Our patient was exposed to burning sumac smoke while clearing out her yard . Toxicodendron vernix is a woody shrub or tree which can grow to 30 ft. It contains urushiol which is the same resin in poison ivy and poison oak but is more toxic in sumac. Poison ivy has a C15 side chain, poison oak has a C17 side chain and poison sumac has a C13 side chain. Whensumac burned, the smoke can cause breakdown in the lining of the lungs causing ARDS.

This is not a new problem. In fact, the Iroquois used sumac in warfare. By setting fires with sumac upwind of their enemies they caused respiratory distress and even death in their enemies. The following is a quote from a book by Thevet in 1557.

“They also used poisons made from the leaves of trees, herbs, and fruits, which are dried in the sun, and placed amongst the faggots and branches, then they set fire when they see the enemy approaching.” A smoke emerges which is so thick, black and dangerous to breathe, as much for the fetid odor as for the poison mixed in these faggots, that several are suffocated.