Analysis of suspected poisoning associated with officinal plants: a case series reported to the Poison Control Center Unit of Umberto I, Policlinico di Roma

The Poison Control Centers (PCCs) play an important role in the field of Pharmacovigilance. This task could be particularly useful also in the field of Phytosurveillance, as the National Pharmacovigilance Network does not collect adverse effects due to plants and herbal-related products. The aim of the present study is to analyze poisoning-related calls, collected by Poison Control Center (PCC) Unit of Umberto I, associated with officinal plants and their derived products. From March 2010 to June 2012, the PCC Unit of Umberto I, received 154 reports of suspected poisoning, of which: 27% (n=41) concerned plants (some of them were ornamental plants), 10% (n=16) related to herbal products, 9% (n=17) due to “complementary/alternative therapies”, and 52% (n=80) related to “other agents” (e.g. cocoa butter, naturally-derived perfumes, other herbal cosmetics). The plants most frequently represented were Atropa belladonna, Nerium oleander, and Prunus amygdalus var. amara, whereas herbal products and complementary/alternative therapies mainly involved in the reactions were aloe, hawthorn, euphrasy, and various essential oils (mint, eucalyptus, etc.). Two-thirds of reporters were patients (67%, n=103) while one-third were hospital doctors or GPs (33%, n=51). Seventy-three percent (n=113) of the suspected poisoning involved pediatric subjects (27.9±19,2 months, range 3-84), while 20% (n=31) were related to adults (42.9±20.1 years, range 14-86). In all other cases (7%, n=10) the age was not reported. An overwhelming majority of the suspected poisoning happened in a household environment (75%; n=115), mostly after unintentional ingestion (82%; n=126). The time elapsed between onset of the poisoning event and the call to PCC Unit was the following: 69% of cases (n=107) within 2 hours, 7% (n=10) between 2 and 24 hours, 3% (n=5) after more than 24 hours, and in the remaining 21% (n=32) of cases the temporality was unknown. A great number of poison calls were done for asymptomatic subjects (n=113), whereas in the other patients adverse reactions affected the following systems/apparatus: i) gastrointestinal tract (n=17) with nausea, vomiting, dry mouth, abdominal pain, etc. ii) CNS (n=6) with agitation, anxiety, drowsiness, hallucinations etc., iii) skin and eyes (n=12) with cyanosis, swelling, ocular lesions, etc. Respiratory, cardiovascular and musculoskeletal systems were also involved (n=6) with sore throat, bronchospasm, tachycardia, arthromyalgia, etc. Almost a quarter of the intoxications were serious (23%), and in these cases hospitalization (3%) or a hospital emergency room (19%) were recommended. The plants more frequently involved in serious poisoning were Ilex aquifolium, Ficus elastica, melaleuca, and eucalyptus. However, botanical names, or products composition, were often underreported. Our data show that calls to PCC mainly involved pediatric subjects and were caused by unintentional exposure to officinal plants and their related products. As patients were generally asymptomatic, calls seemed to occur mainly to get information, but not a real treatment, about the possible poisoning. Our study highlights that PCCs could have a leading role in the information to citizens, as well as they could be an effective instrument of Phytosurveillance.