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Keywords:

  • cyclamen pollen;
  • occupational allergy

F lorists, greenhouse workers, and floriculturists run an increased risk of developing both types I and IV occupational allergies to decorative plants. Regarding type I allergy, the weeping fig (Ficus benjamina) is a pot plant notorious for causing sensitization in those handling it both occupationally and privately ( 1, 2). Cut flowers of the Compositae (daisy) family are also a frequent cause of occupational IgE-mediated sensitization in florists and horticulturists ( 3). Recently, many other decorative plants, such as Christmas cactus and Stephanotis floribunda, have been incidentally reported to cause IgE-mediated allergy ( 4, 5).

In this paper, we describe a floriculturist family of which the mother and daughter developed IgE-mediated allergy to cyclamen pollen.

Patient 1. For 17 years, a 44-year-old woman worked together with her husband and later also with her daughter (patient 2) in a small-scale family business breeding cyclamen cultivars. To improve the characteristics of these indoor plants, substantial amounts (g) of pollen were manually collected and transferred from one (white) cultivar to another (red) cultivar to produce hybridization. High-level exposure to the cyclamen pollen was inevitable. After 10 years, the patient developed progressively symptoms indicating sensitization: sneezing, itchy, watery eyes, running nose, and even severe dyspnea. Mainly because of the last symptom, she was forced to quit her job. Her atopy history was negative.

Patient 2. This was the 17-year-old daughter in the family, who had assisted her parents at weekends during the last few years. Her atopy history revealed only allergy to cats. During her work in the greenhouse, she had developed symptoms of rhinoconjunctivitis, but not dyspnea.

Cyclamen pollen provided by the patients was used to prepare an aqueous extract (10% w/v). Skin prick tests (SPT) with this extract were highly positive in both mother and daughter, but negative in eight healthy controls, including the husband of patient 1. In a control experiment, SPT with aqueous extracts from cyclamen petals (10% w/v) and leaves (10% w/v) proved to be negative in both mother and daughter.

With the cyclamen pollen as a substrate in the RAST, specific IgE was found in the serum of both mother and daughter: 0.4 kU/l and 4.8 kU/l, respectively. These in vitro experiments were done at the Central Laboratory of Blood Transfusion in Amsterdam, The Netherlands. Total IgE was normal in both patients.

SPT with routine inhalant allergens were positive for house-dust mite and dog epithelia in the mother, but only for cat epithelia in the daughter.

Cyclamen cultivars, which belong to the Primulaceae (primrose) family, are popular indoor ornamental plants. Their natural ancestors are short (a few centimeters high), shadow- and humidity-loving plants native to Alpine forests. The brightly colored flowers are pollinated by insects. Therefore, sensitization to these heavy pollens does not occur under normal conditions. However, the specific occupational conditions described in this report led to intense exposure and in that way sensitized two out of the three members of this family. Presumably, their slightly atopic constitution made them more susceptible to this sensitization. No doubt, in many small-scale occupational settings, high-level exposure occurs to substances of both vegetable and animal origin. This entails the risk of sensitization. It is crucial to inform such workers of this serious risk. Only in that way is it possible to implement the necessary preventive measures.

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Footnotes
  1. IgE-mediated respiratory allergy to pollens.