Effects of Manna of Alhagi persarum (Taranjabin) and Portulaca oleracea (Khorfeh) Seed Administration on Nickel-induced Allergic Contact Dermatitis: A Case Report

Document Type : Case Report


1 Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


A 19-year-old girl with documented nickel-induced allergic contact dermatitis was referred to the department of traditional Persian medicine five weeks after the sudden onset of bolus and erythematous skin rash to receive treatment based on complementary and alternative medicine. A detailed history of jewelry exposures, lifestyle, food intake, and dietary habits was obtained, as well as the history of other physicians’ visits and administered treatments within the past eight weeks. Despite receiving treatment with corticosteroids, anti-histamines, and antibiotics, no satisfactory remission was achieved, and the patient discontinued the treatments. As the alternative medicine approach, treatment was started based on avoiding contact with nickel, administration of Manna of Alhagi persarum and Portulaca oleracea seeds, and avoidance of consuming tomato sauce, cocoa, coffee, and bitter chocolate. Within six weeks, a complete remission of the skin lesions and symptoms occurred. Moreover, normal clinical follow-up was observed after 12 months. Notably, the CARE (CAse REport) guidelines were used in the preparation of this case report.


1. Calzada D, Baos S, Cremades-Jimeno L, Cárdaba B. Immunological mechanisms in allergic diseases and allergen tolerance: the role of treg cells. J Immunol Res. 2018:10.
2. Saito M, Arakaki R, Yamada A, Tsunematsu T, Kudo Y, Ishimaru N. Molecular mechanisms of nickel allergy. Int J Mol Sci. 2016;17(2):202.
3. Khatami A, Nassiri-Kashani M, Gorouhi F, Babakoohi S, Kazerouni-Timsar A, Davari P, et al. Allergic contact dermatitis to metal allergens in Iran. Int J Dermatol. 2013; 52(12):1513-8.
4. Jacob SE, Goldenberg A, Pelletier JL, Fonacier LS, Usatine R, Silverberg N. Nickel allergy and our children's health: a review of indexed cases and a view of future prevention. Pediatr Dermatol. 2015; 32(6):779-85.
5. Schäfer T. Complementary and alternative medicine (CAM) and atopic eczema. Allergologie select. 2017;1(1):44-52.
6. Mahmoudpour Z, Shirafkan H, Mojahedi M, Gorji N, Mozaffarpur SA. Digesters in traditional Persian medicine. Caspian J Intern Med. 2018;9(1):1-6.
7. Ali Reza Derakhshan RC, Sohrab Dehghan. A new look at epicardial adipose tissue from the perspective of Iranian traditional medicine. J Integr Med. 2014;12(6):529-30.
8. Kashani MN, Gorouhi F, Behnia F, Nazemi MJ, Dowlati Y, Firooz A. Allergic contact dermatitis in Iran. Contact dermatitis. 2005;52(3):154-8.
9. Nassiri-Kashani M, Nassiri-Kashani MH, Ghafari M. Evaluation of occupational allergic contact dermatitis and its related factors in Iran. Med J Islam Repub Iran. 2016;30:468.
10. Ramezany F, Kiyani N, Khademizadeh M. Persian Manna in the past and the present: an overview. Am J Pharmacol Sci. 2013;1(3):35-7.
11. Hamedi A, Farjadian S, Karami MR. Immunomodulatory properties of Taranjebin (Camel's Thorn) Manna and its isolated carbohydrate macromolecules. Evid Based Complement Alternat Med. 2015;20(4):269-74.
12. Shenefelt PD. Herbal treatment for dermatologic disorders. In: Benzie IFF W-GS, editors. Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition. Boca Raton (FL): CRC Press/Taylor & Francis; 2011, Chapter 18.
13. Rahimi VB, Ajam F, Rakhshandeh H, Askari VR. A pharmacological review on portulaca oleracea l.: focusing on anti-inflammatory, anti- oxidant, immuno-modulatory and antitumor activities. J Pharmacopunct. 2019;22(1):7-15.
14. Tabassum N, Hamdani M. Plants used to treat skin diseases. Pharmacogn Rev. 2014;8(15):52-60.
15. Thomsen BJ, Chow EY, Sapijaszko MJ. The potential uses of omega-3 fatty acids in dermatology: a review. J Cutan Med Surg. 2020;24(5):481-94.
16. Lymperopoulos A, Koch WJ. Chapter 9 - Autonomic Pharmacology. In: Waldman SA, Terzic A, Egan LJ, Elghozi J-L, Jahangir A, Kane GC, et al., editors. Pharmacology and Therapeutics. Philadelphia: W.B. Saunders; 2009. p. 115-39.
17. Shohrati M, Davoud M, Rezazadeh S, Najafian B. Clinical efficacy of topical avena sativa versus betamethasone in chronic pruritus due to sulfur mustard exposure. J Medicinal Plants. 2017;16(63):68-77.
18. Tavassoli AP, Anushiravani M, Hoseini SM, Nikakhtar Z, Baghdar HN, Ramezani M, et al. Phytochemistry and therapeutic effects of Alhagi spp. and tarangabin in the Traditional and modern medicine: a review. J Herbmed Pharmacol. 2020;9(2):86-104.
19. Sur R, Nigam A, Grote D, Liebel F, Southall MD. Avenanthramides, polyphenols from oats, exhibit anti-inflammatory and anti-itch activity. Arch Dermatol Res. 2008;300(10):569.
20. Sadighara P, Gharibi S, Moghadam Jafari A, Jahed Khaniki G, Salari S. The antioxidant and Flavonoids contents of Althaea officinalis L. flowers based on their color. Avicenna J Phytomedicine. 2012;2(3):113-7.
21. Asghari MH, Fallah M, Moloudizargari M, Mehdikhani F, Sepehrnia P, Moradi B. A systematic and mechanistic review on the phytopharmacological properties of alhagi species. Anc Sci Life. 2016;36(2):65-71.
22. Muhammad G, Hussain MA, Anwar F, Ashraf M, Gilani AH. Alhagi: a plant genus rich in bioactives for pharmaceuticals. Phytotherapy Research. 2015;29(1):1-13.
23. Baysak S, Gönül M, Atacan D, Ergin C. A case report of allergic contact dermatitis due to mandragora radix. Case Reports Immunol. 2015:591438.
24. Sen P, Ho MS, Ng SK, Yosipovitch G. Contact dermatitis: a common adverse reaction to topical traditional Chinese medicine. Int J Dermatol. 2010;49(11):1255-60.