Blog Vol.2, # 21. A Nice Day For A ….Fall…Wedding.
This past weekend, my daughter
and her fiancé, hosted us at their much anticipated and much planned
wedding. They have a wonderful garden
and grew most of the flowers for the event.
The table settings, the bouquets, the decorations for the ceremony and
the reception were all adorned with an abundance of beautiful fall
flowers. One of the plants they used was
a very decorative filler called Euphorbia, better known as Spurge. Two of her bridesmaids, very gifted with
flowers and with flower arranging, spent Friday cutting and arranging for the
big day. Saturday morning, the wedding
day, AHHHHH!!!, the bride and one of the
bridesmaids woke up with a nasty rash on their faces and around their
eyes. Redness, swelling and itching
ensued, and a call to the bride’s father, namely me self, to see what to
do. The bridesmaid had a much more
dramatic reaction and went to urgent care.
The bride’s reaction was milder, the diagnosis: contact dermatitis.
Who knew that Euphorbia, such
a lovely, easy-to-grow plant is so notorious?
We learn something every day, sometimes, unfortunately, the hard way. When the plant is cut, it releases a sap that
is a milky latex-like liquid which is quite caustic. The sap contains diterpene esters which are
toxic when ingested and an irritant to the eyes and skin after contact.
The mechanism of contact
dermatitis, or delayed hypersensitivity reaction, involves the immune system. Since Euphorbia is everywhere, up-to 8000
species in the genus, it is very likely that a person has been previously
exposed. The initial exposure to the
esters causes a build-up of T lymphocytes in the lymph nodes, and when this person
makes contact with the Euphorbia sap again, then the body sets up the delayed immune
response. Unlike a normal allergy, where
the mast cells release histamines, in this case the lymphocytes start a cascade
of immune reactions.
Treatment will depend on the
exposure and severity and will also depend on the person’s individual
response. In this case, the severity of
the bridesmaid’s reaction required an oral corticosteroid, which fortunately aided
in reducing symptoms very quickly. The
bride was able to manage her reaction with cold compresses and eye drops. If
the sap gets into the eye, it can cause severe conjunctivitis and even uveitis
(very bad). Immediate attention must be sought.
If you suspect the possibility
of being exposed, time for PPE: gloves
and goggles to keep from contacting the sap.
By the way, there was a happy
ending to this story. Everyone was on the mend by the time of the ceremony, the
flowers were stunning, and the wedding was lovely! Congratulations Emily and Michael!
til next week,
the good doctor, Dr. Mark Germain, Burlington Optometrist
