The Mould Show

What Is Christmas Tree Syndrome?

December 19, 2019 Dr Cameron Jones Episode 28
The Mould Show
What Is Christmas Tree Syndrome?
Show Notes Transcript

Can a live Christmas Tree indoors aggravate your asthma or cause wheeze or contact dermatitis? Is this just a Scrooge conspiracy by a cold-hearted person who despises Christmas and wants us all to buy artificial trees or have no tree at all? Have you or a loved one perhaps started sneezing uncontrollably? Is that due to mould or just the fact that distant Family member/s you don’t see that often are on your doorstep? In this Live Stream, I’m reviewing the facts about what’s been termed Christmas Tree Syndrome and pointing out what’s real news from fake news. Also, find out why there might be fewer Christmas trees in your town or city this year? 

REFERENCES:


Christmas tree dermatitis caused by colophonium allergy. 2017. Contact Dermatitis. 77:406-429. https://www.ncbi.nlm.nih.gov/pubmed/29164686

Identification of mould on seasonal indoor coniferous trees. 2011. Annals of Allergy, Asthma & Immunology. 106: 543-544.  https://doi.org/10.1016/j.anai.2011.03.003

Christmas tree allergy: mould and pollen studies. 1970. C.M.A. Journal. 103: 1272-1276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1930673/

The Christmas Tree Allergy Phenomenon – Live Christmas Trees Carry Mold That Increase Allergy Symptoms in Susceptible Individuals. 2015. https://nhsjs.com/2015/the-christmas-tree-allergy-phenomenon-live-christmas-trees-carry-mold-that-increase-allergy-symptoms-in-susceptible-individuals/#identifier_0_2869

A Review of Colophonium. https://www.the-dermatologist.com/content/review-colophonium

Exposure and Health Effects of Fungi on Humans. J Allergy Clin Immunol Pract. 2016 ; 4(3): 396–404. doi:10.1016/j.jaip.2016.01.008

Kasprzyk I, Rodinkova V, Šaulienė I, et al. Air pollution by allergenic spores of the genus Alternaria in the air of central and eastern Europe. Environ Sci Pollut Res Int. 2015;22(12):9260–9274. doi:10.1007/s11356-014-4070-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473279/

The dreaded promise of Christmas and the New Year. 2007. Psychoanal Q. 2007 Oct;76(4):1351-60. https://www.ncbi.nlm.nih.gov/pubmed/18085014

Hello and welcome to this week's Livestream. And we are talking today for our Christmas edition about something called Christmas tree syndrome. You might've heard about it, you might have some questions, and you might be highly sceptical. I want to talk to you today about what the research literature has to say and whether or not there is a connection with mould. Because as you know every week on these live streams we bring you topical things to do about indoor air quality, water damage, and mould. And as we enter into the Christmas season, well the type of Christmas tree that you decorate your home with could have an impact on your health and wellbeing.

Now, if we look at the history of Christmas trees in the literature, it goes back really to the fourth century CE. And originally these were used as a pagan tradition and it was really due to the fact that wintertime in the Northern hemisphere is particularly cold and using Christmas trees to decorate homes is a way of reminding people about the bountiful spring and the biological opportunities which presented by springtime, especially for farming.

So this issue of the winter solstice and how one decorates the home has been used for many, many years. We moved to more traditional looking Christmas trees of pine and spruce used in Europe really from about the 16th century on. And again the reason is to emphasize a spring and there is a connection of course with Christianity as well.

Now, I want to spend a little bit of time talking about this topic of is Christmas tree syndrome real. And to do this I'm going to be focusing on ... Well, the first paper I'm going to be talking about is an abstract which I was able to get on PubMed for some Danish research. I want to just bring that up now on the screen here. This came out in 2013 and it really presents two case studies from the medical literature.

The first is a 51-year-old woman who presented over Christmas time to the hospital with something which was defined by the clinicians as contact dermatitis. And this was a hypersensitivity reaction as is the other example from this case study from a 41-year-old man who had allergic rhinitis. And so when the clinicians examined both these patients, they were able to establish that there were two causes for the Christmas tree syndrome. One is an allergy to something within the tree and the second is an allergic response to mould. So there is some evidence in the academic literature that there is a problem associated with Christmas trees and in fact, it is a real syndrome. If we move towards what could be causing the problems with the Christmas tree we find that this particular class of trees produce a sticky resin or SAP like material. And this is essentially called Rosin and the type of contact dermatitis allergy is due to a substance within the Rosin called colophonium.

And really this is a term to describe the distilled resin which can be obtained from furs and spruce and Juniper type trees often used as Christmas tree decorations. And again, as the first publication from Denmark showed the colophonium can cause a contact dermatitis reaction. And this affects a lot of people. In the USA for example, contact dermatitis from common elements in the environment affects 14 and a half million people. So that's not to say that Christmas trees impact on 14 and a half million people, but it means that their presence at homes can act to cause this contact dermatitis.

Now this color colophonium or Rosin is found in a lot of different things from tennis racket handles to asphalt, to cement, to chewing gum, to various additives of Rosin, which are added to cosmetics and glues, sunscreens and paints. So it is quite a ubiquitous material and it is included in a lot of products which we use.

And so this contact dermatitis problem can occur not just for Christmas trees, but a lot of other products as well. But again, this is the reason for the contact dermatitis related to Christmas trees. Now, if we move on to the particular types of fungi, which could be responsible for causing allergic rhinitis type response, certainly in that first research paper, they were able to determine that Alternaria fungus is one of the more common fungi, which are correlated with a Christmas tree syndrome. I should point out that Alternaria spores are quite obvious under the microscope. They're also found worldwide and they certainly become able and quite easily. This Alternaria fungus produces numerous mycotoxins and is strongly connected with contamination of grain crops like wheat and rice. And in food security in previous weeks of these live streams, we have discussed the various different funding which calls food spoilage, but this fungus is also strongly found connected with the bark of these types of trees.

Now Alternaria sensitivity is also connected with severe asthma attacks and the fact that Alternaria is easy to really when swabs are taken of Christmas trees you can easily get Alternaria fungus out in pure culture. And certainly, if we look into the literature of the connection between Alternaria and it's induction of severe respiratory illness, we can see that one study from Chicago showed that deaths caused from asthma were more than two times higher on days when the concentration of Alternaria mould spores in the air were over 1000 spores per cubic meter of air. And again, that's another reason why sport trap testing in homes where there is a suspicion of mould exposure is very important because these types of literature and thresholds exist and epidemiologically this is important to note.

If we move towards back now before we move on with the mould issues, I want to also review a paper which came out in 2017 again, focusing on the Rosin or the colophonium because this is really, it's not to be discounted, so anyone who is presenting with a potential Christmas tree syndrome, it could be the mould, but it could well be the colophonium as well.

And so if one presents to the physician, they're going to want to look at your allergy response to these types of things. So this particular paper has gone into some significant detail about what occurred, and I think it's important to highlight this because at the end of the day, if you think of a Christmas tree syndrome, someone actually brought the Christmas tree into the house. So if I look into the paper here, what happened is that a patient was decorating the tree for only one hour. She wasn't using gloves. And gradually she got a dermatitis reaction on her hands, forearms and this rash lightest spread to her neck and face.

Now, she was treated with some mild hydrocortisone cream and some anti-histamines but it got worse and worse. And in fact, she had to go back to the doctor and essentially patch testing was performed and they discovered that it was the colophonium, the spruce needles and the branches on the Christmas tree that were leading to these very severe contact dermatitis response.

So the reason I highlight this is just to emphasize the fact that even though this Livestream is all about mould and it's not always the mould, which is the cause of the problem, it could be the other spores as well and other plant products that are there. And now I want to now definitely move on to fungus. There are a couple of papers in the literature that are focusing on the relationship or the investigation of Christmas tree syndrome. And so they're two good publications out there and one citizen science set of results. And the first publication came out in the 1970s, in fact 1970. And this is a lovely paper, I've got all the references to this in the show notes. And essentially what they were looking at, again, they used petri plates to culture samples of air, and also the physical samples of the bark of the Christmas tree in 10 homes in this particular study. And the main fungi that they were able to culture from the tree where penicillium Epicoccum, Alternaria and Cladosporium.

Now, this is really interesting because the fungi that they found on the tree when they measured the amount of mould spores in the air, they found that there was nearly twice the number of moulds spores after the tree was introduced into the house and the dominant fungus was penicillium. Now, pollens were also a source of allergen and easily become airborne. And in the conclusions to this particular publication, they mentioned this, that pollens may also be connected with the allergy response. So that's one of the reasons I wanted to focus on that in the opening of this particular show.

Now, if we move on to the next publication as well, this came out in 2011. And essentially this is an excellent study. They also used Petri plates but they use molecular techniques and DNA sequencing. And what they did, which was different to the earlier publication, is that they also talk about a conference paper, which obviously one of the academics was privy to and they state in here.

And I've repeated this comment here because I think it's really important because it puts some numbers in here. But they stated that after the Christmas tree was introduced into the apartment, the number of airborne mould spores increased from a background of 800 spores per cubic meter of air to 5,000 spores per cubic meter of the air after a live conifer Christmas tree was introduced for 14 days. Now, this new experiment as 28 staff to provide samples of their Christmas trees. And they were taken back to the clinical microbiology laboratory and the samples were plated out to the Petri plates and also put through a DNA sequencer and to work out their molecular characteristics and identify them in that way. And they found that there was a good connection between the phenotypic identification of the moulds using traditional identification, taxonomic methods and the molecular techniques.

And they found that the dominant moulds on these Christmas trees were aspergillus, Penicillium, Cladosporium and Alternaria when they were grown on the Petri plates. And when they did this via molecular sequencing, DNA sequence, they found aspergillus, Penicillium, Cladosporium, Sydowia.

Now, this is interesting because here we're seeing some other ones which are not found in culture. They also found Nigrospora, Trichoderma and Stachybotrys. And this is interesting research in its own right because it shows that some fungi don't show up in Petri plate culture, but do under molecular sequencing identification.

However, the take-home message was that introducing a Christmas tree definitely does amplify the levels of moulds present not only on the tree but in the air space. And that this is just an effect of bringing a live biological tree into the home.

Now, let's now look at some more recent material because this is not published, but this next study was done really as part of a science experiment. It is a type of citizen science research and it's actually really good. So again, I've got a link to this research in the show notes. And what they did in this experiment is that they did a double-blind study. They tested 90 different homes. Again, Petri plates were used to test the home before any decorations went in. That is in November to click background levels. And then after the decorations went in, they retested the homes. But the important thing is that they tested properties where there was a live tree, where there was an artificial tree or where there was no tree at all. And what they discovered is they also applied a questionnaire to the occupants of the house and they wanted to find out about background respiratory issues and symptoms and problems, and whether or not these were exacerbated or got worse or got better after the live tree went in, the artificial tree or no tree at all.

And if we move forward to some of their results, you can see in the graph here on the left-hand side in the blue bar graph, that is the concentration of mould spores, the number of mould colonies that appeared on these Petri plates before the decorations went in. And you can see that approximately about 12 colonies formed on the Petri plates under just normal conditions in November.

Now, when the live tree was introduced, you can see that that's in the red on the bar graph, you can see that there was a much higher number of mould colonies being formed when the live tree went in. But interestingly, when an artificial tree was also put into the homes, there was an amplification of mould as well. And in a sense that emphasizes the fact that a lot of these objects attract biological particles from the air. When they're stored, they can possibly also get settled spores on them, which then become airborne when the tree is put up and decorated. And the lowest level of mould spores in the house was detected when there was no tree at all.

And that's really an interesting result. If we look at some more data, which was revealed by their study when they ask people what their respiratory history was. Again, you can see that people with respiratory illnesses report a much worse or worsening of their symptoms when the live tree went in. And then similarly, even when the artificial tree went in, there was some amplification of adverse health symptoms with that. And people who had no Christmas tree really had no change in their respiratory distress or illness during the Christmas time period.

So what are some of the conclusions here? Well, we know for a fact that real Christmas trees take approximately a decade to mature. And at this time of year, certainly here in Melbourne, Australia, it's been hard to find Christmas trees. We would've put a Christmas tree in our office in a sense to decorate it over the last couple of weeks. But there aren't any downstairs at the supermarket really. They haven't been on the side of the right either. And when we look at some of the reasons why that might be, it became obvious that the Christmas trees as I said, take approximately a decade to mature before they're ready to be sold. And this coincides with the GFC approximately 10 years ago in 2008, 2009 when a lot of people who are in the business of growing Christmas trees commercially went out of business.

And also there've been a whole lot of insect attacks as well, which have decimated a population of trees suitable for Christmas tree use. And that is really an interesting problem in its own right. And also this issue of the insects is related to climate changes. Well, and when we look at the connection between a real tree versus an artificial tree, obviously a real tree can, if it has to go landfill, it will biodegrade because it is a suitable nutritional material and it will go into landfill quite well.

An artificial tree has a much higher carbon footprint and essentially this isn't going to biodegrade at all, and not much of an artificial tree can be recycled. And also artificial trees have a lot of plasticizers in them. And so artificial trees can also create different types of indoor contamination as well. So in terms of take-home conclusion, Christmas tree allergy is definitely a real phenomenon. Yes, it is true. It is not fake news. And it could be caused by the contact dermatitis to the Rosin or it could be caused by any of a number of dominant moulds which are brought in on the Christmas tree and then liberated within the home as they grow on the tree. And essentially why and how this occurs is bringing a tree indoors create something called a false spring. And essentially this is where you get the liberation of the mould spores into the air and presumably other pollen spores as well.

The mould spores germinate indoors and they can, of course, aggravate preexisting respiratory conditions and it does mean then that there is a proven connection between live Christmas trees increase in the risk of ways persistent cough and allergic sensitization. Obviously an artificial tree is a better alternative if you suffer from any of these respiratory health problems. However, mould from the storage of your artificial tree could also aggravate symptoms. And the really the conclusion to this is that Christmas and the New Year period and the reason why people decorate their home is really to emphasize the fact that this time of year is traditionally about new beginnings and positive resolutions aimed at making a change in the New Year for the better. And so your choice of home decoration is really up to you, but it's something to bear in mind that this Christmas tree syndrome is definitely real.

In any case, my name is Dr Cameron Jones. You have been watching certainly for the last 28 weeks that we've been doing these live streams, to may talk about the relationship to the built environment to mould, water damage and I've hopefully focused on a lot of useful information. We will be back in January. On the 16th of January, we will have some pre-recorded shows coming up over the next two weeks. Thank you for joining me each week and sending in your questions to the various different places where we post these live streams. Next year we've got a lot of really interesting developments happening on the show each week. We're going to have some regular segments, an increasing focus on bringing experts in and we're going to be taking a lot more questions because they are building up on our various different social media channels.

And I want the whole live streams to be a lot more interactive as well. In any case, that's it for me. Derek has been helping me diligently all year to bring you and produce these shows. So thank you from both of us for tuning in each week and watching this, and I hope you have a great Christmas period with your friends and family. And just remember to watch out for any unexplained water or moisture in your home this year and take action and don't ignore it. In any case, thanks for watching and bye for now. Merry Christmas all.