Allergic contact dermatitis caused by the Boston fern Nephrolepis exaltata 'Bostoniensis'.

A49-year-oldmale nursery employee (a skilled gardener) was referred by theDepartment of Occupational and Environmental Medicine with a vesicular and scaling hand eczema, primarily on the two first fingers and dorsum of the right hand. The patient had worked as a greenhouse gardener for 33 years, primarily with Euphorbia species, without skin problems. In his trainee years, the patient worked with Boston fern, and recalled transient redness, but did not think about this at the time. Two years ago, he again started working with Boston fern and the seasonal cultures Aster and Osteospermum. After a year, dermatitis developed on the first and second fingers on the right hand, and on the dorsum of the right hand. The two fingers were used for removing dead Euphorbia flowers, as well as pinna (‘leaves’) and stipes (‘stems’) from theBoston ferns. The patient used gloves intermittently during the work day. Pesticides were not used in the nursery. The patient believed that the nectar from flowering Euphorbia millii was the cause of the dermatitis and also the cause of rhinitis symptoms. The patient was prick tested with the European standard inhalant allergens,