A WORD OR TWO ABOUT GARDENING

Caution: these plants might rub you up the wrong way.

Althoughplants,includingthosefoundinlocallandscapes,oftencontainanarrayof
toxiccompounds,asurveyofUSpoisoncontrolcentersfoundonly30deathsinthe18
yearperiodleadingupto2000.TherewerenoreporteddeathsintheU.S.during2007,
thelatestyearforwhichpublishedstatisticsareavailable.Evenso,incidentsinvolving
plantsarethefourthmostcommoncalltopoisoncontrolcentersnumberingmorethan
60,000for2007comparedtoalmost55,000forinsecticides.Whileweexpectthe
pesticidesweuseintheyardtobetoxic(theycarrywarninglabels),plantscomewith
nosuchwarninglabels.Thepotentialrisksassociatedwithwhatwechoosetoplantare
rarelyconsidered.Wemaybeawareoftheobviousones,spinesandpricklesfor
instance,butareoftenunawareoftheunseendangers.Itisimpossibletototally
removerisk,butwecanatleastbeawareofpotentiallyhazardousplantsinour
landscape,inparticularanythatmightattractachild:thosewithbrightlycolored
fruit/flowersorlargesucculentleaves.Approximately85%ofallplantpoisoning
enquiriestopoisoncontrolcentersconcernyoungchildren.
Thepresentarticleconcentratesonplanttoxinsthatproducesymptomsasaresultof
skincontact(i.e.,contactdermatitis).Asecondarticlewillconsiderplantsthatare
internalpoisonswithsymptomsthatdevelopafterplantpartshavebeeningested.
Threetypesofcontactdermatitisarereferredtobelow.Thefirsttwoproduce
symptomsrapidly(withinminutes):irritantdermatitisresultsfromdirectphysicaland
/orchemicaldamagetotheskin;immunologiccontacturticariaisanimmediatetype
hypersensitivityreactionwhichmanifestsasrapidintenseitchingandwelts.This
reactionisinresponsetothepresenceofforeignproteinsandmediatedbyproduction
ofaspecificantibody(IgE).Antibodies(immunoglobulins,Ig)areproteinsthathelp
neutralizewhatthebodyperceivesasforeign.Immediatetypehypersensitivityis
moreoftenseeninindividualsthatareatopicsensitivetoagreaterrangeof
substancesbecausetheyoverproduceIgE.Thistypeofallergicresponsetocontact
withplantsisrarecomparedtodelayedcontactdermatitis.
Indelayedcontactdermatitis,symptomsdevelop2448hoursafterexposureto
variouslowmolecularweightcompounds(e.g.,componentsinplantsap)towhichan
individualbecomessensitized,andinvolvescytotoxiccells(ratherthanantibodies)of
theimmunesystem.Factorsreleasedbythesecells(stimulatedbythecompoundto
whichyouaresensitized)causethereddening(erythema),intenseitching(pruritis)and
numeroussmalltolargefluidfilledblisters.Thecompoundsintheplantsaptowhich
youbecomesensitizedactashaptens.Afterpenetratingtheskinsurfacehaptensbond
withnormalbodyproteinsmakingthemappearforeignwhichthenelicitstheabove
cellularimmuneresponse.
Aroids(Araceae)makeupthebulkofplantspeciesmostfrequentlyencounteredby
poisoncontrolcenters.OfparticularconcernareDieffenbachia(dumbcane)andtoa
lesserdegreeSpathiphyllum(peacelily),Anthurium,Aglaonema(Chineseevegreen),
Colocasia(taro),Epipremnum(pothosvine),Zantedeschia(callalilies)andCaladium.

Theirpopularityashouseplantsmakesthemespeciallyaccessibletoveryyoung
children.Theyallcontainoxalicacid,bothfreeandasmicroscopicneedlelikecrystals
ofcalciumoxalate(raphides),locatedinspecialmucilagecontainingcells(idioblasts).
Whentheleaf/stemofanaroidiscrushed(orchewed)theidioblasttipsbreakoff.The
mucilagethenswellsasitabsorbwateraffectingarapidmassexpulsionofraphides.
Oncontactwithsapfrombrokenaroidstems,thereleasedraphidescancauselocalized
irritantdermatitisandeyeinjury.Ifarashdevelopsaftertrimmingtreesorcleaningup
afterastorm,checktoseeifyouremovedanyvineshavingsucculentstemsandlarge
greencordate(heartshaped)orpinnatifid(highlylobed)leaves.Ifso,thisisprobably
thepothosvine(Epipremnumpinnatum).Acultivarwithboldlyvariegatedgreenand
yellowleaves,Aureum(someregarditasaseparatespecies,Epipremnumaureum)is
sometimesseengrowinguptallpalmsorlargetrees.Syngoniumpodophyllum,(arrow
head)vineisanotheraroidthatmaybeencounteredclimbingintoareatrees.Both
vinesarecontrolledinMiamiDade(cannotbeplantednearnativeplantcommunities).
Potentiallymoreserious,bitingintoanaroidresultsinvastnumbersofraphides
piercingthemucosaofthemouthandthroatliketinyshardsofglass.Apartfrom
immediatephysicaldamage(andpain),itissuggestedthatraphidesmaydirectly
stimulatethereleaseofhistaminefrommucosalmastcellscausinglocalizededema
(swelling)andinflammation.Idioblastsarealsobelievedtoreleasefreeoxalicacid
whichcanresultinextensiveerosionoftheepithelialcellsofthemucosaofmouthand
throat.Otherfactors(e.g.,proteolyticenzymes)havebeenisolatedbuttheirroleinthe
observedsymptoms,includinganylossofspeech(asoccurswithDieffenbachia)isnot
known.Duetoanalmostinstantaneoussevereburningsensation,itisrarethat
sufficientplantmaterialisingestedforaroidstocauseseriousinternalpoisoning.
Althoughswellingofthethroatcouldobstructtheairpassage,thisisinfrequentandin
thevastmajorityofcasesexposureprovestobeverypainfulbutfarfromlife
threatening.
Apartfromaroids,raphidesoccurwidelyinmanyothermonocotyledons;inthe
Arecacae(palms)raphidesarefoundinstems,roots,leavesandevenflowers.
Especiallyhighconcentrationsarefoundinthefruitsofseveralpalmspeciesgrownin
locallandscapesasmanywhohaveremovedfruitingstemsfromaclusteringfishtail
palm(Caryotamitis)canattest.FruitofthedwarfsugarpalmArengatremula
contains1.5xsasmuchoxalateasthefishtailpalm.Bothpalmsarehapaxanthic(stems
slowlydieoncetheybearfruitatwhichtimetheyareusuallyremoved).Oneoptionis
toremovetheinflorescencebeforefruitsets,ortofirstcarefullyremovefruit,thencut
downthestem.Otherlandscapepalmswithfruitcontaininghighconcentrationsof
oxalateincludebuccaneerpalm(Pseudophoenixsargentii),Macarthurpalm
(Ptychospermamacarthurii),royalpalm(Roystonearegia),hurricanepalm
(Dictyospermumalbum),spindlepalm(Hyophorbeverschaffeltii)andseveral
Chamadoreaspp.Ifyoucollectfruitfromthesepalmsforpropagationwearlong
rubbergloveswhencleaningfleshfromtheseeds.
Anotherfamilyofmonocotyledons,Agavaceae(Agaveamericana,thecenturyplant
ismostfamiliar)formsixsidedraphidesandcontainsaponins(compoundsconsisting
ofacomplextriterpenoid,orsteroidcore,towhichoneormoresugarsareattached).

Saponins(alsoreferredtoassteroidalglycosides)arefoundinvariousplantfamilies;
somearehighlypoisonouswhentakeninternally,whileotherscancausesevereskin
irritation.Thelatterarefoundinagavesandaggravatethemechanicaldamage
inflictedbyraphides.Landscapeagavesareonlyrarelyreportedasthecauseof
contactdermatitis.Thefactthatmostpossessfearsomespinesnodoubtwarnspeople
tobeontheirguard.Ifyouneedtoremovealargeagave(e.g.,afterfloweringwhen
theydie)donprotectiveeyewear,glovesandalongsleevedshirtandusealong
handledcactussaw(definitelynotachainsaw!).
Tradescantiaspp.,monocotyledonsintheCommelinaceae(spiderwortfamily),
featurewidelyinarealandscapes.Purplequeen,Tradescantiapallida(syn.Setcreasea
pallida),inparticular,isawidelyusedgroundcoverwithbrittlesucculentstems.
Dependingonsusceptibility,contactwithsapfrombrokenstemscancausemildto
moderateskinirritation,usuallyofatransientnature.Itisnotknownforcertainwhat
component(s)inthesapareresponsible,butT.pallidaisknowntocontaincalcium
oxalatecrystalsintheformofraphides.TheoysterplantTradescantiaspathaceae,
syn.Rhoeospathaceae(acontrolledspeciesinMiamiDade)alsocausesan
itching/burningskinirritation.Thereappeartobenoaccountsregardingadverse
effectsfollowingcontactwithathirdspeciesTradescantiazebrina(wanderingsailor)
alsousedasagroundcover.
Whileraphidesaremostlyfoundinmonocotyledonstheyalsooccur,tovarying
degrees,in27dicotyledonfamilies.Amongthese,theVitaceae(grapefamily),contain
onespeciesVirginiacreeper(Parthenocissusquinquefolia)responsibleonoccasionfor
mildtomoderateirritantdermatitis.Asuperficialresemblancetopoisonivyhaslead
tothetwoplantsbeingmisidentified.Unlikepoisonivy,whichproducesadelayed
contactdermatitis2448hafterexposure(seebelow),symptomsduetoVirginia
creeperdevelopfarmorerapidly.Theseincludeintenselocalizeditching,inflammation
andswelling,theresultofcontactwithsapfrombrokenstemsandbruisedleaves.
Suchwasthecaseforalocallandscapecrewclearingvinesfromanovergrownlot.
Poisonivywasinitiallysuspected,howeversamplesofthevinebroughttothisoffice
werequicklyidentifiedasVirginiacreeper.
MembersoftheAnacardiaceaeareresponsibleformorecasesofcontactdermatitis
intheU.S.thanallotherplantscombined.Ofthesebyfarthemostimportantarefive
speciesofToxicodendroneasternandwesternpoisonoak,poisonsumacandeastern
andwesternpoisonivy.Onlyeasternpoisonivy(Toxicodendronradicans)isfoundin
southFloridaandinMiamiDadeitisinfrequentinresidentialareas.Sapfromallthese
plantscontainsoilyphenoliclipids,urushiols(alkenylcatechols)thatreadilypenetrate
theouterlayersofskin.Theyarethensusceptibletooxidiationtomorereactive
quinoneswhichactashaptensandbindtoproteinsonthesurfaceofwhitebloodcells
deeperintheskin.Thesemodifiedproteinsarerecognizedasforeign(antigens)and
primethebodysimmunesystem,sensitizingsusceptibleindividualstofurther
exposure.Whileinitialcontactmayelicitamildskinresponseupto2weekslater,
subsequentcontactwithurushiolscausesafarmorepronounceddelayedtype
contactdermatitis(after2448h).

Contactneednotbedirectwithpoisonivybutsurfacescontaminatedwithsap.The
lattercouldbeanythingfromclothing,mulch,gardeningtoolsorevenyourpetsfur
(urushiolsareonlyallergenictoprimates).Inadditionurushiolsremainallergenicfor
manymonths(oryearsincooldryclimates).Intheabsenceoftreatment,fullrecovery
frompoisonivydermatitistakesabout3weeksdependingonthedegreeofsensitivity
andextentofexposure.Approximately1015%oftheUSpopulationistolerant(do
notreact)tourushiolexposure,withupto75%inagivenareasensitized(farfewerin
largeurbancenterswherethereislessgreenery).Thedegreeofsensitivityvariesand
appearstobegeneticallydetermined,withpeaksensitivitytoexposureoccurringin
childrenbetweentheagesof814years.
Urushiolsandrelatedphenoliclipidsarefoundinothermembersofthe
Anacardiaceae.Locallythisincludesthenativepoisonwoodtree(Metopium
toxiferum)whichcontainshighlyallergenicalkenylcatecholssimilartothosefoundin
Toxicodendronspp.Thisisahazardoustreethatisbestlimitedtoseriousnativeplant
collectors.Twootherrelatedplantsoflocalinterestaremango(Mangiferaindica)and
Brazilianpepper(Schinusterebinthifolius)whichcontainlessallergenicalkenyl
resorcinolsandalkenylphenolsrespectively.Allergensareconcentratedwithinthe
bark,berriesandnewleavesofBrazilianpepper,whileinmangotheyarefoundinsap,
butmoresignificantlyalsointheskinofthefruit(traceamountsinflesh).Theallergens
inallofthesemembersoftheAnacardiaceaecrossreactwithoneanothertovarying
degrees.Forinstance,apersonwhohasbeensensitizedbypriorexposedtopoisonivy
isalsolikelytoreacttotheallergensinmangoskin.Thereisevidencethatpersons
raisedinmangogrowingareaswhohaveconsumedmangoregularlyfromanearlyage
developatolerancetomangoinducedallergicdermatitis.Thecashewtree
Anacardiumoccidentale)isgrownlocallyinMiamitoalimitedextent.Greatcare
needstobeexercisedinhandlingthenut.Thedoublewalledshellcontainshigh
concentrationsofapotentallergenandvesicant,anacardicacid,whichisstructurally
relatedtothealkenylcatechols(urushiols).
Philodendronspparearoidsthatapartfrompossessingirritantraphides,alsocontain
alkenylresorcinols.Thesehavebeenassociatedwithadelayedtypecontact
dermatitisthatdevelopsinsusceptibleindividualsafterrepeatedcontactwith
philodendronsovermonthsoryears.Thereishowevernoevidenceofcrossreactivity
withextractsobtainedfromToxicodendronspp.Phenoliclipidsarefoundinmembers
oftheProteaceaeincludingalkenylresorcinolsinthesilkoak(Grevillearobusta).
Appreciatedforitsdelicatefoliageandorangeyyellowflowersitisafastgrowingtree
producingrapidshade.MorecommonincentralFlorida,itadaptspoorlytolocal
alkalinesoilsandishighlypronetostormdamage.Thetreehasbeenreportedasthe
causeofcontactdermatitissimilarbutlessseveretothatseeninpoisonivy.
PlantsofthespurgefamilyEuphorbiaceaecontainnotonlysomeofthemostdeadly
ofallplanttoxins(e.g.,ricin),butdependingonthespeciesthelactiferoussap(latex)
cancausesevereirritantdermatitis.Theirritantsinvolved,diterpeneesters
(especiallyphorbolesters),arefoundinboththelatexandseedsofmanyeuphorbs.If
takeninternallytheycancauseseverepoisoning.Skincontactwithlatexresultsina
rangeofsymptomsfrommildskinirritationtolocalizedswellingandsevereblistering,

whilecontactwiththeeyescauseintenseburningandpossibletemporaryblurred
vision.
ThemostcommonEuphorbiafoundinlocallandscapesiscrownofthorns,Euphobia
milii;severalcompactcultivarsandthefloriferousE.xlomihybridshavingstimulated
renewedinterestoverthepast67years.Thelatexfromcrownofthornsusually
causesamildtomoderateirritantdermatitiscomparedtothemoreseveresymptoms
seeninthelargesocalledcactuseuphorbs.Severalditerpeneestersareknowntoact
ascocarcinogens(i.e.,theyarenotdirectlycarcinogenic,butmaypromotecancerin
concertwithotherfactors).Inthisregardattentionhasbeendrawntothecoincidental
distributioninE.Africaofpencilcactus,Euphorbiatirucalliwithareasthatexperience
particularlyhighratesofBurkittslymphoma.Thisisanaggressiveformofcancer
foundmostlyinchildren(extremelyrareintheUS)inwhichtheEpsteinBarrvirusmay
playanessentialrole.
Inlocallandscapespencilcactuslatexcancauseintenseinflammation,blisteringof
skin(whichcanbeslowtoheal)andsevereeyeinjury.Itisalargeplantwithmanythin
brittlebrancheswhichbreakeasilyreleasingastreamoflatexmakingitespecially
hazardoustoprune.Althoughpencilcactushasbecomerarerinlocallandscapes,small
plantsaresometimesseeninthesucculentsectionofgardenshops(intendedfor
windowsilluse)includingacultivarsoldasSticksonFirewithnumerousthinorangey
redtippedstems.ThisandEuphorbiatrigona(Africanmilktreeorcathedralcactus),
anotherpotentiallylargespecies,shouldbeplacedwheretheyareinaccessibleto
children.Thislattereuphorbisalsoavailableinastrikingredformandwhereusedasa
pottedpatioplanteventuallybecomestoolargeandunwieldyeasilytoppled,
especiallyifthespinescatchonclothing.Thecandelabracactus(Euphorbialactea)is
anotherlargespecieswithespeciallytoxiclatex,thoughnowmoreusuallyseeninone
ofseveraldwarfcristateforms.Highlyornamental,lookinglikepiecesofcoral,they
areusuallygraftedontoEuphorbianeriifoliaandareavailableinareagardenshops.
Widelyusedinlocallandscapes,thecrotonCodiaeumvariegatumhasclearsapand
whilenotcausingtheirritanttypedermatitisdescribedfortheaboveeuphorbs,itis
associatedwithdelayedtypecontactdermatitisfollowingrepeatedexposuretosap.
Documentedcaseshaveinvolvedfrequenthandlingofcrotons(e.g.,takingcuttings)
eitherashobbygardenersornurseryworkers.Theallergeninvolvedhasnotbeen
identified.Incidentally,truecrotons(Crotonspp.)arerarelycultivated,butcontainat
leastoneespeciallypoisonousspeciesCrotontiglium,theseedsofwhichwereonce
usedasapurgative.Isolatedinstancesofallergicdermatitishavebeenrecordedafter
contactwithanothereuphorbfoundinlocallandscapes,thechenilleplant,Acalypha
hispida.ThemanchineelHippomanemancinella,nativetosouthFlorida(andsouthto
Columbia)findslittleuseasashadetreedespiteitsattractivefoliagebecauseofhighly
irritantsap.Useofthetreeforshadehasprovedunwise,finedropletsofsapdripping
fromthetreehavebeenknowntocausepainfulskinblistersandtemporaryeyeinjury.
TheApocynaceaeisanotherfamilycharacterizedbymilkylatex.Whilecertain
speciesareextremelypoisonousiftakeninternally,contactwiththelatexisan
infrequentcauseofirritantdermatitis.Thelatexfromallamandas,Plumeriaspp.
(frangipanis)andAdeniumspp.(desertrose)maycausemildirritation.Unidentified

allergensincrushedoleander(Neriumoleander)leaveshavebeendocumentedasthe
causeofdelayedcontactdermatitis.Latexisalsofoundinmanymembersofthe
Moraceae.Ediblefig(Ficuscarica)latexcontainsaproteolyticenzyme(ficin,usedto
tenderizermeat)thatinpartisresponsibleforanirritantdermatitis.Severalsmall
proteinspresentinthelatexofFicusbenjaminahavebeenassociatedwith
immunologiccontacturticariaaswellashayfeverlikesymptoms(immediatetype
hypersensitivity)insusceptibleindividuals.Somecrossreactivitywithnaturalrubber
latexisalsoseen.
TheleavesofF.caricacontainfuranocoumarins,contactwithwhichisassociated
withphytophotodermatitis.Followingcontactandexposureofskintosunlight,
severeerythemaandblisteringdevelopoverthenext48hoursoftenfollowedbya
periodofprolongedhyperpigmentationofaffectedskin.MembersoftheRutaceae
alsopossessphotosensitizingfuranocoumarins.Bergapten(foundinoilofbergamot
fromCitrusbergamia)isinlargepartresponsibleforthephotodermatitisthatmay
followcontactwithlimes(moresoPersianthanKeylimes).
Hayfever(immediatetypehypersensitivityreactiontopollenantigens,IgEmediated)
isanalltoofamiliaroutcomeofexposuretomanymembersoftheAsteraceae
(Compositae).Delayedcontactdermatitisisfarlesscommonandmostoften
developsinmiddleagemen.Ratherthanreactingtotheproteinantigensofpollenit
involvesrepeatedexposuretolowmolecularweightcomponents,notably
sesquiterpenelactones,foundinleavesandstems.Manyofthesecompoundsare
relativelybenign(tastebittertowardoffherbivores),andsomehaveimportant
medicinalproperties,e.g.,artemisininfromChinesewormwoodasanantimalarial.
Onlysesquiterpenelactoneswithaparticularchemicalconfigurationareallergenic,
(i.e.,functionashaptens,bondwithproteinssoastomakethemappearforeign).
WithintheAsteraceae,thelandscape/houseplantsmostoftenfoundresponsiblefor
dermatitisarechrysanthemums(crossesinvolvingDendranthemagrandiflorum).There
areotherornamentalspeciestowhichsusceptibleindividualscanbecomesensitized
includingTagetesspp.(marigolds),Helianthusspp.(sunflowers),Tithoniadiversifolia
(Mexicansunflower),Pseudogynoxyschenopodioides(syn.SenecioconfususMexican
flamevine)andGamelopsischrysanthemoides(Africandaisybush).TheAsteraceae
containsfamiliarhighlyallergenicweedssuchasragweed(Ambrosiaartemisiifolia)that,
inadditiontobeingimportantcausesofhayfever,arelinkedtodelayedcontact
dermatitis.Partheniumhysterophorus(partheniumweed)isacommonweedlocallyin
theRedlandfarmingdistrict.InIndiaandAustraliaithasbecomeaserioushealth
problemandisresponsibleforwidespreadairbornedermatitisduetocontactwith
driedwindblownplantparts.
PlantsintheAraliaceaecontainvariouspolyacetylenes,especiallyfalcarinol,which
cancauseirritantdermatitisandlessoftensensitizesusceptibleindividualstoa
delayedcontactdermatitis.Mostreportsconcerncommonivy;howeverofmore
potentiallocalrelevanceScheffleraarboricola(dwarfschefflera)alsocontains
falcarinolandhasbeenlinkedtodelayedcontactdermatitis.Variouscultivarsofthis
shrub,especiallyTrinettearewidelyusedinarealandscapesandgrowncommercially
(usuallycuttings).Symptomsaremostlikelytodevelopfollowingahistoryoffrequent

contactwithcutstemsorbruisedleaves(duringpruningortakingcuttings)when
exposuretosapismorelikely.Irritantdermatitishasalsobeenreportedaftercontact
withPolysciasspp.(aralias)allpartsofwhichcontainsaponins,pluspolyacetylenesin
atleastonespecies,Polysciasfruticosa(mingaralia).
Theaboveplantfamiliesarethosemostcommonlyfoundinlocallandscapesthat
havethepotentialtocauseirritantand/orallergicdermatitis.Sensitivitytoagiven
plantvariesandinmanycasessymptomsmaybemildoronlydevelopafterrepeated
exposure.Ifyousufferanirritantdermatitiswhenworkingintheyardandcannotlink
symptomstocontactwithoneoftheabovegroupsofplants,thelistisnotexhaustive.
Inadditiontherearenonplantcausesofirritantdermatitis.Plantsmayhavebeen
sprayedwithachemicalorharborunseeninsectse.g.,contactwiththenativelittlefire
ant,Wasmanniaauropunctataoroneofseveralcaterpillarswithurticating(stinging)
hairs/spines).Ifyouhaveanyconcernsaboutsymptomsthatdevelopafterindooror
outdoorcontactwithplantscallPoisonControl18002221222
Yes,itshotandhumidformostoftheyearinMiami.Nevertheless,whendoingyard
workwearalongsleevedshirt,longpantsandgloves.Thiswillprovideprotectionfrom
skincontactwithplantmaterialespeciallythatscatteredbypowerequipmentsuchas
linetrimmers(wheneyeprotectionisalsoadvisable).Beextracarefulclearingout
overgrownareaswhereyouarentquitecertainwhatmighthavesproutedup.Thisis
particularlyimportantifyouaretakingoverapreviouslyrepossessedpropertywitha
yardwhichmayhavebeenneglectedforanextendedperiod.Ifyouarentcertainasto
theidentityofplantsinyouryardtakecuttings(notjustaleaf!)toyourlocalExtension
office.IamindebtedtoJeffreyBernsteinMD,MedicalDirectorFloridaPoison
InformationCenterMiamiOffice,forthebenefitofhisexpertise.

JohnMcLaughlin

October5,2009