Retrospective poisons centres-based study on adverse effects due to plant food supplements

Objective: Plant Food Supplements (PFS) are products of increasing popularity and widespread distribution. Nevertheless, information about their risks and bene ts is limited. To fill this gap, the PlantLIBRA project - a part of the EU’s Seventh-Framework- Programme - was started. Within this project, a poisons centre- based study on the risks of PFS was performed. Methods: Through a systematic multicenter retrospective review of data from selected European and brazilian poisons centres (PCs), documented human cases of adverse effects or poisoning due to plants consumed as food or ingredients of food supplements or due to misidenti ed poisonous plants consumed as food were collected for the period 2006–2010. Results: From the 66 contacted PCs, 11 were able to provide a total of 153 cases: 76 cases of adverse effects after intentional ingestion, 76 cases of poisoning due to misidenti cation, and one case of interaction between a PFS and a pharmaceutical. A total of 249 plants and plant-related substances (e.g. caffeine, naringin, olive oil) were involved. The 10 most frequently reported plants were Mandragora offcinarum, Valeriana offcinalis, Aesculus hippocastanum, Colchicum autumnale, Camellia sinensis, Melissa offcinalis, Passifora incarnata, Paullinia cupana, and Mentha piperita. Most cases occurred in adults (91%). The plants most frequently involved in the 76 cases of adverse effects due to intentional ingestion were Valeriana offcinalis and Camellia sinensis. Irritation of skin or mucosa, gastro-intestinal symptoms, signs of neurotoxicity (e.g. dizziness, somnolence, restlessness), and hepatotoxicity were the most frequently observed clinical events. Most cases showed a benign clinical course, however, a severe outcome was recorded in 5 cases. In the 76 cases of misidentifcation only 6 different identi ed plants were recorded: Mandragora offcinarum, Aesculus hippocastanum, Colchicum autumnale, Digitalis sp./D. purpurea, Allium ursinum, Datura stramonium. Severe symptoms were only observed with Colchicum autumnale (multi-organ failure) and Mandragora of cinarum (anticholinergic syndrome). In the remaining cases, mostly mild gastro-intestinal symptoms were recorded. Conclusion: PFS-related adverse effects seem to be relatively infrequent issues for PCs. Most cases showed mild symptoms and a benign clinical course. Nevertheless, the occurrence of some severe adverse effects and the increasing popularity of PFS require continuous active surveillance, and further research is warranted.