Oral desensitization therapy for poison ivy urushiol contact allergy: A systematic review
DOI:
https://doi.org/10.25251/pcyj0173Keywords:
desensitization, poison ivy, urushiol, oral toleranceAbstract
Oral desensitization is a promising approach to reduce the frequency and severity of allergic contact dermatitis reactions to poison ivy. Rhus dermatitis, characterized by itching, redness, and blistering, can appear up to three weeks post-exposure in first-time sufferers and after 1-2 days in those previously exposed. Bentoquatam cream can serve as a barrier to protect the skin from contact with urushiol resin, but it must be applied before exposure to the plant. Current treatments focus on relieving symptoms and managing inflammatory reactions with topical therapies such as calamine lotion and corticosteroids. Oral desensitization involves administering small amounts of urushiol orally to induce immune tolerance. Although successful in food allergies, little research exists on the efficacy for poison ivy. We identified six studies, involving 410 human subjects, assessing the use of oral desensitization for poison ivy. Studies used various urushiol formulations in liquid or tablet form. Most yielded promising results with minimal adverse effects. The reported side effects of oral desensitization therapy include rash, pruritus ani, and flushing. These findings suggest that oral desensitization may decrease poison ivy reactions, potentially benefiting communities with frequent outdoor exposure. However, the limited number of studies and small sample sizes highlight the need for further research.
References
1. American Academy of Dermatology Association. Poison Ivy, Oak, and Sumac. American Academy of Dermatology Association website. https://www.aad.org/public/everyday-care/itchy-skin/poison-ivy/who-gets-contagious Accessed August 23, 2024.
2. Weinberg L, Malani PN. Poison Ivy, Poison Oak, and Poison Sumac. JAMA. 2024 Jun 4;331(21):1872. doi: 10.1001/jama.2023.26355. PMID: 38753316.
3. Mayo Clinic. Poison Ivy Rash: Symptoms & Causes. Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/poison-ivy/symptoms-causes/syc-20376485 Accessed August 23, 2024.
4. National Center for Biotechnology Information. PubChem Compound Summary for Bentoquatam. https://pubchem.ncbi.nlm.nih.gov/compound/Bentoquatam. Accessed Sept. 10, 2024.
5. Strid J, Thomson M, Hourihane J, Kimber I, Strobel S. A novel model of sensitization and oral tolerance to peanut protein. Immunology. 2004;113(3):293-303. doi:10.1111/j.1365-2567.2004.01989.x
6. Land MH, Kim EH, Burks AW. Oral desensitization for food hypersensitivity. Immunol Allergy Clin North Am. 2011 May;31(2):367-76, xi. doi: 10.1016/j.iac.2011.02.008. PMID: 21530825; PMCID: PMC3111958.
7. Van Hoogstraten IM, Boos C, Boden D, Von Blomberg ME, Scheper RJ, Kraal G. Oral induction of tolerance to nickel sensitization in mice. J Invest Dermatol. 1993;101(1):26-31. doi:10.1111/1523-1747.ep12358502
8. Di Gioacchino M, Ricciardi L, De Pità O, et al. Nickel oral hyposensitization in patients with systemic nickel allergy syndrome. Ann Med. 2014;46(1):31-37. doi:10.3109/07853890.2013.861158
9. Sjövall P, Christensen OB, Möller H. Oral hyposensitization in nickel allergy. J Am Acad Dermatol. 1987;17(5 Pt 1):774-778. doi:10.1016/s0190-9622(87)70262-x
10. Bellanti JA. Mechanisms of desensitization with oral immunotherapy and epicutaneous immunotherapy. J Food Allergy. 2023;5(1):10-18. Published 2023 Jun 1. doi:10.2500/jfa.2023.5.230002
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
12. Ouzzani M, Hammady H, Fedorowicz Z, and Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. 2016. doi:https://10.1186/s13643-016-0384-4.
13. Balduzzi S, Rücker G, Schwarzer G (2019). “How to perform a meta-analysis with R: a practical tutorial.” Evidence-Based Mental Health, 153–160. doi: 10.1136/ebmental-2019-300117.
14. R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.
15. Epstein WL, Byers VS, Frankart W. Induction of antigen-specific hyposensitization to poison oak in sensitized adults. Arch Dermatol. 1982;118(9):630-633.
16. Epstein WL, Baer H, Dawson CR, Khurana RG. Poison oak hyposensitization. Evaluation of purified urushiol. Arch Dermatol. 1974;109(3):356-360.
17. Institute of Medicine (US) Committee on Ethical Considerations for Revisions to DHHS Regulations for Protection of Prisoners Involved in Research; Gostin LO, Vanchieri C, Pope A, editors. Ethical Considerations for Research Involving Prisoners. Washington, DC: National Academies Press; 2007. Chapter 5, The Ethical Framework for Research Involving Prisoners. Accessed May 28, 2025. https://www.ncbi.nlm.nih.gov/books/NBK19885/
18. Casanova V. Outdoor Workers and Poisonous Plant Exposures | Blogs | CDC. Published May 4, 2022. Accessed September 10, 2024. https://blogs.cdc.gov/niosh-science-blog/2022/05/04/poisonous-plants/
19. Johnson RA, Haer H, Kirkpatrick CH, Dawson CR, Khurana RG. Comparison of the contact allergenicity of the four pentadecylcatechols derived from poison ivy urushiol in human subjects. J Allergy Clin Immunol. 1972;49(1):27-35. doi:10.1016/0091-6749(72)90120-0
20. Marks JG Jr, Trautlein JJ, Epstein WL, Laws DM, Sicard GR. Oral hyposensitization to poison ivy and poison oak. Arch Dermatol. 1987;123(4):476-478.
21. Lofgran T, Mahabal GD. Toxicodendron Toxicity. [Updated 2023 May 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557866/
22. Chad S Boomershine, MD. A Phase I, Single-Center Study of PDC-APB in Healthy Volunteers. ClinicalTrials.gov identifier: NCT02700373. Updated February 2, 2018. Accessed February 3, 2025.
23. Langs RJ, Strauss MB. Oral prophylaxis against poison ivy dermatitis with aqua ivy tablets. I. A controlled experiment and preliminary clinical report. J Allergy. 1959;30(2):130-139. doi:10.1016/0021-8707(59)90082-6
24. Vassallo MA. Oral prophylaxis against poison ivy dermatitis: a controlled study in adults and children with an alum precipitated pyridine-ivy complex. Am Pract Dig Treat. 1961;12:263-267.
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Copyright (c) 2026 Natasha Barton, John Meisenheimer, Dakota Hitchcock, Parker Juels, Olivia Ueltschi, Emily Woolhsier, Elizabeth Lamberty, Robert Dellavalle, Cory A. Dunnick (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
