Dermatitis from common ivy (Hedera helix L. subsp helix) in Europe: past, present, and future

Common ivy (Hedera helix subsp. helix) is a well-known native and ornamental plant in Europe. Reports on contact dermatitis from ivy have regularly appeared since 1899. Recently, it has been suggested that allergic contact dermatitis from the plant may be under-diagnosed, partly due to lack of commercial patch test allergens. The objective of the article is to present the results of aimed patch testing with the main common ivy allergen, falcarinol, during a 16-year period and review the newer literature. Consecutive patients tested with falcarinol 0.03% petrolatum from May 1993 to May 2009 were included. Cases published since 1987 were retrieved from the PubMed database. One hundred and twenty-seven Danish patients were tested with falcarinol and 10 (7.9%) tested positive. Seven were occupationally sensitized. Between 1994 and 2009, 28 new cases of contact dermatitis from ivy were reported, 2 of which were occupational. Only 11 of the 28 patients were tested with pure allergens. Falcarinol is not only widely distributed in the ivy family, but also in the closely related Apiaceae. Sensitization may occur in childhood or in adults pruning ivy plants or handling them in an occupational setting. In view of the ubiquity of falcarinol-containing plants and the relatively high prevalence of positive reactions in aimed patch testing, falcarinol should be the next plant allergen to be commercially available and included in the plant series worldwide.