title: Adverse effects of plant food supplements and botanical preparations: a systematic review with critical evaluation of causality.
abstract: OBJECTIVE
  The objective of this review was to collect available data on the following: (i) adverse effects observed in humans from the intake of plant food supplements or botanical preparations; (ii) the misidentification of poisonous plants; and (iii) interactions between plant food supplements/botanicals and conventional drugs or nutrients.
  
  
  METHODS
  PubMed/MEDLINE and Embase were searched from database inception to June 2014, using the terms 'adverse effect/s', 'poisoning/s', 'plant food supplement/s', 'misidentification/s' and 'interaction/s' in combination with the relevant plant name. All papers were critically evaluated according to the World Health Organization Guidelines for causality assessment.
  
  
  RESULTS
  Data were obtained for 66 plants that are common ingredients of plant food supplements; of the 492 papers selected, 402 (81.7%) dealt with adverse effects directly associated with the botanical and 89 (18.1%) concerned interactions with conventional drugs. Only one case was associated with misidentification. Adverse effects were reported for 39 of the 66 botanical substances searched. Of the total references, 86.6% were associated with 14 plants, including Glycine max/soybean (19.3%), Glycyrrhiza glabra/liquorice (12.2%), Camellia sinensis/green tea ( 8.7%) and Ginkgo biloba/gingko (8.5%).
  
  
  CONCLUSIONS
  Considering the length of time examined and the number of plants included in the review, it is remarkable that: (i) the adverse effects due to botanical ingredients were relatively infrequent, if assessed for causality; and (ii) the number of severe clinical reactions was very limited, but some fatal cases have been described. Data presented in this review were assessed for quality in order to make the results maximally useful for clinicians in identifying or excluding deleterious effects of botanicals.
authors.affiliation: Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, via Balzaretti 9, 20133, Milano, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ceschi
authors.forename: Hugo
authors.initials: H
authors.lastname: Kupferschmidt
authors.forename: Saskia
authors.initials: S
authors.lastname: Lüde
authors.forename: Elizabeth
authors.initials: E
authors.lastname: De Souza Nascimento
authors.forename: Ariana
authors.initials: A
authors.lastname: Dos Santos
authors.forename: Francesca
authors.initials: F
authors.lastname: Colombo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Frigerio
authors.forename: Karin
authors.initials: K
authors.lastname: Nørby
authors.forename: Jenny
authors.initials: J
authors.lastname: Plumb
authors.forename: Paul
authors.initials: P
authors.lastname: Finglas
authors.forename: Patrizia
authors.initials: P
authors.lastname: Restani
mesh_terms: D019587:Dietary Supplements / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D018565:Food-Drug Interactions; D006801:Humans; D028321:Plant Preparations / Q000009:adverse effects*; D010946:Plants, Medicinal / Q000009:adverse effects / Q000145:classification
chemical_list: D028321:Plant Preparations
keywords: adverse effects; biomarkers; botanicals; interactions; misidentification; poison centres