Sources of exposure:
(1) raw tree sap
(2) tea made from roots, leaves or bark
(3) leaves
Risk factor for a serious reaction:
(1) history of sensitization following repeated exposures to lacquer
(2) sensitization to poison ivy or poison oak (see previous section)
(3) a large dose
The onset of symptoms may range from a few minutes after ingestion to a week afterwards. The longer the symptom-free interval the greater the chance of misidentifying the cause of the reaction.
Features of the allergic reaction:
(1) skin reaction
(1a) generalized erythroderma
(1b) generalized maculopapular rash
(1c) erythema multiforme
(1d) urticarial rash
(1e) purpura
(1f) pustules and/or blisters
(2) fever
(3) chills
(4) gastrointestinal symptoms (cramps, diarrhea, etc.)
(5) headache
(6) pruritus
(7) chest tightness
(8) syncope
(9) leukocytosis with eosinophilia
More severely affected patients may become hypotensive with shock.
