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CINNAMON AND CINNAMON OIL

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Cinnamon is derived from Cinnamomum zeylanicum (Ceylon cinnamon), C. loureirii, or C. cassia. Cinnamon oil is often made from C. cassia rather than C. zeylanicum.

Specific Substances

    A) CINNAMIC ACID
    1) 3-phenyl-2-propenoic acid
    2) Beta phenylacrylic acid
    CINNAMYL ALCOHOL
    1) 3-phenyl-2-propen-l-ol
    2) Cinnamic alcohol
    3) Styryl carbinal
    4) Lambda-phenylallyl alcohol
    CINNAMALDEHYDE
    1) 3-phenyl-2-propenal
    2) Cinnamic aldehyde
    3) Phenylacrolein
    4) Cinnamal
    CINNAMON OIL
    1) Aetheroleum cinnamomi
    2) Ceylon cinnamon bark oil
    3) Esencia de canela
    4) Essence de cannelle de ceylan
    5) Oleum cinnamoni
    6) Zimtol
    7) Cas 8007-80-5

Available Forms Sources

    A) SOURCES
    1) Cinnamon is derived from the dried inner part of the shoots of Cinnamomum zeylanicum (Ceylon cinnamon), C. loureirii, or C. cassia. Cinnamon oil is often made from C. cassia rather than C. zeylanicum (Laubach et al, 1953). This may make a difference for those that have allergies to one or the other cinnamons. Cinnamon leaf oil may be mostly eugenol.
    2) The volatile oil obtained from Cinnamonum zeylanicum varies considerably in its content.
    3) Cinnaldehyde is in the bark, eugenol in the leaf oil and camphor in the root bark oil (Wijesekera, 1978).
    4) The primary aromatic substances found in Cinnamonum species are cinnamaldehyde and small amounts of cinnamyl alcohol, cinnamyl acetate and 2-methoxy-cinnamaldehyde (Archer, 1988).
    B) USES
    1) Cinnamon has primarily been used as a spice in cooking and in cosmetics (Deng, 2012; Ackermann et al, 2009; Maibach, 1986), and occasionally as a dietary supplement in diabetic patients for its reported hypoglycemic effects (Deng, 2012).
    2) CINNAMON CHALLENGE: Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the internet, predominantly involving children and adolescents. Ingestion of large amounts of dry cinnamon may result in aspiration, leading to pulmonary inflammation and aspiration pneumonia; individuals with cinnamon allergies or with bronchopulmonary diseases (eg, asthma) may be at increased risk. Commonly reported symptoms following the cinnamon challenge included coughing, choking, and burning of the mouth, nose, and throat. Other effects that have occurred include vomiting, epistaxis, and chest tightness (Grant-Alfieri et al, 2013).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) USES: Cinnamon is derived from the dried inner part of the shoots of Cinnamomum zeylanicum (Ceylon cinnamon), C. loureirii, or C. cassia. Cinnamon oil is often made from C. cassia rather than C. zeylanicum. Cinnamon leaf oil may be mostly eugenol. Please refer to the Eugenol management for further information. Cinnamon and cinnamon oil are primarily used in cooking and cosmetics and occasionally used as a dietary supplement. Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the internet, predominantly involving children and adolescents.
    B) PHARMACOLOGY: Cinnamic acid is converted to benzoic acid which is in turn changed to hippuric acid. The remaining product, which escapes oxidation, is most likely excreted as monocinnamoyl glucuronic acid.
    C) TOXICOLOGY: Cinnamon is an irritant similar to other aldehyde volatile oils.
    D) EPIDEMIOLOGY: Severe poisoning from cinnamon is rare with few case reports in the literature. However, given the recent popularity of the cinnamon challenge, a number of mild to moderate symptoms have been reported.
    E) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Mucous membrane irritation, contact dermatitis, facial flushing, allergic reactions, double vision, nausea, vomiting, and CNS depression have been reported. These symptoms are usually self-limiting and resolve within 5 hours. Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the Internet, predominantly involving children and adolescents. Commonly reported symptoms following the cinnamon challenge include coughing, choking, and burning of the mouth, nose, and throat, nausea, and vomiting. Epistaxis and chest tightness have occasionally been reported.
    2) SEVERE TOXICITY: Ingestion of large amounts of dry cinnamon may result in aspiration, leading to pulmonary inflammation and aspiration pneumonia; individuals with cinnamon allergies or with bronchopulmonary diseases (eg, asthma) may be at increased risk. Hypotension, CNS depression, diplopia, and dermal burns have rarely been reported.

Laboratory Monitoring

    A) Monitor arterial blood gases, electrolytes, renal function, and hepatic function in patients with hypoxia, respiratory failure, or altered mental status.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Patients with mild to moderate toxicity, such as rash, headache, dizziness, nausea/vomiting, or persistent cough, typically do well with symptomatic and supportive care.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Patients with significant bronchospasm, hypoxemia/hypercarbia, or alterations in mental status should receive standard therapy for these conditions. INGESTION: Gastrointestinal symptoms and CNS suppression are reported in large overdoses. INHALATION EXPOSURE: Patients with inhalational exposures should be watched for signs of pneumonitis. Intubation may be required for severe hypoxemia. DERMAL EXPOSURE: Decontaminate with water, saline, or soap and water. There are reports of urticarial rash, which is usually self-limiting. One report found steroids worsened the rash. EYE EXPOSURE: Rinse with copious amounts of normal saline.
    C) DECONTAMINATION
    1) PREHOSPITAL: No oral decontamination is indicated. Dermal exposures should be irrigated with water to remove the exposure.
    2) HOSPITAL: No oral decontamination is indicated. Dermal exposures should be irrigated with water, saline, or soap and water to remove the exposure.
    D) AIRWAY MANAGEMENT
    1) Respiratory failure may occur, particularly in patients undergoing a cinnamon challenge, necessitating advanced airway management.
    E) ANTIDOTE
    1) None.
    F) ENHANCED ELIMINATION
    1) It is unknown if hemodialysis or hemoperfusion are likely to be useful following an oral exposure.
    G) PATIENT DISPOSITION
    1) HOME CRITERIA: Asymptomatic patients can be managed at home. Any patient with altered mental status, weakness, or syncope should be evaluated at a healthcare facility.
    2) OBSERVATION CRITERIA: Patients with altered mental status, weakness, or syncope should be evaluated at a healthcare facility and observed until signs and symptoms have resolved.
    3) ADMISSION CRITERIA: Patients with persistent hypoxemia, ventilation difficulties, or altered mental status should be admitted to a hospital ward or an ICU setting.
    4) CONSULT CRITERIA: Consult a poison center or toxicologist for patients who develop respiratory failure, hemodynamic instability, or any other symptoms that require hospitalization following exposure.
    H) PITFALLS
    1) Most of these cases are straightforward with a clear history of exposure. Potential errors for managing include failing to screen electrolytes, failing to look for other exposures, and not identifying other similar presenting medical conditions.
    I) DIFFERENTIAL DIAGNOSIS
    1) Most of these cases are straightforward with a clear history of exposure. Other causes of bronchospasm include asthma, respiratory infections, and other pulmonary irritants. Altered mental status may also be produced by a wide range of toxic exposures (eg, alcohols, anticonvulsant, antidepressant, antipsychotic, hallucinogen, sedative-hypnotic, opioid withdrawal) and non-toxicologic causes (eg, CNS or systemic infection, hypercarbia, hypoglycemia, hypoxemia, intracranial bleeding and trauma).
    0.4.3) INHALATION EXPOSURE
    A) Patients with inhalational exposures should be watched for signs of pneumonitis. Intubation may be required for severe hypoxemia.
    0.4.4) EYE EXPOSURE
    A) Cinnamon oil is very irritating to the eye and needs to be irrigated copiously with water for at least 15 to 30 minutes.
    B) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) Decontaminate with water, saline, or soap and water. There are reports of urticarial rash, which is usually self-limiting. One report found steroids worsened the rash.

Range Of Toxicity

    A) TOXICITY: A specific toxic dose has not been established. Ingestion of 60 mL (2.5 mL/kg) resulted in CNS and gastrointestinal symptoms in a child.

Clinical Effects

Summary Of Exposure

    A) USES: Cinnamon is derived from the dried inner part of the shoots of Cinnamomum zeylanicum (Ceylon cinnamon), C. loureirii, or C. cassia. Cinnamon oil is often made from C. cassia rather than C. zeylanicum. Cinnamon leaf oil may be mostly eugenol. Please refer to the Eugenol management for further information. Cinnamon and cinnamon oil are primarily used in cooking and cosmetics and occasionally used as a dietary supplement. Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the internet, predominantly involving children and adolescents.
    B) PHARMACOLOGY: Cinnamic acid is converted to benzoic acid which is in turn changed to hippuric acid. The remaining product, which escapes oxidation, is most likely excreted as monocinnamoyl glucuronic acid.
    C) TOXICOLOGY: Cinnamon is an irritant similar to other aldehyde volatile oils.
    D) EPIDEMIOLOGY: Severe poisoning from cinnamon is rare with few case reports in the literature. However, given the recent popularity of the cinnamon challenge, a number of mild to moderate symptoms have been reported.
    E) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Mucous membrane irritation, contact dermatitis, facial flushing, allergic reactions, double vision, nausea, vomiting, and CNS depression have been reported. These symptoms are usually self-limiting and resolve within 5 hours. Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the Internet, predominantly involving children and adolescents. Commonly reported symptoms following the cinnamon challenge include coughing, choking, and burning of the mouth, nose, and throat, nausea, and vomiting. Epistaxis and chest tightness have occasionally been reported.
    2) SEVERE TOXICITY: Ingestion of large amounts of dry cinnamon may result in aspiration, leading to pulmonary inflammation and aspiration pneumonia; individuals with cinnamon allergies or with bronchopulmonary diseases (eg, asthma) may be at increased risk. Hypotension, CNS depression, diplopia, and dermal burns have rarely been reported.

Heent

    3.4.3) EYES
    A) WITH POISONING/EXPOSURE
    1) DIPLOPIA: Diplopia occurred within 25 minutes after ingestion and persisted for 5 hours in a child who ingested 60 mL (Pilapil, 1989).
    2) IRRITATION: Contact has resulted in mild irritation which was treated with irrigation. Conjunctivitis resolved within 24 hours (Perry et al, 1990).
    3.4.6) THROAT
    A) WITH THERAPEUTIC USE
    1) Stomatitis, leukoplakia and ulcers have been allergic reactions caused by cinnamon-flavored dental products and chewing gum (Drake & Maibach, 1976; Mathias et al, 1980; Kirton & Wilkinson, 1973; Mihail, 1992; Miller et al, 1992). Gingivostomatitis has also been reported (Millard, 1973).
    2) CHEILITIS: Cracking, peeling, and swelling of the lips were reported in an 82-year-old who was using a cinnamic aldehyde lipstick and toothpaste. Although the lipstick did not test positively in a patch test (possibly due to a low concentration) a cinnamic aldehyde-free regimen eliminated her symptoms (Maibach, 1986).
    3) CONTACT DERMATITIS/CASE REPORTS: Intraoral allergic contact dermatitis was reported in 3 patients following exposure to cinnamic aldehyde via various methods including using breath freshening strips, containing cinnamic aldehyde and cinnamic alcohol, while wearing a mouth guard, using a toothpaste containing a high concentration of cinnamic aldehyde to clean dentures, and eating an apple dipped in cinnamon daily at bedtime. Signs of the contact dermatitis included erythematous patches on the hard and soft palate, and erythema on the tip of the tongue with slight atrophy of the papillae on the dorsal side. All 3 patients patch-tested positive for cinnamic aldehyde with one patient also testing positive for cinnamic alcohol. Recovery occurred in all patients following discontinuation of the products (Isaac-Renton et al, 2015).
    B) WITH POISONING/EXPOSURE
    1) STOMATITIS: Ingestion of the oil will cause mucous membrane irritation. A burning sensation in the mouth, chest, and stomach occurred after a large ingestion (Pilapil, 1989).

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) HYPOTENSIVE EPISODE
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: Transiently decreased blood pressure and elevated pulse occurred in a child who ingested a large amount (Pilapil, 1989).

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) COUGH
    1) WITH POISONING/EXPOSURE
    a) CINNAMON CHALLENGE: Ingesting a tablespoon of ground cinnamon in 60 seconds without drinking fluids, termed "cinnamon challenge", has become sensationalized via the internet, predominantly involving children and adolescents. Ingestion of large amounts of dry cinnamon may result in aspiration, leading to pulmonary inflammation and aspiration pneumonia; individuals with cinnamon allergies or with bronchopulmonary diseases (eg, asthma) may be at increased risk. Commonly reported symptoms following the cinnamon challenge included coughing, choking, and burning of the mouth, nose, and throat. Other effects that have occurred include vomiting, epistaxis, and chest tightness (Grant-Alfieri et al, 2013).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) DROWSY
    1) WITH POISONING/EXPOSURE
    a) A 7.5-year-old child ingested approximately 60 mL of cinnamon oil and experienced immediate sensation of burning in the mouth, chest, and stomach, followed by diplopia, dizziness, vomiting, and collapse. Upon arrival to the emergency room, 25 minutes postingestion, he was very sleepy. Treatment included dilution with milk, syrup of ipecac, and activated charcoal. Symptoms noted later included vomiting, dizziness, diplopia, and rectal burning. Vital signs were normal except for mild hypotension (88/62) and tachycardia (88 to 104/minute). He was asymptomatic 5 hours postingestion (Pilapil, 1989).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) GASTROENTERITIS
    1) WITH POISONING/EXPOSURE
    a) Nausea, diarrhea, abdominal cramps, vomiting, and rectal burning have been reported from ingestion of the concentrated oil (Pilapil, 1989; Perry et al, 1990).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) CONTACT DERMATITIS
    1) WITH THERAPEUTIC USE
    a) Cinnamon (or its oils) may produce contact-type eczematous dermatitis in sensitized individuals (Hjorth, 1971). Contact urticaria has been reported from cinnamic aldehyde (Mathias et al, 1980). A vulvar dermatitis was reported in a woman using a sanitary napkin containing a perfume with cinnamic alcohol and cinnamaldehyde (Larsen, 1979).
    b) CASE REPORT: AIRBORNE EXPOSURE: Four cases of occupational allergic contact dermatitis from cinnamon were diagnosed at an allergy and skin hospital between 1991 and 2007. In one case, a woman working in a bakery developed erythematous and vesicular eczema of the face and neck during work. She did not handle cinnamon but worked in an area where cinnamon rolls were made. She wore gloves while working and did not develop hand eczema. Her exposure was determined to be airborne. When she was not working, the eczema healed completely and she had no recurrence of eczema after retiring from her job (Ackermann et al, 2009).
    B) ITCHING OF SKIN
    1) WITH THERAPEUTIC USE
    a) Stomatitis and pruritus reported (Drake & Maibach, 1976; Roberts, 1976).
    C) VITILIGO
    1) WITH THERAPEUTIC USE
    a) Cutaneous leukoderma similar to contact vitiligo has been reported (Mathias et al, 1980).
    D) CHEMICAL BURN
    1) WITH POISONING/EXPOSURE
    a) Facial burning, welts, and/or blisters have been reported after accidental dermal contact (Perry et al, 1990).
    b) CASE REPORT: A vial of cinnamon oil shattered in the pocket of an 11-year-old. The skin remained unwashed for 48 hours and a 2nd degree burn developed (Sparks, 1985).
    E) FLUSHING
    1) WITH THERAPEUTIC USE
    a) Facial flushing may occur after sucking a toothpick or finger dipped in cinnamon oil (Perry et al, 1990) and in some individuals exposed to cinnamon extracts in provocation tests (Mihail, 1992).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) WITH THERAPEUTIC USE
    a) Allergic skin reactions to cinnamon, cinnamon oil, or other cinnamon extracts are common (Hjorth, 1971; Addo et al, 1982; Mihail, 1992; Miller et al, 1992). Cinnamon oil may cause an allergic cross reaction with Balsam of Peru, celery, bergamot oil, dill and lemon turpentine (Fisher, 1973).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Monitor arterial blood gases, electrolytes, renal function, and hepatic function in patients with hypoxia, respiratory failure, or altered mental status.

Methods

    A) MULTIPLE ANALYTICAL METHODS
    1) Cinnamaldehyde has been determined by colorimetry, polarography, fluorimetry, gas chromatography, and high performance liquid chromatography (Archer, 1988).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.1) DISPOSITION/ORAL EXPOSURE
    6.3.1.1) ADMISSION CRITERIA/ORAL
    A) Patients with persistent hypoxemia, ventilation difficulties, or altered mental status should be admitted to a hospital ward or an ICU setting.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Asymptomatic patients can be managed at home. Any patient with altered mental status, weakness, or syncope should be evaluated at a healthcare facility.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) Consult a poison center or toxicologist for patients who develop respiratory failure, hemodynamic instability, or any other symptoms that require hospitalization following exposure.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients with altered mental status, weakness, or syncope should be evaluated at a healthcare facility and observed until signs and symptoms have resolved.

Monitoring

    A) Monitor arterial blood gases, electrolytes, renal function, and hepatic function in patients with hypoxia, respiratory failure, or altered mental status.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) No oral decontamination is indicated. Dermal exposures should be irrigated to remove the exposure.
    6.5.2) PREVENTION OF ABSORPTION
    A) No oral decontamination is indicated.
    6.5.3) TREATMENT
    A) MONITORING OF PATIENT
    1) Monitor arterial blood gases, electrolytes, renal function, and hepatic function in patients with hypoxia, respiratory failure, or altered mental status.
    B) AIRWAY MANAGEMENT
    1) Respiratory failure may occur, particularly in patients undergoing a cinnamon challenge, necessitating advanced airway management.

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).
    6.8.2) TREATMENT
    A) INJURY OF CORNEA
    1) Consider an ophthalmic examination if irritation persists for more than 30 minutes. Corneal burns have not been reported, but data are minimal.
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
    6.9.2) TREATMENT
    A) CORTICOSTEROID
    1) One study exploring treatment methods showed a worsening of a cinnamic aldehyde dermal reaction after treatment with 1% triamcinolone (Clark & Rietschel, 1982).
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Enhanced Elimination

    A) HEMODIALYSIS
    1) It is unknown if hemodialysis or hemoperfusion are likely to be useful following an oral exposure.

Abstracts

Case Reports

    A) PEDIATRIC
    1) A 7.5-year-old child ingested approximately 60 mL of cinnamon oil and experienced immediate sensation of burning in the mouth, chest, and stomach, followed by diplopia, dizziness, vomiting, and collapse. Upon arrival to the emergency room, 25 minutes postingestion, he was very sleepy. Treatment included dilution with milk, syrup of ipecac, and activated charcoal. Symptoms noted later included vomiting, dizziness, diplopia, and rectal burning. Vital signs were normal except for mild hypotension (88/62) and tachycardia (88 to 104/minute). He was asymptomatic 5 hours postingestion (Pilapil, 1989).

Range Of Toxicity

Summary

    A) TOXICITY: A specific toxic dose has not been established. Ingestion of 60 mL (2.5 mL/kg) resulted in CNS and gastrointestinal symptoms in a child.

Therapeutic Dose

    7.2.1) ADULT
    A) GENERAL
    1) 0.06 to 0.2 milliliter of the oil has been recommended as a carminative.
    2) Acceptable Daily Intake (Temp Stand): 700 micrograms/kilogram of cinnamaldehyde (Anon, 1984).

Maximum Tolerated Exposure

    A) SUMMARY
    1) A specific toxic dose has not been established.
    B) CASE REPORT
    1) PEDIATRIC: A 7.5-year-old child ingested approximately 60 mL of cinnamon oil and experienced immediate sensation of burning in the mouth, chest, and stomach, followed by diplopia, dizziness, vomiting, and collapse. Upon arrival to the emergency room, 25 minutes postingestion, he was very sleepy. Treatment included dilution with milk, syrup of ipecac, and activated charcoal. Symptoms noted later included vomiting, dizziness, diplopia, and rectal burning. Vital signs were normal except for mild hypotension /88/62) and tachycardia (88 to 104/minute). He was asymptomatic 5 hours postingestion (Pilapil, 1989).

Pharmacology Toxicology

Toxicologic Mechanism

    A) Cinnamon is an irritant similar to other aldehyde volatile oils. Cinnamon has considerable bacterial activity for a volatile oil being number 1 of 22 tested oils (Yousef & Tawil, 1980).

Physicochemical

Physical Characteristics

    A) A yellow oil with the characteristic odor of cinnamon. It darkens to a reddish-brown in age (Reynolds, 1986).

Molecular Weight

    A) Varies

Animal Toxicology

Range Of Toxicity

    11.3.2) MINIMAL TOXIC DOSE
    A) DOG
    1) CASE REPORTS
    a) A moderate-sized dog was killed by 30 milliliters within 5 hours. Ten milliliters killed another in 40 hours. Symptoms on autopsy were inflammation and corrosion of the GI mucosa (United States Dispensatory, 1955).

References

General Bibliography

    1) Ackermann L, Aalto-Korte K, Jolanki R, et al: Occupational allergic contact dermatitis from cinnamon including one case from airborne exposure. Contact Dermatitis 2009; 60(2):96-99.
    2) Addo HA, Ferguson J, & Johnson BE: The relationship between exposure to fragrance materials and persistent light reaction in the photosensitivity dermatitis with actinic reticuloid syndrome. Br J Dermatol 1982; 107:261-274.
    3) Anon: Twenty-eighth Report of Joint FAD/WHO Expert Committee on Food Additives. Tech Rep Ser Wld Hlth Org No 710, 1984.
    4) Archer AW: Determination of cinnamaldehyde, coumarin and cinnamyl alcohol in cinnamon and cassia by high performance liquid chromatography. J Chromatography 1988; 447:272-276.
    5) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    6) Clark RA & Rietschel RL: 0.1% triamcinolone acetonide ointment and patch test responses. Arch Dermatol 1982; 118:163-165.
    7) Deng R: A review of the hypoglycemic effects of five commonly used herbal food supplements. Recent Pat Food Nutr Agric 2012; 4(1):50-60.
    8) Drake TE & Maibach HI: Allergic contact dermatitis and stomatitis caused by a cinnamic aldehyde-flavored toothpaste. Arch Dermatol 1976; 112:202-203.
    9) Fisher AA: Contact Dermatitis, 2nd ed, Lea & Febiger, Philadelphia, 1973.
    10) Grant-Alfieri A, Schaechter J, & Lipshultz SE: Ingesting and aspirating dry cinnamon by children and adolescents: the "cinnamon challenge". Pediatrics 2013; 131(5):833-835.
    11) Hjorth N: Allergy to balsams. Spectrum 1971; 8:97.
    12) Isaac-Renton M, Li MK, & Parsons LM: Cinnamon spice and everything not nice: many features of intraoral allergy to cinnamic aldehyde. Dermatitis 2015; 26(3):116-121.
    13) Kirton V & Wilkinson DS: Contact sensitivity to toothpaste. Br Med J 1973; 11:115-116.
    14) Larsen WG: Sanitary napkin dermatitis due to perfume. Arch Dermatol 1979; 115:363.
    15) Laubach JL, Malkinson FD, & Ringrose EJ: Cheilitis caused by cinnamon (cassia) oil in toothpaste. JAMA 1953; 152:404-405.
    16) Maibach HI: Chelitis: occult allergy to cinnamic aldehyde. Contact Dermatitis 1986; 15:106-107.
    17) Mathias CGT, Chappler RR, & Maibach HI: Contact urticaria from cinnamic aldehyde. Arch Dermatol 1980; 116:74-76.
    18) Mihail RC: Oral leukoplakia caused by cinnamon food allergy. J Otolaryngol 1992; 21:366-367.
    19) Millard LG: Contact sensitivity to toothpaste. Br Med J 1973; 1:676.
    20) Miller RL, Gould AR, & Bernstein ML: Cinnamon-induced stomatitis venenata. Oral Surg Oral Med Oral Pathol 1992; 73:708-716.
    21) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    22) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    23) Perry PA, Dean BS, & Krenzelok EP: Cinnamon abuse by adolescents. Vet Hum Toxicol 1990; 32:162-164.
    24) Pilapil VR: Toxic manifestations of cinnamon oil ingestion in a child. Clin Pediatr 1989; 28:276.
    25) Roberts MJ: New product pruritus. Br Med J 1976; 2:47.
    26) Schwartz RH: Cinnamon oil: kids use it to get high (letter). Clin Pediatr 1990; 29:196.
    27) Siegel RK: Herbal intoxication: psychoactive effects from herbal cigarettes, tea and capsules. JAMA 1976; 236:473-476.
    28) Sparks T: Cinnamon oil burn. West J Med 1985; 142:835.
    29) Wijesekera RO: Historical overview of the cinnamon industry. CRC Crit Rev Food Sci Nutr 1978; 10:1-30.