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Swallowing American Mistletoe
Your Holiday Question Answered
Poison Control
The Bottom Line
Swallowing American
mistletoe can cause symptoms such as gastrointestinal upset but is not likely
to cause serious poisoning if small amounts are unintentionally swallowed.
The Full Story
There are two types
of evergreen shrubs with the common name mistletoe: American mistletoe (Phoradendron
serotinum) and European mistletoe (Viscum album).
Abundant literature
and folklore describe the European variety’s herbal, mythical, and medicinal
history.
Poisonings and
deaths have been reported from ingestion of European mistletoe.
American
mistletoe’s toxic reputation is probably guilt by association because it has
the same common name as its European relative.
How poisonous is
ingestion of American mistletoe?
One study examined
the outcomes of 1754 American mistletoe exposures.
The overwhelming
majority of exposures occurred during the Christmas season when American
mistletoe is used decoratively.
Children accounted
for 92% of these cases, and 96% of all exposures were by swallowing.
The vast majority
of patients had no symptoms and there were no fatalities, including the 72
people who swallowed mistletoe on purpose.
Another study
described 92 American mistletoe exposures (mostly very young children) reported
to three poison control centers.
Ingestions of up to
20 berries and five leaves were reported. In cases where five or more berries
were consumed, none of the patients had symptoms.
Three of the 11
patients who swallowed 1-5 leaves developed gastrointestinal upset. One child
had a seizure, but it could not be clearly connected to mistletoe.
The study concluded
that symptoms are uncommon even in large ingestions of American mistletoe.
It appears that
American Phoradendron mistletoe is less toxic than the
European species Viscum album.
The literature on
the European variety includes reports of serious poisonings and deaths, usually
due to excessive concentrated herbal use such as brewing mistletoe in
tea.
V. album is not native
to or sold in the US, but it could be privately imported.
American mistletoe doesn’t deserve its highly toxic reputation.
According to ancient myth, anyone kissed under mistletoe would
be blessed by love.
So enjoy the “kissing ball” this holiday season but, as with any
plant, keep it out of reach of curious children and pets!
This Really Happened
Case 1. Some
decorative American mistletoe was still hanging in a home in February. As it
was taken down, dried leaves fell to the floor. The parents of a 9-month-old
boy thought they had gathered up all the leaves but later found a mistletoe
leaf in the child’s mouth.
His mother called Poison Control and
was advised to give him something to drink and watch for gastrointestinal
upset. When Poison Control followed up 6 hours later, the boy was fine.
Case 2. A family
decorated a holiday dessert with European mistletoe leaves and berries grown on
their US property. A 3-year-old boy ate 1-2 berries and leaves but didn't have
any symptoms.
His father, who witnessed the event,
called Poison Control. Poison Control recommended giving a snack and something
to drink and washing the child's hands.
Poison Control also instructed the father to
watch the child for vomiting, confusion and drowsiness over the next several
hours.
When Poison Control checked back by phone 4
hours later and again the next day, the father reported the child was fine.
Mistletoe should not be used to decorate food!
If you think someone might have
swallowed mistletoe, call Poison Control right away at 1-800-222-1222 or use
the webPOISONCONTROL® tool
for guidance online.
Mary Elizabeth May, RN, BA, MPH
Certified Specialist in Poison Information
Certified Specialist in Poison Information
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