Contact Us    Contact Us     |     Feedback
MOBILE VIEW  | 

PLANTS-ALOE

Export To Excel

Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) There are approximately 500 species of Aloes (family Liliaceae). Aloe is the source of two completely different products (Anon, 1998).
    B) Aloe gel (mucilage), obtained from the inner portion of the leaf, is the product used most frequently in the cosmetic and health food industries. Aloe juice/latex, obtained from the cells beneath the plant's skin, contains the cathartic laxative anthraquinones.
    C) Aloe gel products sold for internal consumption might be contaminated with aloe latex, thus inducing an unwanted cathartic laxative effects.
    D) Refer to "ANTHRAQUINONES" management for further information.

Specific Substances

    A) Aloe Species
    1) Erret
    2) Ghee-guar-ka-paththa
    Aloe Africana Miller
    1) Aloe Africana Miller
    Aloe Arborescens Mill
    1) Aloe Arborescens var. Natalensis Berger
    2) Inkalane
    3) Kidachiaroe
    4) Kidachirokai
    Aloe Bainesii Th. Dyer
    1) Natal Aloe
    Aloe Cooperi Baker
    1) Isiphuthumana
    2) Isiphukutwane
    Aloe Davyana Schonl
    1) Kxophane
    Aloe Ferrox Miller
    1) Aloe Capensis
    2) Aloe Ferox Lam.
    3) Cape Aloe
    Aloe Perryi Baker
    1) Socotrine Aloe
    2) Zanzibar Aloe
    Aloe Spicata Baker
    1) Aloe Spicata Baker
    Aloe Vera L
    1) Aloe Barbadensis Miller
    2) Aloe Perryi Baker
    3) Aloe Vulgaris
    4) Barbados Aloe
    5) Curacao Aloe
    6) Jelly Leek
    7) Lu Hui
    8) Medicine Plant
    9) Musabbar
    10) Plant of Life
    11) Savila
    12) True Aloe
    13) Venezuela-Aloe
    14) Za'bila
    Aloe Emodin (an active ingredient)
    1) 1,8-dihydroxy-3-(hydroxymethyl)-9,
    2) 10-anthracenedione
    Aloin (an active ingredient)
    1) Barbarloin
    2) 10-(1',5'-anhydroglucosyl) Aloe-emodin-9-
    3) anthrone
    GENERAL TERM
    1) ALOE

Available Forms Sources

    A) FORMS
    1) Aloe barbadensis/capensis/vera products may be found in capsule forms (75 mg, 100 mg, 200 mg, 250 mg, 470 mg), cream, gel (72%, 98%, 99%, 100%), and softgel (1000 mg). Aloe powder, aqueous- and aqueous-alcoholic extracts in powdered or liquid form may be found for oral use (Jellin et al, 2000) Prod Info Aloe, 2000).
    B) USES
    1) Dried latex is the only formulation that is approved for internal use as a cathartic. The Food and Drug Administration has only approved the following forms for use as natural food flavorings: Aloe perryi, Aloe vera, Aloe ferox (Anon, 1992).
    2) ALOE GEL
    a) ORAL - Used as a general tonic, as a cleanser, anesthetic, antiseptic, antipyretic, antipruritic, vasodilator, anti-inflammatory agent, and promoter of cell proliferation. It has also been used orally for gastroduodenal ulcers, diabetes, and asthma (Jellin et al, 2000).
    b) TOPICAL - Used to promote burn or wound healing and to treat cold sores; to manufacture non-laxative drugs and cosmetic products, as well as moisturizing preparations (Jellin et al, 2000). Aloe vera is an ingredient in a wide variety of cosmetic products, including night creams, soaps, shampoos, suntan lotions, and cleansers (Klein & Penneys, 1988).
    3) ALOE JUICE/LATEX
    a) ORAL - Used as a laxative or cathartic. In addition, it is used for seizures, asthma, colds, ulcers, bleeding, amenorrhea, colitis, depression, diabetes, glaucoma, multiple sclerosis, hemorrhoids, peptic ulcers, varicose veins, bursitis, arthritis, and vision problems (Jellin et al, 2000).

Overview

Life Support

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

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) The topical use of aloe gel is generally safe. Since aloe gel products might be contaminated with aloe latex/juice which contains anthraquinones, the oral use of these products may induce an unwanted cathartic laxative effects.
    B) ANTHRAQUINONES: Most human cases are mild to moderate in severity, with nausea, vomiting, diarrhea, abdominal cramps, and palpitations as the primary effects. Severe poisonings may rarely produce kidney damage, heart disturbances, gastrointestinal hemorrhage, and fluid depletion.
    C) There have been several reports of toxic hepatitis following the use of aloe vera tablets or extract in previously healthy individuals; symptoms and laboratory studies improved with drug cessation.
    D) Refer to "ANTHRAQUINONES" management for further information.
    0.2.20) REPRODUCTIVE
    A) Aloe latex contains anthraquinones that may stimulate uterine muscle activity, initiate premature labor, or possibly cause abortion when given orally. Aloes have been used as an abortifacient in India. Teratogenic effects have been reported in rats.

Laboratory Monitoring

    A) In cases where diarrhea and vomiting have been excessive, fluid and electrolyte abnormalities might be observed. In such cases, monitor for electrolyte loss and/or dehydration.
    B) Monitor liver enzymes in symptomatic cases, as infrequent reports of aloe-induced toxic hepatitis have been reported.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) Overdose information is limited. Treatment is symptomatic and supportive. Gastrointestinal decontamination is generally not necessary.

Range Of Toxicity

    A) ALOE JUICE/LATEX: Lethal dose has been reported to be 1 gram per day for several days.

Clinical Effects

Summary Of Exposure

    A) The topical use of aloe gel is generally safe. Since aloe gel products might be contaminated with aloe latex/juice which contains anthraquinones, the oral use of these products may induce an unwanted cathartic laxative effects.
    B) ANTHRAQUINONES: Most human cases are mild to moderate in severity, with nausea, vomiting, diarrhea, abdominal cramps, and palpitations as the primary effects. Severe poisonings may rarely produce kidney damage, heart disturbances, gastrointestinal hemorrhage, and fluid depletion.
    C) There have been several reports of toxic hepatitis following the use of aloe vera tablets or extract in previously healthy individuals; symptoms and laboratory studies improved with drug cessation.
    D) Refer to "ANTHRAQUINONES" management for further information.

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) CONDUCTION DISORDER OF THE HEART
    1) Dysrhythmias may occur in rare cases secondary to electrolyte imbalance (particularly hypokalemia) (Prod Info Aloe. PDR for Herbal Medicines, 2000).
    B) EDEMA
    1) Edema may occur in rare cases (Prod Info Aloe. PDR for Herbal Medicines, 2000).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) DRUG-INDUCED GASTROINTESTINAL DISTURBANCE
    1) The primary toxic manifestation is a watery diarrhea, often associated with abdominal cramping (MMWR, 1978; Keeler & Tu, 1983). The action of these agents is to stimulate the wall of the lower intestine. There may rarely be hemorrhage and bloody diarrhea in some cases (Cooper & Johnson, 1984; Lampe & Fagerstrom, 1968).
    2) Nausea and vomiting may also be present in overdose (Lampe & McCann, 1985).
    3) A benign melanotic pigmentation of the colonic mucosa (pseudomelanosis coli) may occur with prolonged use (at least 4 months) of the anthraquinones such as aloe. This is generally reversible within 4 to 15 months after drug discontinuation (Prod Info Aloe, 2000; (Mueller-Lissner, 1993; Curry & Tatum-Butler, 1990).
    4) Poor colonic function (cathartic colon) may result from chronic use of anthraquinone laxatives such as aloe (Bisset, 1994).

Hepatic

    3.9.2) CLINICAL EFFECTS
    A) ACUTE HEPATITIS
    1) WITH THERAPEUTIC USE
    a) CASE REPORTS: Three healthy women with no history of alcohol use developed elevated liver enzymes after taking aloe (tablets or extracts) for up to 6 months. Laboratory studies gradually improved with drug cessation. One patient developed a recurrence of elevated liver enzymes after restarting aloe therapy one month after discharge and had a third episode of jaundice and elevated liver enzymes 6 months later. The patient refused to be admitted and was lost to follow-up. The authors concluded that the hepatic effects observed in these cases were likely due to hepatocellular (ie, early predominant elevation of ALT level) injury due to an idiosyncratic immunological (hypersensitivity) effect as supported by the presence of eosinophilic granulocytes in the portal fields biopsy in one patient (Yang et al, 2010).
    b) CASE REPORT: A 24-year-old man, with no previous history of liver disease or alcohol consumption, had been taking 500 mg/day of aloe vera (1 capsule/day) for 3 weeks and subsequently developed jaundice, pruritus, nausea and vomiting, abdominal pain, and fatigue. Laboratory studies revealed elevated liver enzyme levels and a liver biopsy showed portal and acinar infiltrates, primarily consisting of lymphocytes, monocytes, and eosinophils, as well as necrosis, all of which is indicative of acute hepatitis. The patient completely recovered, with a normalization of his liver enzyme levels, within 6 weeks after discontinuing the aloe vera (Kanat et al, 2006).

Genitourinary

    3.10.2) CLINICAL EFFECTS
    A) NEPHRITIS
    1) Large doses of anthraquinones may cause nephritis (Prod Info Aloe, 2000; (Gilman et al, 1990). Albuminuria and hematuria may occur with long-term use of oral products (Prod Info Aloe. PDR for Herbal Medicines, 2000).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) Contact dermatitis to aloe gel may be due to irritation of the skin by needle-like crystals (Nakamura & Kotajima, 1984) (Konno et al, 1981).
    2) CASE REPORT: Severe erythema, crusting, and dermatitis were observed in a 65-year-old woman after the application of aloe leaf juice (unknown if latex only or latex and gel was applied) to a skin area that had been subjected to a perioral chemical peel. A hydrocortisone and diphenhydramine ointment was prescribed as treatment. The dermatitis subsided without scarring in 5 months (Hunter & Frumkin, 1991).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) DISORDER OF BONE
    1) Accelerated bone deterioration may occur in rare cases (Prod Info Aloe. PDR for Herbal Medicines, 2000).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ACUTE ALLERGIC REACTION
    1) Hypersensitivity reactions have been reported after long-term use of oral and topical Aloe preparations (Prod Info Aloe. PDR for Herbal Medicines, 2000; Nakamura & Kotajima, 1984; Shoji, 1982; Morrow et al, 1980).
    2) Itchy, erythematous, burning, papular, edematous eruptions around the mouth were reported in a 7-year-old boy who applied the fresh gel from aloe arborescens on the perioral areas for 4 days. A patch test was positive in 48 hours; patch testing on 6 controls was negative. Discontinuing the aloe and application of a topical corticosteroid resulted in a rapid recovery (Nakamura & Kotajima, 1984).
    3) A 66-year-old man developed nummular and papular allergic contact dermatitis after using aloe jelly from aloe arborescens for 20 days. Patch testing was positive for the patient but negative for 8 control patients (Shoji, 1982).

Reproductive

    3.20.1) SUMMARY
    A) Aloe latex contains anthraquinones that may stimulate uterine muscle activity, initiate premature labor, or possibly cause abortion when given orally. Aloes have been used as an abortifacient in India. Teratogenic effects have been reported in rats.
    3.20.2) TERATOGENICITY
    A) ANIMAL STUDIES
    1) ANIMALS - Teratogenic effects have been reported in rats. Animals given Aloes were found to have the following birth deformities: tail kinking, right hind limb clubbing, left wrist drop, non-ossification of skull bones, wavy ribs, non-ossified ribs, fused tarsal, and intercostal rib space (Nath et al, 1992).
    3.20.3) EFFECTS IN PREGNANCY
    A) HUMANS
    1) Aloe latex contains anthraquinones that may stimulate uterine muscle activity, initiate premature labor, or possibly cause abortion when given orally. Aloes have been used as an abortifacient in India (Lepik, 1997; (Briggs, 1995; Nath et al, 1992).
    2) There is little information on the gel, which does not contain the anthraquinones.

Genotoxicity

    A) Mutagenic activity of lectins that are found in aloe have been noted (Suzuki et al, 1979).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) In cases where diarrhea and vomiting have been excessive, fluid and electrolyte abnormalities might be observed. In such cases, monitor for electrolyte loss and/or dehydration.
    B) Monitor liver enzymes in symptomatic cases, as infrequent reports of aloe-induced toxic hepatitis have been reported.
    4.1.2) SERUM/BLOOD
    A) In cases where diarrhea and vomiting have been excessive, fluid and electrolyte abnormalities might be observed. In such cases, monitor for electrolyte loss and/or dehydration.
    B) Monitor liver enzymes in symptomatic cases, as infrequent reports of aloe-induced toxic hepatitis have been reported (Yang et al, 2010).
    4.1.3) URINE
    A) SPECIFIC AGENT
    1) A red color is seen in alkaline urine, which turns a yellow-brown in acid urine. This is called the borntrager's reaction and is diagnostic for anthraquinones. The red urine should be differentiated from hematuria (Lampe & Fagerstrom, 1968).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) In cases where diarrhea and vomiting have been excessive, fluid and electrolyte abnormalities might be observed. In such cases, monitor for electrolyte loss and/or dehydration.
    B) Monitor liver enzymes in symptomatic cases, as infrequent reports of aloe-induced toxic hepatitis have been reported.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) SUMMARY -
    1) Significant toxicity is unlikely. Gastrointestinal decontamination is generally not needed.
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY
    1) Significant toxic effects are unlikely. Gastrointestinal decontamination is generally not necessary.
    6.5.3) TREATMENT
    A) SUPPORT
    1) Most ingestions are self-limiting and require symptomatic and supportive care for correcting any fluid and electrolyte abnormalities (Lampe & McCann, 1985) and reduction of abdominal pain.

Range Of Toxicity

Summary

    A) ALOE JUICE/LATEX: Lethal dose has been reported to be 1 gram per day for several days.

Therapeutic Dose

    7.2.1) ADULT
    A) GENERAL
    1) Since no official standards have been established to date to regulate the production of herbal medicines in the United States, dosage ranges must be employed as guidelines.
    2) ALOE GEL
    a) ORAL: The following oral doses have been used - 50 milligrams to 200 milligrams daily capsules; 30 milliliters of aloe gel internally three times daily or 15 to 60 drops of an aloe tincture (1:10, 50% alcohol) as needed (Jellin et al, 2000).
    b) TOPICAL: Aloe gel is used liberally as needed three to five times daily (Jellin et al, 2000).
    3) ALOE JUICE/LATEX
    a) The use of aloe as a laxative has been superseded by other less toxic agents; aloe has more drastic and irritating effects. Aloe may be found in some combination products (S Sweetman , 2001).
    b) ORAL: The following laxative doses have been used - 100 to 200 milligrams aloe or 50 milligrams aloe extract taken in the evening; 1 to 8 ounces of the juice containing 99.7% of the whole leaf aloe vera juice daily (Jellin et al, 2000).
    7.2.2) PEDIATRIC
    A) GENERAL
    1) Not recommended for children under the age of 12. For topical application, same as adult dosage (Prod Info Aloe, 2000). The use of aloe as a laxative has been superseded by other less toxic agents; aloe has more drastic and irritating effects. Aloe may be found in some combination products (S Sweetman , 2001).
    2) ALOE/CASCARA SAGRADA -
    a) The usual recommended dose for children 8 to 15 years of age using combination products containing aloe and cascara is 100 milligrams and 150 milligrams (1 tablet), respectively, with a full glass of water (Prod Info Nature's Remedy(R), 1991).

Minimum Lethal Exposure

    A) GENERAL
    1) ALOE JUICE/LATEX: Lethal dose has been reported to be 1 gram per day for several days (Jellin et al, 2000; Bisset, 1994).

Pharmacology Toxicology

Pharmacologic Mechanism

    A) ALOE VERA LATEX
    1) The pericyclic cells of the leaf produce a bitter yellow latex which is dried to give a dark brown solid material (Aloes). This material is a strong cathartic containing various anthraquinones usually designated as aloin, which is primarily 1,8-dihydroxy-3-(hydroxymethyl)-p, 10-anthracenedione (Briggs, 1995). Other ingredients include Aloe-emodin, Aloesin, Aloetic acid, anthracene, anthranol, barbaloin, beta-or isobarbaloin, chrysophanic acid, cinnamic acid ester, emodin, an ethereal oil, resins (resistannol), and saponins (Shelton, 1991; Ghannam et al, 1986; Holdsworth, 1971; McCarthy & Haynes, 1967).
    2) ANTHRAQUINONE LAXATIVES: Anthraquinones such as aloe are colonic-specific stimulant laxatives which have a direct action on intestinal mucosa, increasing the rate of colonic motility, enhancing colonic transit, and inhibiting water and electrolyte secretion (Gossel, 1991; Godding, 1988). Aloe cathartic products may also have stool softening properties (Gilman et al, 1990; Godding, 1988).
    3) DIGESTIVE AID: Aloenin (4-methoxy-6-(2-beta)-D-glucopyranosyoxy-4-hydroxy-6- methylphenyl)-2-pyrone, a bitter glucoside from aloe, has been established in animal studies to be an inhibitor of gastric acid secretion (Hirata et al, 1981).
    4) ANTIVIRAL: A hot glycerin extract of aloe vera leaves was shown to inactivate herpes simplex virus type 1 in vitro. The agent responsible for this plant extract activity was determined to be the anthraquinones. Aloe-emodin was obtained by extraction from aloin (in aloe vera) and was found to inactivate herpes simplex virus 1 & 2, varicella-zoster virus, pseudorabies virus, and influenza virus when aloe was incubated with each virus at various concentrations and for 15 minutes (Sydiskis et al, 1991).
    B) ALOE VERA GEL
    1) ANTIBACTERIAL EFFECTS: The sugar and polysaccharide content of the gel may be antibacterial via osmotic inhibition of bacterial growth. An antibacterial action is still under investigation (Briggs, 1995).
    2) ANTI-INFLAMMATORY EFFECTS: The anti-inflammatory effect of the gel may be due to the salicylates, inactivation of bradykinin (via carboxypeptidases) and inhibition of histamine formation (Briggs, 1995; Natow, 1986). It appears that various non-specified components in the gel reduce the oxidation of arachidonic acid, thereby reducing prostaglandin synthesis and inflammation (Davis et al, 1987) Pennys, 1982). Bradykinase activity has been shown in guinea pig ileum as early as 1976 (Fujita et al, 1976). An antibradykinin material from aloe gel has been isolated and tested for activity in guinea pigs (Yagi et al, 1982).
    3) WOUND HEALING EFFECTS: The exact mechanism for the wound healing abilities is uncertain, but probably involves an anti-inflammatory effect involving consumption of complement 3, depletion of classical and alternative pathway complement activity, inhibition of free oxygen radicals by activating polymorphonuclear leucocytes, thromboxane inhibition, and bradykinin inhibition ('tHart et al, 1989; 'tHart et al, 1988) Zachary et al, 1987).
    a) Thromboxane, an agent that inhibits wound healing, was shown to be inhibited in a rabbit model (Zachary et al, 1987). Bradykinin may also be inhibited. Allantoin, found in the gel, is known to stimulate epithelial cell development and proliferation. When ALOE vera gel is applied to necrotic wounds it is thought the various enzymes in the gel breakdown the damaged tissue. Aloctin-A, one of the noncharacterized substances in the gel, does stimulate macrophage production, potentially increasing dead cells (Briggs, 1995; Robson et al, 1980; Cera et al, 1980) Heggers et al, 1979).
    b) Phagocytosis by peripheral neutrophils was evaluated using a Candida albicans killing test and it was found that a non-phenolic amino acid fraction positively affected the phagocytosis tests, while the phenolic fraction produced a suppression of phagocytosis of neutrophils reported in adult bronchial asthmatics (Yagi et al, 1987).

References

General Bibliography

    1) 'tHart LA, van Enckevort PH, & van Dijk H: Two functionally and chemically distinct immunomodulatory compounds in the gel of Aloe vera. J Ethnopharmacol 1988; 23(1):61-71.
    2) 'tHart LA, van den Berg AJJ, & Kuis L: An anti-complementary polysaccharide with immunological adjuvant activity from the leaf parenchyma gel of Aloe vera. Planta Med 1989; 55(6):509-512.
    3) Anon: Aloe. Med Lett Drugs Ther 1992; 22(17):1-3.
    4) Bisset NG: Herbal Drugs and Phytopharmaceuticals, CRC Press, Boca Raton, FL, 1994.
    5) Briggs C: Herbal medicine: Aloe. CPJ/RPC 1995; 128:48-50.
    6) Cera LM, Heggers JP, & Robson MC: The therapeutic efficacy of aloe vera cream (Dermaide Aloe) in thermal injuries: two case reports. J Am Anim Hosp Assoc 1980; 16:768-772.
    7) Cooper MR & Johnson AW: Poisonous Plants in Britain. Ministry of Agriculture Fisheries and Food, Ref Book 161, Her Majesty's Stationery Office, Norwich, UK, 1984.
    8) Curry CE Jr & Tatum-Butler D: Laxative products. In: Feldmann EG (ed): Handbook of Nonprescription Drugs, 9th ed, American Pharmaceutical Association, Washington, DC, 1990.
    9) Davis RH, Leitner MG, & Russo JM: Topical anti-inflammatory activity of Aloe vera as measured by ear swelling. J Am Podiatr Med Assoc 1987; 77(11):610-612.
    10) Fujita K, Teradaira R, & Nagatsu T: Bradykininase activity of Aloe extract. Biochem Pharmacol 1976; 25(2):205.
    11) Ghannam N, Kingston M, & Al-Meshaal: The antidiabetic activity of Aloes: Preliminary clinical and experimental observations. Horm Res 1986; 24(4):288-294.
    12) Gilman AG, Rall TW, & Nies AS: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed, Pergamon Press, City, NY, USA, New York, NY, 1990.
    13) Godding EW: Laxatives and the special role of senna. Pharmacology 1988; 36(suppl 1):230-236.
    14) Gossel TA: Constipation? A treatment guide. US Pharmacist 1991; 30-34.
    15) Hirata T, Sakano S, & Suga T: Biotransformation of Aloein, a bitter glucoside constitutent of Aloe arboreescens, by rats. Experientia 1981; 37(12):1252-1253.
    16) Holdsworth DK: Chromones in Aloe species, part 1: aloesin- C-glucosyl-7-hydroxychrome. Planta Med 1971; 19(4):322-325.
    17) Hunter D & Frumkin A: Adverse reactions to vitamin E and Aloe vera preparations after dermabrasion and chemical peel. Cutis 1991; 47(3):193-196.
    18) Jellin JM, Gregory P, & Batz F: Pharmacist's letter/Prescriber's Letter Natural Medicines Comprehensive Database, 3rd ed, Therapeutic Research Faculty, Stockton, CA, 2000.
    19) Kanat O, Ozet A, & Ataergin S: Aloe vera-induced acute toxic hepatitis in a healthy young man. Eur J Intern Med 2006; 17(8):589-.
    20) Keeler RF & Tu AT: Handbook of Natural Toxins Vol 1: Plant and Fungal Toxins, Marcel Dekker Inc, New York, NY, 1983.
    21) Klein AD & Penneys N: Aloe vera. J Am Acad Dermatol 1988; 18(4 pt 1):714-720.
    22) Lampe KF & Fagerstrom R: Plant Toxicity and Dermatitis, Williams and Wilkens Co, Baltimore, MD, 1968.
    23) Lampe KF & McCann MA: AMA Handbook of Poisonous and Injurious Plants, American Medical Association, Chicago, IL, 1985.
    24) Longe RL & DiPiro JT: Diarrhea and constipation, in: DiPiro JT, Talbert RL & Hayes PE (eds): Pharmacotherapy: A Pathophysiologic Approach, 2nd ed, Elsevier Science Publishing Co, New York, NY, 1992, pp 566-578.
    25) MMWR: Diarrhea from herbal tea - New York, Pennsylvania. MMWR: MMWR 1978; 27:248-249.
    26) McCarthy TJ & Haynes LJ: The distribution of Aloesin in some South African Aloe species. Planta Med 1967; 15(3):342-344.
    27) McGuffin M, Hobbs C, & Upton R: Aloe. American Herbal Products Association's Botanical Safety Handbook: Guidelines for the Safe Use and Labeling for Herbs in Commerce, CRC Press, Boca Raton, FL, 1997, pp 7-8.
    28) Morrow DM, Rapaport MJ, & Strick RA: Hypersensitivity to Aloe. Arch Dermatol 1980; 116(9):1064-1065.
    29) Mueller-Lissner SA: Adverse effects of laxatives: facts and fiction. Pathophysiology 1993; 47(suppl 1):138-145.
    30) Nakamura T & Kotajima S: Contact dermatitis from aloe arborescens. Contact Dermatitis 1984; 11(1):51.
    31) Nath D, Sethi N, & Singh RK: Commonly used Indian abortifacient plants with special reference to their teratological effects in rats. J Ethnopharmacol 1992; 36(2):147-154.
    32) Natow AJ: Aloe vera, fiction or fact?. Cutis 1986; 37(2):106-108.
    33) Product Information: Aloe. PDR for Herbal Medicines. Medical Economics Company, Montvale, New Jersey, 2000.
    34) Robson MC, DelBeccaro EJ, & Heggers JP: Increasing dermal perfusion after burning by decreasing thromboxane production. J Trauma 1980; 20(9):722-725.
    35) S Sweetman : Martindale: The Complete Drug Reference (Internet version). The Pharmaceutical Press. London, UK (Internet Version). Edition expires 2001; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    36) Shelton RM: Aloe vera: its chemical and therapeutic properties. Int J Dermatol 1991; 30(10):679-683.
    37) Shoji A: Contact dermatitis to Aloe arborescens. Contact Dermatitis 1982; 8(3):164-167.
    38) Suzuki I, Saito H, & Inoue S: Purification and characterization of two lectins from Aloe arborescens Mill (Tokyo). J Biochem 1979; 85(1):163-171.
    39) Sydiskis RJ, Owen DG, & Lohr JL: Inactivation of enveloped viruses by anthraquinones extracted from plants. Antimicrob Agents Chemother 1991; 35(12):2463-2466.
    40) Tyler VE: The Honest Herbal. Pharmaceutical Products Press, An imprint of the Haworth Press,Inc, Binghamton, NY, 1993, pp 25-28.
    41) Yagi A, Harada N, & Yamada H: Antibradykinin active material in Aloe saponaria. J Pharm Sci 1982; 71(10):1172-1174.
    42) Yagi A, Shida T, & Nishimura H: Effect of amino acids in Aloe extract on phagocytosis by peripheral neutrophil in adult bronchial asthma. Arerugi 1987; 36(12):1094-1101.
    43) Yamaguchi I, Mega N, & Sanada H: Components of the gel of Aloe vera (L.) burm-f. Biosci Biotechnol Biochem 1993; 57(8):1350-1352.
    44) Yang HN, Kim DJ, Kim YM, et al: Aloe-induced toxic hepatitis. J Korean Med Sci 2010; 25(3):492-495.