Shiitake Dermatitis - North American Mycological Association

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By Michael W. Beug, PhD
PO Box 116, Husum, WA 98623, email: beugm [at] evergreen.edu

Shiitake dermatitis was first reported by Nakamura in 1977 And he later reviewed 51 cases (Nakamura 1977, 1992). The symptoms are dark red, almost purple welts all over the body so that the victim appears to have been flogged or has been vigorously scratching a poison oak rash. Shiitake. Shiitake. Shiitake. The syndrome was long thought to be restricted to Asia since most of the world's production of Shiitake [Lentinula edodes] (Berk.) Pegler] occurs in Asia. However, in 2006 the case was reported in England (Mak and Wakelin 2006) and in 2010 the case was reported in France (Herault et al 2010). The February 18, 2011 New York Times carried an article by Lisa Sanders, MD about a 56 year-old Portland, Oregon woman who developed a rash that initially stung her dermatologists, until one of them enquired whether or not she had recently consumed Raw or undercooked Shiitake. Lentinula edodes

Sometimes known as flagellate dermatitis, Shiitake dermatitis is a toxic reaction to a starch-like polysaccharide known as lentinan found in Lentinula edodes . Shitake dermatitis does not respond to the prick tests used by dermatologists, but there would be a response if it was an allergic reaction. Lentinan has antitumor activity and is used as an adjunctive treatment for colorectal and gastric malignancies in Japan (Chihura et al 1969). Clinically the rash resembles flagellate dermatitis caused by Bleomycin, a sulfur-containing polypeptide derived from Streptomyces verticillus .

For affected individuals, the rash usually begins about 48 hours after consumption of raw or undercooked Shiitake and lasts for about 10 days. It is a toxic, not an allergic reaction and is believed to result from lentinan triggering blood vessels to dilate and leak small amounts of inflammatory compounds just beneath the skin. The rash typically begins with the red areas that neither hurt nor itch. Soon red blisters form and then harden over the red regions but the rash is not initially itchy like a poison oak rash would be at that point. While the Shiitake dermatitis itself is a toxic reaction, not an immune-stimulated allergic reaction, consumption of large amounts of raw Shiitake in individuals who would otherwise Be unaffected, can lead to an allergic response (Kopp et al 2009). Sensitized individuals react strongly when pricked with raw Shiitake but not with Shiitake, indicating that they have developed an allergy. Some workers in Shiitake grow houses develop an eczema-like rash due to Shiitake specific immunoglobulin (Aalto-Korte, et al 2005). There are also documented cases of allergic and chronic hypersensitivity pneumonitis induced by spores of Shiitake.

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