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Poinsettia

Scientific Name(s): Euphorbia pulcherrima Willd. ex Klotzsch
Common Name(s): Christmas flower, Christmas star, Easter flower, Lobster flower plant, Mexican flame leaf, Noch Buena, Papagallo, Poinsettia, Star of Bethlehem

Clinical Overview

Use

Poinsettias are used primarily as Christmas ornamentation but have been used traditionally to treat skin conditions, warts, and toothaches; however, clinical studies are lacking to support these uses.

Dosing

No recent clinical evidence exists to support specific dosing of poinsettia in a therapeutic context.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Allergy and contact dermatitis have been reported. Minor GI irritation following ingestion is possible requiring only supportive therapy.

Toxicology

Although many published reports have warned of the plant's toxicity, there is little clinical evidence to support this claim.

Botany

Poinsettia belongs to the Euphorbiaceae (spurge) family, which includes more than 1,000 herbs, shrubs, and trees. Many members of this family, including poinsettia, are characterized by the presence of a milky latex emulsion found in the lactiferous vessels. When damaged, the plants secrete this latex. Poinsettia is a perennial ornamental found throughout warmer climates in the United States and Mexico. The plant has small yellow flowers and red leaves (bracts), which are prized for their decorative effect. The plant has also been referred to as Euphorbia poinsettia Buist and Poinsettia pulcherrima Graham.1, 2

History

The poinsettia plant was brought from Mexico to the United States by Joel Robert Poinsett, a physician, botanist, and US diplomat, in the early 1800s.2 E. pulcherrima sap has been used as a depilatory agent, and extracts of the plant were used traditionally as an antipyretic and to stimulate lactation.3, 4 Poinsettia has also been used as a natural remedy for warts and toothaches, although the plant is now primarily used for decorative purposes.2, 3

Chemistry

The stems and leaves may contain small amounts of alkaloids; however, there are conflicting data regarding the presence of these compounds. The latex or milky sap contains aminobutyric acids, cycloartenol, and pseudotaraxasterol.3 Although saponic glycosides and diterpene esters from the sap are often believed to be toxic, there is little evidence of the plant's toxicity.5, 6 Compounds found in the leaves and stems include germanicol, beta-amyrin, pulcherol, octaeicosanol, beta-sitosterol, rubber, caffeic acid, and anthocyanin.3 Chemical constituents of the flowers and fruit have also been described.3, 7

Uses and Pharmacology

Animal data

Crude E. pulcherrima extract exhibited some antiviral activity; however, further fractionation resulted in loss of this effect.8

Molluscicidal activity against fresh water snails has been demonstrated with aqueous poinsettia latex extract.9

Effects of dried poinsettia latex on the CNS, including antinociception, anticonvulsant, motor coordination, sedative-hypnotic potentiation, and antianxiety effects, were evaluated in rodents; only anticonvulsant effects were observed.10

Clinical data

Research reveals no clinical data regarding the use of poinsettia.

Dosing

Clinical evidence does not support specific dosing of poinsettia in a therapeutic context.

Pregnancy / Lactation

Avoid use. Information regarding safety and efficacy in pregnancy and lactation is lacking. Traditional use as a galactogenic agent has not been clinically supported.4

Interactions

None well documented.

Adverse Reactions

Reports of contact dermatitis11, 12 and allergy with rhinitis and asthma have been reported,13 especially in atopic individuals.14, 15

Toxicology

Although many published reports have warned of the plant's toxicity, there is little clinical evidence to support this claim.4, 14 The apparent source of these reports is a single, poorly documented 1919 case in which a 2-year-old child in Hawaii died after ingesting the plant leaves.4, 14, 16 Due to the bright color of the foliage, ingestion by children is common; however, there are very few poison center reports of adverse effects.14, 16 Supportive therapy is recommended; lavage or induction of vomiting is not necessary.16

Reports of toxicity (increased salivation, vomiting, and, rarely, diarrhea) in domestic cats, thought to be due to diterpenoid esters, have been published.6, 17 However, the diterpenes responsible for GI upset that are found in other members of the Euphorbia spp. are not found in E. pulcherrima.14 Toxicity studies in rodents show no evidence of toxicity, even following instillation of the plant's latex into the eyes.14, 18, 19 Minor skin irritation has been observed after repeated exposure in rabbits.11, 14

References

1. Euphorbia pulcherrima. USDA, NRCS. 2015. The PLANTS Database (http://plants.usda.gov/java/, 2015). National Plant Data Center, Baton Rouge, LA 70874-4490 USA. 2015.
2. Trejo L, Feria Arroyo TP, Olsen KM, et al. Poinsettia's wild ancestor in the Mexican dry tropics: Historical, genetic, and environmental evidence. Am J Bot. 2012;99(7):1146-1157.2276335410.3732/ajb.1200072
3. Duke J. Handbook of Biologically Active Phytochemicals and Their Activities. Boca Raton, FL: CRC Press; 1992.
4. Winek CL, Butala J, Shanor SP, Fochtman FW. Toxicology of poinsettia. Clin Toxicol. 1978;13(1):27-45.737986
5. Petersen DD. Common plant toxicology: a comparison of national and southwest Ohio data trends on plant poisonings in the 21st century. Toxicol Appl Pharmacol. 2011;254(2):148-153.2103475610.1016/j.taap.2010.10.022
6. Cortinovis C, Caloni F. Epidemiology of intoxication of domestic animals by plants in Europe. Vet J. 2013;197(2):163-168.2357077710.1016/j.tvjl.2013.03.007
7. Gupta DR, Bhushan R, Ahmed B, Dhiman RP. Chemical Investigation of Fruits of Poinsettia pulcherrima. J Nat Prod. 1983;46(6):937-938.
8. Forero JE, Avila L, Taborda N, et al. In vitro anti-influenza screening of several Euphorbiaceae species: structure of a bioactive Cyanoglucoside from Codiaeum variegatum. Phytochemistry. 2008;69(16):2815-2819.1885186210.1016/j.phytochem.2008.09.003
9. Singh A, Singh SK. Molluscicidal evaluation of three common plants from India. Fitoterapia. 2005;76(7-8):747-751.16253436
10. Singh KK, Rauniar GP, Sangraula H. Experimental study of neuropharmacological profile of Euphorbia pulcherrima in mice and rats. J Neurosci Rural Pract. 2012;3(3):311-319.2318898410.4103/0976-3147.102612
11. D'Arcy WG. Letter: Severe contact dermatitis from poinsettia. Arch Dermatol. 1974;109(6):909-910.4830105
12. Massmanian A. Contact dermatitis due to Euphorbia pulcherrima Willd, simulating a phototoxic reaction. Contact Dermatitis. 1998;38(2):113-114.9506231
13. Ibáñez MD, Fernández-Nieto M, Martínez J, et al. Asthma induced by latex from 'Christmas flower' (Euphorbia pulcherrima). Allergy. 2004;59(10):1127-1128.15355476
14. Evens ZN, Stellpflug SJ. Holiday plants with toxic misconceptions. West J Emerg Med. 2012;13(6):538-542.2335984010.5811/westjem.2012.8.12572
15. Aydin Ö, Erkekol FÖ, Misirloigil Z, Demirel YS, Mungan D. Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma. Allergy Asthma Proc. 2014;35(2):e9-e14.2471777910.2500/aap.2014.35.3733
16. Krenzelok EP, Jacobsen TD, Aronis JM. Poinsettia exposures have good outcomes...just as we thought. Am J Emerg Med. 1996;14(7):671-674.8906768
17. Botha CJ, Penrith ML. Potential plant poisonings in dogs and cats in southern Africa. J S Afr Vet Assoc. 2009;80(2):63-74.19831265
18. Runyon R. Toxicity of fresh poinsettia (Euphorbia pulcherrima) to Sprague-Dawley rats. Clin Toxicol. 1980;16(2):167-173.7398206
19. Stone RP, Collins WJ. Euphorbia pulcherrima: toxicity to rats. Toxicon. 1971;9(3):301-302.5092399

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