Toxic Christmas and New Year Holiday Plants...or Are They?

Background: Poinsettia (Euphorbia pulcherrima), holly (Ilex opaca) and mistletoe (Phoradendron flavescens) adorn homes during the Christmas and New Year holiday season and create the potential for curious children to sample their colorful leaves and enticing berries. This study was aimed to review the American Association of Poison Control Centers National Poison Data System (AAPCC NPDS) to describe the epidemiologic profile of ingestion of these plants and to determine whether there was associated morbidity and mortality. Methods: All plant ingestion exposures reported to American poison centers (PCs) from 2000-2009 were analyzed to identify all exposures to E. pulcherrima, I. opaca and P. flavescens. The data analysis included ingestions by age, gender, patient management site, symptoms, intention and outcome. Results: The AAPCC NPDS database included 668,111 plant ingestions during 2000 to 2009. E. pulcherrima (19,862; 3.0%), I. opaca (5,432; 0.8%) and P. flavescens (1,138; 0.2%) exposures accounted for 26,632 (4.0%) of all plant ingestion exposures. Children younger than six years were responsible for majority of ingestions (88.0%). Ingestions were more likely to occur unintentionally (P < 0.001). Most cases (96.1%) were asymptomatic. When clinical effects developed (1,046 cases), the most frequent reported signs were gastrointestinal in nature (59.8%) including abdominal pain, diarrhea and/or vomiting. Moreover, the development of gastrointestinal signs was higher in patients who ingested P. flavescens compared to the other two species. Most exposures (96.1%) were managed at home with the guidance from PC experts. When the outcome was known, the majority of exposures (89.2%) experienced no adverse effects. Moderate effects occurred in only 28 ingestions (0.1%), and one major effect was recorded in a patient who ingested poinsettia. Conclusion: These holiday plants were associated with extremely low morbidity and no mortality. Home management along with expert guidance can be adequate intervention in the majority of these exposures.