 2&#37; vas<span class="elsevierStyleSup">b</span>&#44; pet<span class="elsevierStyleSup">c&#44;e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lemon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Orange oil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orange oil 2&#37;<span class="elsevierStyleSup">e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orange&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primin 0&#46;01 pet<span class="elsevierStyleSup">a</span>&#44; vas<span class="elsevierStyleSup">b</span>&#44; pet<span class="elsevierStyleSup">c&#44;e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Primula obconica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Geraniol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Geraniol 1&#37; pet<span class="elsevierStyleSup">a</span>&#44; vas<span class="elsevierStyleSup">b</span>&#44; pet<span class="elsevierStyleSup">c&#44;e</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lemon&#44; Orange&#44; Bergamot&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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Información del artículo

ISSN: 15782190
Idioma original: Inglés

DOI:10.1016/j.adengl.2012.07.006

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