Dieffenbachia species exposures: an evidence-based assessment of symptom presentation

The literature often ascribes significant morbidity to Dieffenbachia exposures. However, poison center experience suggests a discordant view from that presented in the literature. This project determined if the symptoms described in the literature were consistent with clinical practice. To profile the symptoms reported in the literature, an extensive literature search using Medline and Webspirs (http:/(/)infoshare.library.pitt.edu/webspirs /webspirs.htm) was conducted to identify publications that described Dieffenbachia toxicity. Standard toxicology references and medical botany texts found in poison centers were used to profile symptoms in the tertiary literature; and an Internet search using the Savvy Search program (http:/(/)www.guaraldi.cs.colostate.edu:20 00) to search simultaneously all other search engines. The symptom information was compared to AAPCC TESS (1993-1996) symptom data reported on Dieffenbachia exposure reports. Twenty-three reference sources profiled the literature perspective on Dieffenbachia exposures. AAPCC TESS contained 10,796 Dieffenbachia exposures, and 34.7% of the reports documented symptoms. Oral irritation was reported in 18.2% of the reports and 92.6% of the queried literature listed this symptom (18.2%/92.6%). Additionally dermal pain = 8.7%/63.0%; vomiting = 2.6%/18.5%; erythema = 2.5%/5.3%; throat irritation = 2.3%/22.2%; dermal edema = 2.2%/3.7%; pruritus = 2.1%/7.4%; ocular irritation = 1.7%/44.4%; rash = 1.2%/29.6%; cough/choke = 1.1%/3.7%; loss of speech = 0%/29.6%; salivation = 0%/29.6%; respiratory obstruction = 0%/48.1%; death = 0%/11.18%. When multiple symptoms occurred the most common toxidrome was oral and throat irritation that occurred in 2.9% of the AAPCC TESS reports. There is similarity between the literature and the clinical experience with regard to the irritant properties of Dieffenbachia species, but there is also significant disparity because the literature fails to put the symptoms into a clinical frequency perspective. In general, the literature portrays Dieffenbachia exposures associated with more morbidity and mortality than what was reported in the AAPCC TESS clinical practice data.