Holly
Scientific Name(s): Ilex aquifolium L., I. opaca Sol., and I. vomitoria Aiton. Family: Aquifoliaceae
Common Name(s):A number of members of the genus Ilex are referred to as “holly.” Holly, English holly , Oregon holly , and American holly are the species most often associated with the ornamental Christmas holly. Yaupon , Appalachian tea , cassena , deer berry , Indian holly , Indian black drink are also commonly discussed with the hollies.
Clinical Overview
 |
Uses of Holly
Primarily used as a holiday decoration. Historically used in teas as an emetic and a CNS stimulant.
Holly Dosing
There are no recent clinical studies of holly to provide a basis for dosage recommendations.
Contraindications
Contraindications have not yet been identified.
Pregnancy/Lactation
Documented adverse effects. Avoid use. 1
Holly Interactions
None well documented.
Holly Adverse Reactions
The spines of some leaves may tear or puncture skin or mucus membranes.
Toxicology
Although no fatalities have been reported, 20 to 30 berries is the estimated lethal dose in small children. 2 Ingestion can cause vomiting, diarrhea, stupor, dehydration, and electrolyte imbalance. 3
Botany
Ilex species are evergreen trees or shrubs with stiff leathery leaves. The flowers are often white and produce fruits that range in color from black to bright red to yellow. The plants are found throughout most of the eastern and southern United States.
The genus Ilex consists of over 400 species. It requires a wet and equable climate and shows a worldwide distribution, except in arctic or arid regions. The major areas of distribution are Central and South America, with Brazil alone having 60 species, and Asia which has at least 112 different species. The North American species are largely ornamental and derived from Central and South America. 4
History
The plants in the holly family have been used as ornamentals and in herbal medicine for centuries. Early history records the European pagans offering holly branches as gifts during the Saturnalia. Early Christians decorated their homes with holly during Christmas, a practice still continued today. 4 The early settlers in the southeastern United States made yaupon tea from I. vomitoria , reserving a stronger decoction for use as an emetic. I. opaca fruit tea had been used as a cardiac stimulant by the American Indians; the Chinese had used it to treat coronary disease.
One of the most economically important species, I. paraguayensis or Maté tea (see separate monograph) has long been cultivated and used in Brazil and Paraguay as a tea-like beverage containing caffeine. The mixed leaves of I. cassine , I. vomitoria and I. dahoon were also used for another hot drink called yaupon or black drink. Drinkers used it ceremonially to “cleanse” themselves, probably due to its sweat- and vomiting-inducing effects. Another beverage made from the leaves of I. cassine and I. vomitoria was used as a stimulant tea in the Southern US during the Civil War. 4
Chemistry
A fair amount has been written about the chemistry of the holly. Most contain tannins. Analyses done on the leaves of I. aquifolium described the presence of tannic acid, a bitter glycoside (ilicin), ilexanthin (rutin), and ilicic acid. 5 Some members of the genus, such as I. paraguayensis St. Hill (yerba mate) contain xanthine alkaloids such as caffeine in levels as high as 2%. Other species contain saponins and triterpenes. 6
One review on the chemistry of Ilex documented hundreds of compounds isolated from Ilex from the late 1800s up to 1987. Selected examples of the various classes of chemical constituents include phenols and phenolic acids (p-hydroxybenzoic acid, arbutin), anthocyanins (pelargondin 3-bioside, cyanidin 3-glucoside), flavonols and flavons (rutin, kaempferol), terpenoids (alpha-amyrin, ursolic acid), sterols (sitosterol, ergosterol), purine alkaloids (caffeine, theobromine), amino acids (aspartic acid, glutamic acid), miscellaneous nitrogen compounds (trigonelline, choline), fatty acids (oleic, linolenic), alkanes and alcohols (nonacosane, mellisyl alcohol), carbohydrates (sugar alcohols, sucrose), vitamins and carotenoids (ascorbic acid, thiamine).
Holly Uses and Pharmacology
Many Ilex species seem to be devoid of significant pharmacologic activity; however, some are capable of inducing vomiting through a local irritant action. Saponins are found in some species of Ilex but their absorption through intact mucosa is minimal. Saponins generally cause severe diarrhea and GI upset.
Traditional usesOne extensive review provides a cosmopolitan view of the folkloric uses of Ilex . These include the use of I. pubescens in the traditional medicine of China for treating coronary heart disease, I. cornuta for dizziness and hypertension, I. aquifolium leaves for intermittent fevers and rheumatism as well as for its antipyretic, astringent, diuretic and expectorant properties, and the use of I. opaca leaves as a diuretic, tonic, purgative and cardiac stimulant. Earlier reports from the early 1930s indicate that the dried powder emulsion made from the leaves and berries of I. aquifolium and I. opaca possessed the pharmacological activity of digitalis.
Animal dataResearch reveals no animal data on the traditional uses of holly.
Clinical dataSeveral studies have confirmed the depurative, stimulant, and diuretic actions of I. paraguayensis and related these effects to its high purine content.
Other usesMore recent studies have shown that I. asprella constituents (asprellic acids A and C) have shown cytotoxicity against RPMI-7951 and KB cells, whereas asprellic acid B was inactive.
Dosage
There are no recent clinical studies of holly to provide a basis for dosage recommendations.
Pregnancy/Lactation
Documented adverse effects. Avoid use. 1
Interactions
None well documented.
Adverse Reactions
The leaves of most species are generally considered to be nontoxic, although the spines of some leaves may tear or puncture skin and mucous membranes.
Toxicology
Although they are not usually considered to be poisonous, ingestion of the holly berry may cause gastrointestinal disturbances such as vomiting and diarrhea, and may result in stupor if eaten in quantity. 7 Their ingestion should be considered dangerous to small children with the probable fatal dose having been estimated to be 20 to 30 berries. 2
A case of 2-year-old identical twins who ingested a “handful” of holly berries ( I. opaca ) has been reported. 3 Both children vomited for more than 6 hours and one became drowsy; 20 hours after ingestion, both had an episode of green watery diarrhea. Both were asymptomatic 30 hours after ingestion of the berries. This report indicated that the gastrointestinal effects associated with this plant could be so severe that its presence could cause dehydration and electrolyte imbalance. The drowsiness experienced by one of the children may have been induced by ipecac.
General schemes are available for treating holly poisoning. They involve induction of vomiting if large quantities of berries are ingested, followed by activated charcoal and a saline cathartic. Excess stimulation caused by theobromine may be countered with barbiturates or benzodiazepines. The central nervous system should be monitored.
Bibliography
1. Wickersham RM, Novak KK, managing eds. Drug Facts and Comparisons . St. Louis, MO: Wolters Kluwer Health, Inc.; 2004.2. Ellis MD. Hosp Phys 1972 Dec 2;42–3.
3. Rodriguez TD, et al. Vet Hum Toxicol . 1984;26:157.
4. Alikaridis F. J. Ethnopharmacol 1987;20:121–44.
5. Fournier P. Plantes medicinales et veneneuses de France. P . [French] Le Chevalier, Paris, 1948.
6. West LG, et al. Phytochemistry . 1977;16:1846.
7. Arena JA. JAMA 1979;242:2341.
 |
Link to Page |  |
Print Page |  |
Email Page |  | Add to List |
