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PLANTS-PELARGONIUM

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Pelargoniums are the common annual geraniums widely used as landscape ornamentals and bedding plants. They are cultivated worldwide, and represent more than 250 different species and varieties. They should not be confused with the genus Geranium (cranesbill), a hardy perennial that has symmetrical flowers.

Specific Substances

    A) Pelargonium capitatum
    1) Rose-scented geranium
    Pelargonium citrosum
    1) Mosquito plant
    Pelargonium crispum
    1) Lemon geranium
    Pelargonium domesticum
    1) Fancy geranium
    2) Lady Washington geranium
    3) Martha Washington geranium
    4) Pansy-flowered geranium
    5) Regal Geranium
    6) Shown geranium
    7) Summer geranium
    Pelargonium graveolens
    1) Rose geranium
    2) Sweet scented geranium
    Pelargonium hortum
    1) Geranium
    2) Zonal geranium
    3) bedding geranium
    Pelargonium pelatum
    1) Ivy geranium
    2) Hanging geranium
    Pelargonium sidoides
    1) Umckaloabo
    Geranium oil bourbon
    1) Oil of geranium
    2) Oil of pelargonium geranium
    3) Oil of rose geranium
    4) CAS Number 8000-46-2
    5) Geraniol is a constituent of geranium oil bourbon

Available Forms Sources

    A) FORMS
    1) Pelargoniums are the common geraniums used around the house and garden. They are cultivated worldwide, and represent many different species, cultivars, and varieties.
    2) Geranium oil bourbon is the volatile oil distilled from the leaves of Pelargonium odoratissimuim and Pelargonium geranaceae. It consists of monoterpene geraniol esters (geranyl tiglate), citronellol and linaloollinallol (Budavari, 1996) Lewis, 1977)
    3) Pelargonium citrosum (mosquito plant) has the ability to repel mosquitoes due to vaporization of the plant's volatile oils. This produces a barrier of protection up to 3 meters (Cilek & Schreiber, 1994). This oil contains geraniol, citronellol, isomenthone, and linalool (Matsuda, 1996).
    B) USES
    1) Geranium oil bourbon has been used in dusting powder, tooth powders, ointments and in the manufacture of perfumes. It is also used in the manufacture of Rhodinol (l-citronellol) which is used in perfumery (Budavari, 1996).
    2) Geraniol has been investigated for its antifungal and antimicrobial activity (Keeler & Tu, 1983). The steam distillate products and some solvent extracts resulting in other Pelargonium essential oils have also shown antibacterial activity (Lis-Balchin et al, 1998). The fatty acid pelargonic acid was shown to have a minimum inhibitory concentration of 0.04 mg/mL on solid growth media and 0.05 mg/mL in broth, against the fungus Microsporum gypseum (Chadeganipour & Haims, 2001).
    3) The essential oil from Pelargonium odoratissimumodorantissimum has been used in herbal medicine as a tonic, analgesic, antidepressant, diuretic, and sedative (Ody, 1993).
    4) Antimicrobial and immunomodulatory effects have been attributed to P. sidoides and P. reniforme, in vitro.
    a) Antimicrobial effects may be due to the generation of reactive nitrogen intermediates. A moderate increase in tumor necrosis factor production was noted after use of these plants (Kayser et al, 2001). P. reniforme has a number of tannins (ellagitannins) which may contribute to its proposed palliative effects for gastrointestinal, hepatic, and respiratory diseases (Latte & Kolodziej, 2000).
    b) At least 5 different compounds in Pelargonium extracts have shown antibacterial actions against Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus 1451, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae (Kayser & Kolodziej, 1997).
    5) An ethanolic extract from Pelargonium graveolens has been shown to contain the insect repellent citronellol. Water and oil extracts did not contain citronellol, so sweating and/or tanning oils are not likely to release appreciable amounts (Botha & McCrindle, 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) BACKGROUND: Pelargoniums are common annual geraniums widely used as landscape ornamentals and bedding plants. They are cultivated worldwide, and represent more than 250 different species and varieties. They should not be confused with the genus Geranium (cranesbill), a hardy perennial that has symmetrical flowers. Pelargonium sidoides is a perennial found in the Eastern Cape Province of South Africa and have been referred to historically as Khoi-khoi. The roots are described as fleshy, bright red tubers or rhizomes and have been commonly used to treat diarrhea and dysentery. It is widely used in local communities as a traditional medicine for curing various ailments including gastrointestinal (ie, diarrhea, colic, gastritis), respiratory/pulmonary disorders (ie, acute bronchitis, asthma, sinusitis, tonsillopharyngitis and tuberculosis), hepatic illnesses, and gonorrhea. It may also have some antibacterial activity. Other species: P. antidysentericum, P. grossularioides, P. triste and P. reniforme.
    B) USES: Pelargonium sidoides has been formulated into a phytopharmaceutical product (ie , Umckaloabo(R), an ethanolic agent that contains the roots of Pelargonium sidoides and P. reniforme and sold in the European Union) that has been used to treat cold symptoms and sold as dietary supplement in France. Tinctures containing P sidoides have been sold in Europe and various liquids and solid preparations are available as herbal supplements in North America and Mexico.
    C) PHARMACOLOGY: TINCTURES/EXTRACTS: In general, herbal products may contain other substances that have antigenic properties (eg, terpenes, coumarins, proteins or glycosides).
    D) WITH POISONING/EXPOSURE
    1) CLINICAL EFFECTS: Geraniums are NOT highly toxic plants.
    2) TOPICAL EXPOSURE: Pelargonium (geraniums) appears to have an irritant/sensitizing effect and may lead to dermatitis in some individuals.
    3) PLANT EXTRACT: Limited data. Adverse events reported with Pelargonium root (ethanolic) extract have commonly included: gastrointestinal events (eg, diarrhea), nervous system complaints, respiratory and mediastinal ailments, ear and labyrinth complaints, exanthema, tracheitis, epistaxis, dermatitis, and acute allergic reactions. Hepatotoxicity has been suggested but the findings appear inconsistent. Other substances found in the extract may be responsible for the symptoms observed.
    4) OIL OF GERANIUM is an essential oil which may also have an irritant/sensitizing effect and whose ingestion may cause more serious symptoms. See the ESSENTIAL OILS management for more information.
    0.2.14) DERMATOLOGIC
    A) WITH POISONING/EXPOSURE
    1) A MILD DERMATITIS is the primary effect seen after exposure to these plants. Symptoms have NOT been severe, and usually present as minor erythema, edema, and possibly vesiculation.
    2) Cheilitis was reported after use of a lipstick that used geranium oil as a perfume.
    0.2.20) REPRODUCTIVE
    A) At the time of this review no human or animal data were available to assess the potential effects of exposure of this agent during pregnancy and lactation.

Laboratory Monitoring

    A) Routine laboratory studies are unlikely to be necessary.
    B) Patch testing an individual may prove allergic versus primary irritation.
    C) For patients that may have ingested the root extract, monitor liver enzymes as indicated.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) MANAGEMENT OF TOXICITY
    1) Treatment is symptomatic and supportive. Limited exposure information. No symptomatic cases have been reported following the ingestion of plant material. Serious cases of dermatitis may be treated with oral antihistamine or topical steroids. Patients who are allergic to the plant should avoid exposure to geraniums and any products that contain oil of geranium and oil of pelargonium. Ingestion of oil of geranium may cause serious symptoms - refer to the ESSENTIAL OIL management for further information. Patients that intentionally ingest the plant extract should be monitored for possible gastrointestinal symptoms and possible hepatic injury. Monitor liver enzymes as necessary. Acute allergic reaction has occurred in several patients following therapeutic use of the plant extract available as a dietary supplement.
    B) DECONTAMINATION
    1) PREHOSPITAL: If ingestion is suspected in a young child, make sure the ingested plant material does not block the airway. Activated charcoal is unlikely to be necessary following a minor ingestion of plant material.
    2) HOSPITAL: If ingestion is suspected in a young child, make sure the ingested plant material does not block the airway. Activated charcoal is unlikely to be necessary following a minor ingestion of plant material.
    C) AIRWAY MANAGEMENT
    1) Monitor airway and respiratory effort (possible foreign body) of a young child they may have ingested the plant material.
    D) ENHANCED ELIMINATION
    1) Enhanced elimination is unlikely to be necessary following exposure to the various plants in this family.
    E) PATIENT DISPOSITION
    1) HOME CRITERIA: Patients seldom, if ever, require treatment for ingestion of the plant material. For those that develop mild symptoms (ie, nausea, vomiting), most patients can be managed at home. If large amounts of oil geranium is ingested treatment may be indicated. Refer to the ESSENTIAL OIL management for further information.
    2) OBSERVATION CRITERIA: Patients that develop a significant pruritus or a topical allergic reaction that is unresponsive to home care may need to be seen in a healthcare center. Patients with a self-harm ingestion of the plant material or plant extract should be referred to a healthcare facility for evaluation.
    3) ADMISSION CRITERIA: Admission is almost never necessary unless aspiration or airway obstruction following ingestion of the plant material.
    4) CONSULT CRITERIA: A toxicologist should be consulted if there is a question of possible systemic toxicity, especially in patients that have been exposed inadvertently or intentionally to the plant extract.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) Patients who are allergic to the plant should avoid exposure to geraniums and any products that contain oil of geranium and oil of pelargonium.
    2) Moderate to severe dermatitis and pruritus may be aided by antihistamines or topical steroids.

Range Of Toxicity

    A) TOXICITY: A toxic amount of Pelargonium material has not been established. INGESTION: There are NO reports of toxic ingestion. ALLERGY: If sensitive, contact with one leaf or any plant part may produce a reaction. OIL OF GERANIUM: A toxic dose has not been established. A very rough estimate of systemic toxicity used for various volatile oils is that 5 mL may produce significant CNS effects in children. There are no data to substantiate this figure for oil of geranium; it is an estimate.

Clinical Effects

Summary Of Exposure

    A) BACKGROUND: Pelargoniums are common annual geraniums widely used as landscape ornamentals and bedding plants. They are cultivated worldwide, and represent more than 250 different species and varieties. They should not be confused with the genus Geranium (cranesbill), a hardy perennial that has symmetrical flowers. Pelargonium sidoides is a perennial found in the Eastern Cape Province of South Africa and have been referred to historically as Khoi-khoi. The roots are described as fleshy, bright red tubers or rhizomes and have been commonly used to treat diarrhea and dysentery. It is widely used in local communities as a traditional medicine for curing various ailments including gastrointestinal (ie, diarrhea, colic, gastritis), respiratory/pulmonary disorders (ie, acute bronchitis, asthma, sinusitis, tonsillopharyngitis and tuberculosis), hepatic illnesses, and gonorrhea. It may also have some antibacterial activity. Other species: P. antidysentericum, P. grossularioides, P. triste and P. reniforme.
    B) USES: Pelargonium sidoides has been formulated into a phytopharmaceutical product (ie , Umckaloabo(R), an ethanolic agent that contains the roots of Pelargonium sidoides and P. reniforme and sold in the European Union) that has been used to treat cold symptoms and sold as dietary supplement in France. Tinctures containing P sidoides have been sold in Europe and various liquids and solid preparations are available as herbal supplements in North America and Mexico.
    C) PHARMACOLOGY: TINCTURES/EXTRACTS: In general, herbal products may contain other substances that have antigenic properties (eg, terpenes, coumarins, proteins or glycosides).
    D) WITH POISONING/EXPOSURE
    1) CLINICAL EFFECTS: Geraniums are NOT highly toxic plants.
    2) TOPICAL EXPOSURE: Pelargonium (geraniums) appears to have an irritant/sensitizing effect and may lead to dermatitis in some individuals.
    3) PLANT EXTRACT: Limited data. Adverse events reported with Pelargonium root (ethanolic) extract have commonly included: gastrointestinal events (eg, diarrhea), nervous system complaints, respiratory and mediastinal ailments, ear and labyrinth complaints, exanthema, tracheitis, epistaxis, dermatitis, and acute allergic reactions. Hepatotoxicity has been suggested but the findings appear inconsistent. Other substances found in the extract may be responsible for the symptoms observed.
    4) OIL OF GERANIUM is an essential oil which may also have an irritant/sensitizing effect and whose ingestion may cause more serious symptoms. See the ESSENTIAL OILS management for more information.

Heent

    3.4.4) EARS
    A) WITH THERAPEUTIC USE
    1) PELARGONIUM SIDOIDES EXTRACT: Ear and labyrinth complaints have been reported following the therapeutic use of P. sidoides extract (Moyo & Van Staden, 2014)
    3.4.5) NOSE
    A) WITH THERAPEUTIC USE
    1) PELARGONIUM SIDOIDES EXTRACT: Epistaxis has been reported following the therapeutic use of P. sidoides extract (Moyo & Van Staden, 2014)

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) ACUTE LOWER RESPIRATORY TRACT INFECTION
    1) WITH THERAPEUTIC USE
    a) PELARGONIUM SIDOIDES EXTRACT: Respiratory and mediastinal illnesses (not further specified) have been reported following the therapeutic use of P. sidoides extract. Tracheitis has also developed (Moyo & Van Staden, 2014).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) NEUROLOGICAL FINDING
    1) WITH THERAPEUTIC USE
    a) PELARGONIUM SIDOIDES EXTRACT: Neurologic complaints (not further specified) have been reported following the therapeutic use of P. sidoides extract (Moyo & Van Staden, 2014)

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) GASTROINTESTINAL TRACT FINDING
    1) WITH THERAPEUTIC USE
    a) PELARGONIUM SIDOIDES EXTRACT: In studies containing over 7000 adults and children being treated for acute bronchitis, acute tonsillo-pharyngitis, or acute sinusitis, the risk of developing an adverse event following pelargonium root (ethanolic) extract use was infrequent (occurring in 1% to 15% of individuals) and mostly minor adverse events (ie, gastrointestinal or skin rashes) developed (Brendler & van Wyk, 2008).
    b) Diarrhea has been reported with the use of pelargonium sidoides extract (Moyo & Van Staden, 2014).

Hepatic

    3.9.2) CLINICAL EFFECTS
    A) TOXIC LIVER DISEASE
    1) WITH THERAPEUTIC USE
    a) PELARGONIUM SIDOIDES EXTRACT
    1) Hepatotoxicity has been reported with P. sidoides root extract use as a herbal medication. In Germany, there have been about 30 reports of liver injury attributed to Pelargonium herbal medication in 2012. Of those cases, approximately 11 resulted in hepatitis and 8 had jaundice. One patient required a liver transplant. However, other potentially hepatotoxic agents (ie, paracetamol, aspirin and ibuprofen) were also found to be coingested by some patients (None Listed, 2012).
    2) LACK OF EFFECT: In a study of 13 cases of suspected hepatotoxicity due to P. sidoides extract, all of the cases showed a lack of hepatotoxicity due to P. sidoides use. Highly probable or a probable causal relationship with P. sidoides could not be determined in any case. Possible confounding variables included an alternative diagnosis, inaccuracies in data collection, and low quality case data (Teschke et al, 2012).

Dermatologic

    3.14.1) SUMMARY
    A) WITH POISONING/EXPOSURE
    1) A MILD DERMATITIS is the primary effect seen after exposure to these plants. Symptoms have NOT been severe, and usually present as minor erythema, edema, and possibly vesiculation.
    2) Cheilitis was reported after use of a lipstick that used geranium oil as a perfume.
    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) WITH POISONING/EXPOSURE
    a) Dermatitis and exanthema have been reported after exposure to the leaves of the plant, the essential oil derived from the plant and the plant extract (Agrup, 1969; Klarmann, 1958; Moyo & Van Staden, 2014). A case of vesicular dermatitis after contact with the leaves was reported by Anderson (1923). Eleven of 110 skin tests done by Agrup (1969) with Pelargonium leaves proved positive for dermatitis.
    b) Although many of the cases appear to be allergic reactions, Agrup (1969) stated several of his cases were due to primary irritation. Four of 52 patients tested by Hjorth (Mitchell & Rook, 1979) had positive skin tests, while none of the 400 patients tested by Fregert & Hjorth (1968) showed positive reactions. Allergic contact dermatitis was reported after use of an ointment containing 2% geraniol (Aguirre, 1993).
    c) Allergic reactions to Pelargoniums are not common. In a study of 253 Danish gardeners and greenhouse workers, 7 workers who had immediate reactions to Pelargonium hybrids were skin tested. One subject was positive for contact urticaria and contact irritant dermatitis (Paulsen et al, 1998).
    d) PELARGONIUM SIDOIDES EXTRACT: In studies containing over 7000 adults and children being treated for acute bronchitis, acute tonsillo-pharyngitis, or acute sinusitis, the risk of developing an adverse event following pelargonium root (ethanolic) extract use was infrequent (occurring in 1% to 15% of individuals) and mostly minor adverse events (ie, gastrointestinal or skin rashes) developed (Brendler & van Wyk, 2008).
    B) CHEILITIS
    1) WITH POISONING/EXPOSURE
    a) Cheilitis including fissuring, drying, and scaling of the red portions of the lips was noted in one case where geranium oil was used as a perfume in a lipstick (Sezary & Horowitz, 1937).

Reproductive

    3.20.1) SUMMARY
    A) At the time of this review no human or animal data were available to assess the potential effects of exposure of this agent during pregnancy and lactation.
    3.20.3) EFFECTS IN PREGNANCY
    A) LACK OF INFORMATION
    1) At the time of this review no human or animal data were available to assess the potential effects of exposure of this agent during pregnancy and lactation.

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) ALLERGIC REACTION
    1) WITH THERAPEUTIC USE
    a) PELARGONIUM EXTRACT
    1) CASE REPORTS: Allergic reactions have occurred with P. sidoides administration. In one case a young woman developed life-threatening acute urticarial and circulatory failure requiring hospital admission after taking Umckaloabo(R) (an ethanolic agent that contains the roots of P. sidoides and P. reniforme and sold in the European Union) drops for cold symptoms. Following the administration of corticosteroids and antihistamines, the patient recovered completely. A skin prick test was positive for pelargonium. In the second case, a 71-year-old man developed swelling of the lips and tongue and dyspnea less than 24 hours after taking Umckaloabo(R) drops. He recovered following medical treatment. In general, herbal products may contain other substances that have antigenic properties (eg, terpenes, coumarins, proteins or glycosides) (de Boer et al, 2007).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Routine laboratory studies are unlikely to be necessary.
    B) Patch testing an individual may prove allergic versus primary irritation.
    C) For patients that may have ingested the root extract, monitor liver enzymes as indicated.

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) Admission is almost never necessary unless aspiration or airway obstruction following ingestion of the plant material.
    6.3.1.2) HOME CRITERIA/ORAL
    A) Patients seldom, if ever, require treatment for ingestion of the plant material. For those that develop mild symptoms (ie, nausea, vomiting), most patients can be managed at home. If large amounts of oil geranium is ingested treatment may be indicated. Refer to the ESSENTIAL OIL management for further information.
    6.3.1.3) CONSULT CRITERIA/ORAL
    A) A toxicologist should be consulted if there is a question of possible systemic toxicity, especially in patients that have been exposed inadvertently or intentionally to the plant extract.
    6.3.1.5) OBSERVATION CRITERIA/ORAL
    A) Patients that develop a significant pruritus or a topical allergic reaction that is unresponsive to home care may need to be seen in a healthcare center. Patients with a self-harm ingestion of the plant material or plant extract should be referred to a healthcare facility for evaluation
    6.3.4) DISPOSITION/EYE EXPOSURE
    6.3.4.2) HOME CRITERIA/EYE
    A) Significant irritation is not expected, unless allergy exists. Eyes should be irrigated with copious amounts of warm water for 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist, an ophthalmologic examination should be performed.
    6.3.5) DISPOSITION/DERMAL EXPOSURE
    6.3.5.2) HOME CRITERIA/DERMAL
    A) Significant irritation is not expected unless an allergy exists. Wash the exposed area with soap and water. If pain or irritation persists, a physician should be contacted.

Monitoring

    A) Routine laboratory studies are unlikely to be necessary.
    B) Patch testing an individual may prove allergic versus primary irritation.
    C) For patients that may have ingested the root extract, monitor liver enzymes as indicated.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) SUMMARY
    1) If ingestion is suspected in a young child, make sure the ingested plant material does not block the airway.
    B) ACTIVATED CHARCOAL
    1) Activated charcoal is unlikely to be necessary following a minor ingestion of plant material.
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY
    1) If ingestion is suspected in a young child, make sure the ingested plant material does not block the airway.
    B) ACTIVATED CHARCOAL
    1) Activated charcoal is unlikely to be necessary following a minor ingestion of plant material.
    6.5.3) TREATMENT
    A) SUPPORT
    1) MANAGEMENT OF TOXICITY
    a) Treatment is symptomatic and supportive. Limited exposure information. No symptomatic cases have been reported following the ingestion of plant material. Serious cases of dermatitis may be treated with oral antihistamine or topical steroids. Patients who are allergic to the plant should avoid exposure to geraniums and any products that contain oil of geranium and oil of pelargonium. Ingestion of oil of geranium may cause serious symptoms - refer to the ESSENTIAL OIL management for further information. Patients that intentionally ingest the plant extract should be monitored for possible gastrointestinal symptoms and possible hepatic injury. Monitor liver enzymes as necessary. Acute allergic reaction has occurred in several patients following therapeutic use of the plant extract available as a dietary supplement.
    B) MONITORING OF PATIENT
    1) Routine laboratory studies are unlikely to be necessary. Patch testing may be indicated to rule out an allergic versus primary irritation of the plant. For patients that may have ingested the root extract, monitor liver enzymes as indicated.

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).

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DERMAL DECONTAMINATION
    1) 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) DERMATITIS
    1) Avoid exposure to Pelargonium species, if allergic.
    2) Moderate to severe dermatitis and pruritus may be aided by antihistamines or topical steroids.
    3) Patch testing may be of benefit to determine if a particular reaction was allergic or primary irritant in nature (Aguirre, 1993) (Agrup, 1969).
    B) Treatment should include recommendations listed in the ORAL EXPOSURE section when appropriate.

Enhanced Elimination

    A) SUMMARY
    1) Enhanced elimination is unlikely to be necessary following exposure to the various plants in this family.

Abstracts

Case Reports

    A) ADULT
    1) An 18-year-old was seen with a vesicular eruption of the back and side finger surfaces of both hands. Initially this was diagnosed as eczema, and while the attack decreased over the next 10 days, it recurred after 2 weeks. He was treated similarly, and a third attack occurred. During an attack, the vesicles were thick walled and difficult to rupture, and varied in size from a match head to a large pea. Some had coalesced to form bullae. The vesicles were fluid filled. There was some finger swelling. The patient removed the dead leaves from a common geranium plant before each occurrence, so a cutaneous test was made and proved positive. Treatment consisted of treating the vesicles with an ointment and removing the plant (Anderson, 1923).

Range Of Toxicity

Summary

    A) TOXICITY: A toxic amount of Pelargonium material has not been established. INGESTION: There are NO reports of toxic ingestion. ALLERGY: If sensitive, contact with one leaf or any plant part may produce a reaction. OIL OF GERANIUM: A toxic dose has not been established. A very rough estimate of systemic toxicity used for various volatile oils is that 5 mL may produce significant CNS effects in children. There are no data to substantiate this figure for oil of geranium; it is an estimate.

Maximum Tolerated Exposure

    A) SUMMARY
    1) A toxic amount of Pelargonium material has not been established.
    B) ROUTE OF EXPOSURE
    1) INGESTION: There are NO reports of toxic ingestion.
    2) ALLERGY: If sensitive, contact with one leaf or any plant part may produce a reaction.
    3) OIL OF GERANIUM: A toxic dose has not been established. A very rough estimate of systemic toxicity used for various volatile oils is that 5 mL may produce significant CNS effects in children. There are no data to substantiate this figure for oil of geranium; it is an estimate.

Pharmacology Toxicology

Toxicologic Mechanism

    A) The specific irritant/allergen is not known. Some contain volatile oils with agents such as geraniol, which are sensitizers (Budavari, 1996; Keil, 1947).

Physicochemical

Physical Characteristics

    A) Oil of Geranium (Pelargonium) is a volatile oil derived from the leaves of P. odoratissimum and related species. It contains various geraniol esters, (21%-35%), citronellol and linalool (Budavari, 1996).

Molecular Weight

    A) Not applicable

References

General Bibliography

    1) Agrup G: Hand eczema and other hand dermatoses in South Sweden. Acta Derm Venereol 1969; 49(Suppl):5-90.
    2) Anderson JW: Geranium dermatitis. Arch Dermatol Syph 1923; 7:510-511.
    3) Botha BM & McCrindle CM: An appropriate method for extracting the insect repellent citronellol from an indigenous plant (Pelargonium graveolens L'Her) for potential use by resource-limited animal owners (abstract). J S Afr Vet Assoc 2000; 71:103-105.
    4) Brendler T & van Wyk BE: A historical, scientific and commercial perspective on the medicinal use of Pelargonium sidoides (Geraniaceae). J Ethnopharmacol 2008; 119(3):420-433.
    5) Budavari S: The Merck Index, 12th ed, Merck & Co, Inc, Whitehouse Station, NJ, 1996.
    6) Burgess JL, Kirk M, Borron SW, et al: Emergency department hazardous materials protocol for contaminated patients. Ann Emerg Med 1999; 34(2):205-212.
    7) Chadeganipour M & Haims A: Antifungal activities of pelargonic and capric acid on Microsporum gypseum (abstract). Mycoses 2001; 44:109-112.
    8) Cilek JE & Schreiber ET: Failure of the "mosquito plant" Pelargonium x citrosum Van Leenii to repel adult Aedes albopictus and Culex quinquefaciatus in Florida. J Am Mosquito Control Assn 1994; 10:473-476.
    9) Kayser O & Kolodziej H: Antibacterial activity of extracts and constituents of Pelargonium sidoides and Pelargonium reniforme (abstract). Planta Med 1997; 63:508-510.
    10) Kayser O, Kolodziej H, & Kiderlen AF: Immunomodulatory principles of Pelargonium sidoides. Phytother Res 2001; 15:122-126.
    11) Keeler RF & Tu AT: Toxicology of Plant and Fungal Compounds, Vol 6, Marcel Dekker, New York, 1983.
    12) Keil H: Contact dermatitis due to oil of citronella. Report of three cases with experimental studies on ingredients with related substances. J Invest Derm 1947; 8:327.
    13) Klarmann EG: Perfume dermatitis. Ann Allergy 1958; 16:425-434.
    14) Latte KP & Kolodziej H: Pelargoniins, new ellagitannins from Pelargonium reniforme. Phytochemistry 2000; 54:701-708.
    15) Lis-Balchin M, Buchbauer G, & Ribisch K: Comparative antibacterial effects of novel Pelargonium essential oils and solvent extracts (abstract). Lett Appl Microbiol 1998; 27:135-141.
    16) Mitchell J & Rook A: Botanical Dermatology, Greengrass Press, Vancouver, BC, 1979.
    17) Moyo M & Van Staden J: Medicinal properties and conservation of Pelargonium sidoides DC. J Ethnopharmacol 2014; 152(2):243-255.
    18) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    19) None Listed: Pelargonium: severe liver damage. Prescrire Int 2012; 21(131):241-.
    20) Paulsen E, Skov PS, & Andersen KE: Immediate skin and mucosal symptoms from pot plants and vegetables in gardeners and greenhouse workers. Contact Dermatitis 1998; 39:166-170.
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