The Last Furlong

Ivy science – burning throat after pruning English Ivy

I have been posting about an allergy to English Ivy we might have,

Here, here and here and here

So I have actually got to the opinion in my Ivy research adventures that no one knows much at all!

I should think that patients who go to the doctor with burning throats, coughs and bronchitis are usually diagnosed with an infection/virus. The only reason that my suspicions fell upon the Ivy-dust being the cause of our illness was because we BOTH got symptoms simultaneously! Would your doctor ASK “Have you recently been pruning Ivy?”

Well maybe they should.

Here are a few nuggets from science –

“Immediate, possibly allergic, reactions from common ivy causing rhinitis and asthma have been reported, although rarely, and the majority of mucosal symptoms in gardeners are probably irritant, perhaps caused by hederin (30, 36, 37)”

Link – pay for access….

Then another study –

Each quote has a link…Hb=Ivy

RESULTS: There were more complaints among gardeners compared to the control group f as to symptoms of asthmatic bronchitis (OR 4.6 [0.98-21.2]), rhino conjunctivitis (OR 6.4 [2.1-20.2]) and skin symptoms (OR 4.3 [1.5-12.5]). The symptoms were especially profound among the caretakers of Fb and Hh and to a lesser degree among gardeners working in greenhouses growing Fb and Hh. The symptoms of the gardeners were to a higher degree independent of the season (OR 3.1 [1.1-9]), related to working environment (OR 16.1 [3.3-78.9]) and indoor work (OR 24 [4.8-118.7]).

DISCUSSION: This study seems to demonstrate high frequencies of apparently allergic and/or toxic irritative symptoms among gardeners and should be followed by a study including clinical examinations. With knowledge of the allergenic and toxic irritative properties of Fb and Hh it seems problematic that these plants are found in such high numbers in public and private places. Allergic testing including these plants should be performed to a higher degree than is actually the case.

And another –

Occupational asthma (OA) associated with decorative plants is not rare (1, 2), and occupational (3) and nonoccupational (4) sensitization to green plants has also been reported. Common ivy, Hedera helix (family Araliaceae) is a climbing plant with beautiful evergreen leaves but humble flowers. It is a popular decorative green plant grown both outdoors and indoors. Unfortunately, ivy is known to cause contact dermatitis, with first reports dating from 1899 (5). There are also suggestions of an association between ivy and rhinitis symptoms (6). As far as we know, ivy-induced OA has not been reported previously. In the present paper, such a case is presented.

The patient was a 40-year-old female who had worked in her own flower shop for the past 11 years. She was an ex-smoker having stopped smoking 3 years earlier and had no history of atopy. Symptoms of cough had started 4 years prior to the current examinations, appearing especially when she handled ivy. One year later she began to experience dyspnoea, and she was treated with inhaled steroids for a short time. She also had work-related skin symptoms, which were later diagnosed as nonimmunologic contact urticaria for narcissus and rose.

At the Finnish Institute of Occupational Health, respiratory and allergologic investigations were performed, as reported previously (1, 2), and the diagnosis of OA was made according to the European guidelines (7). The total serum IgE was 105 kU/l; radioallergosorbent test for ivy was not available. The skin prick tests (SPT) were performed to 18 common allergens as well as to storage mites. Sensitization to the following plants was studied with the prick–prick method (4):Ficus benjamina (leaf), Dracaena fragrans (leaf), Asplenium nidus (leaf), Yucca aloifolia (leaf), Spathiphyllum wallisi (leaf), Euphorbia trigona (stalk), rose (leaf),Euphorbia pulcherrima (green and red leaf), Rumohra adiantiformis (leaf), Lilium orienthalis (pollen), Hedera helix (leaf), Hyacinthus orientalis (leave, petal and bulb) and Narcissus pseudonarcissus (petal, leaf and stalk). All SPTs were negative. Spirometry showed normal ventilatory function, but in the histamine challenge test, strong bronchial hyperresponsiveness (BHR) was noted (PD15 0.08 mg). Peak expiratory flow (PEF) varied between 340 and 510 l/min during working days, with the lowest values occurring when handling green plants, especially ivy; during holidays PEF varied between 410 and 510 l/min. Bronchial asthma was diagnosed, and inhaled budesonide dipropionate started, after which BHR was mild (PD150.43 mg).

Specific bronchial challenge tests were performed in a 6 m³ challenge chamber, in which the patient cut and tore the flowers, stalks and leaves of the plants for 30 min. The forced expiratory volume in 1 s (FEV1) and PEF values during the challenge test procedure were measured by a portable, pocket-size spirometer (One Flow; STI MEDICAL, Saint-Romans, France). The referent inhalation challenge test to lettuce leaves was negative. In the specific test, the handling of ivy caused an immediate asthmatic reaction, with 21% reduction in FEV1 (Fig. 1) and with 20–30% reductions in PEF (not shown), with simultaneous subjective symptoms of dyspnoea. The PEF and FEV1 values returned to normal after Atrodual®(Boehringer Ingelheim GmbH, Ingelheim, Germany) 2.5 ml mist inhalation.

Forced expiratory volume in 1 s (FEV1) follow-up during challenge tests: , placebo (lettuce);, ivy. Challenge ended at 0 h.s

Based on exposure and respiratory symptoms, peak flow surveillance, and specific inhalation challenge testing, OA caused by ivy was diagnosed. Regular inhaled budenoside dipropionate and, on demand, salbutamol were prescribed, and avoidance of exposure to ivy was recommended.

In our patient, the mode of asthmatic reaction was immediate in the specific bronchial challenge test. This mode generally, but not necessarily, points to hypersensitivity type I reaction. However, an IgE-mediated allergy to ivy could not be proven. Therefore, the mechanism by which ivy causes asthma is unclear and requires further study.

And just for FUN!

An Unusual Case of Death: Suffocation Caused by Leaves of Common Ivy (Hedera helix). Detection of Hederacoside C, α-Hederin, and Hederagenin by LC—EI/MS-MS