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Feature Christmas 2021: Time Warp

The holly and the ivy: a festive platter of plant hazards

BMJ 2021; 375 doi: (Published 15 December 2021) Cite this as: BMJ 2021;375:BMJ-2021-066995
  1. George R Huntington, clinical fellow,
  2. Megan L Byrne, registrar
  1. University Hospital Lewisham, Lewisham and Greenwich Trust, London, UK
  2. Correspondence to: G Huntington

An unsystematic review, inspired by Christmas culture, examining the potential for harm from consumption or exposure to plants associated with Christmas

Christmas has come again, and while we merrily adorn our hallways, perhaps few of us pause to consider what harm might result from the verdant leaves. Christmas trees have been described as a source of harm,1 and much has been written about mistletoe.2 But which other plants are on the naughty list? We decided to investigate (box 1)—our work comes with a hazard warning that it is far from systematic, nor is it a definitive guide to instances of poisonings or their management.

Box 1

How this article was made

To compile a list of greenery for investigation, we carried out informal interviews with 22 friends and colleagues on the plants they associated with Christmas, checked aisles of shops, garden centres and florists, looked in magazine back catalogues, and immersed ourselves in Yuletide songs, films, and stories. Our friends and colleagues are from a largely British background, and the traditions and plants they mentioned reflect this.

We checked the plants identified in the TOXBASE database. Those listed as low toxicity were excluded from further search criteria. For those listed as toxic, we searched PubMed with the terms “poison,” “poisoning,” and “Christmas.” Examples of animal and livestock poisoning were excluded.


Plants from songs and carols

Christmas trees (at least the organic kind) are thankfully considered safe to rock around,3 barring a few cases of contact dermatitis from workers with unusually high exposure.1 As for the titular holly and ivy, European ivy (Hedera helix) is a low risk plant with no documented human poisonings associated with its consumption,45 though once again a few cases of allergic dermatitis resulting from its handling have been reported.67 Evergreen English holly (Ilex aquifolium), on the other hand, needs be …

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