Have You Heard of Christmas Tree Syndrome?

Christmas Tree and Menorah

Happy holidays!

I’m sure, at the time of this post’s publication, everyone has all their Christmas shopping done, their holiday food purchased, all travel plans are arranged and you’re just sitting back and enjoying a nice peaceful breath of relaxation.

You probably aren’t running around to get last minute everything done like I am doing.

But on the off chance that you are a little stressed over the next few days, you STILL need a break. That’s why I wrote this quick, fun post about an allergy problem you’ve probably never head of: Christmas tree syndrome.

 

Christmas Tree Syndrome??!! — Am I For Real?

I admit that every year there seems to be more and more “allergies” appearing (in google search engines). Some of them are true allergies (like red meat allergy), some are click bait (Kanye has 5 allergies… you wont believe #2 [spoiler alert: its modesty. He has an allergy to modesty]) and some of them are… just snake oil salesmen trying to make a quick buck.

Today’s topic, Christmas tree syndrome, was originally believed to be a fake allergy. For years people complained about it and allergists nodded and classified it right up there with wifi-allergy.

But over time, it turned out to be a rather interesting problem.

What is Christmas Tree Syndrome?

Christmas tree syndrome is a catchall term used to describe certain effects people would feel around the Christmas holiday that seemed to correlate with when they purchased and set up a fresh cut Christmas tree in their house.

Creepy christmas tree lot
You can catch Christmas Tree Syndrome from a creepy place like this. Along with Hepatitis.

In general, Christmas tree symptoms could include one or all of these AFTER purchasing a Christmas tree:

  • Feeling sick after purchasing a Christmas tree
  • Having nasal allergy symptoms (nasal congestion, stuffy nose, runny nose, itchy sneezing nose)
  • Having eye allergy symptoms (itchy, red, watery eyes)
  • Headaches or sinus pain
  • Asthma attacks
  • Skin rashes and hives
  • Experiencing increased frustration watering the cut Christmas tree as the pine needles became dried out, more pokey, and hurt… usually resulting in sending your child (and future allergist) to crawl under the tree and try to refill the basin and letting _him _get poked by the tree

Okay, maybe that last one just occurred in my house when I was a child. But all the other symptoms have collectively been called the Christmas tree syndrome.

If you have one or many of these symptoms around the time you add a Christmas tree in your house, you have Christmas tree syndrome (Ok, I’ll admit… allergists aren’t that great at naming things. Just wait until summer when I write my article about having strong mosquito bite reactions… it’s called, no joke, Skeeter syndrome.)

If any of this describes you, or if I’ve captured your interest in a new type of Christmas tale, please keep reading. And if you want to stay up to date with semi-witty allergy information, consider sharing some Christmas spirit and clicking the follow button:

The History of Christmas Tree Syndrome

This Christmas tale begins in Canada in 1970 (god bless you, Canada, for being so awesome). A pair of researchers found about 7% of their allergic patients had some type of nasal, lung or skin disorder when they were around Christmas Trees. These researchers reported that the majority of people had symptoms within the first 24 hours but about 15% would have symptoms days later!

Christmas tree and grinch
How the Grinch stole Christmas tree syndrome

Thus began the tale of Christmas tree syndrome.

That very next year, in a letter to the editor of Canadian Medical Association, a group of allergists criticized the article for describing the skin symptoms as “spots” and said that a lot of Christmas tree syndrome was probably due to being poked by Christmas tree needles.

Thus ended the tale of Christmas tree syndrome

Yup. That’s it. You are now 100% current with the research about Christmas tree syndrome and, honestly, now know more than most primary care providers and even some allergists.

Overall, Christmas tree syndrome is not very common. But it has also not been tracked very well so it might be more prevalent than we know. But to those of you who have experienced this, it deserves a little more of a discussion.

What People USUALLY Think Causes Christmas Tree Syndrome

When I hear people talking about Christmas tree syndrome, I hear them saying that they are allergic to the pine tree itself or possibly allergic to the pine tree’s sap.

As an allergist, when I first heard about Christmas tree syndrome this explanation never really made sense. If you’re allergic to pine, then you’r allergic to the pine pollen which is specifically released from pollinating trees in the spring time. Pine pollen is not released from a cut tree in the winter.

I would have believed a reaction to the sap might cause some skin irritation (I discuss this below) but that type of reaction should be confined to the skin itself causing “spots” and should not cause the classic allergy-type symptoms that people were complaining about (unless they were snorting the sap… which I’m sure some teenage in America has tried. Again, god bless you Canada).

Because of this discrepancy between reported symptom and understanding allergies, I believe many providers IGNORE your complaints about Christmas tree syndrome or DISMISS them as a manifestation of pet dander allergy, dust mite allergy, cold/flus, or even stress from the fact that you might be typing an allergy article instead of getting Christmas gifts for your family.

But there are actually a few different, better explanations for Christmas tree syndrome (#1 will shock you!)

cat on christmas
How could you blame this instead of the more obvious Christmas tree?!

What is the True Cause of Christmas Tree Syndrome?

For most people experiencing the typical allergy symptoms, the problem is actually mold!

It was discovered that a cut Christmas tree, after being stored, shipped, and then introduced into the warm and humid environment of your home, could activate mold spores and cause your allergy symptoms! Specifically (if you’re an allergist reading this, if you have a skin test showing mold positives, or if you LOVE minutia) the molds were Penicillium, Epicoccum and Alternaria.

During the initial article, it was noted that these molds might not be fully airborne which might also cause some of the skin symptoms too.

But what happens if you get Christmas tree syndrome and AREN’T allergic to molds? There are a few other possible causes.

Typical allergy-type symptoms

While molds are probably the most likely cause, there are two other possible triggers of typical nose and eye symptoms:

  1. If you have an irritant rhinitis/irritant allergies, it is possible that some allergy symptoms are triggered by the smell/scent of pine causing nose irritation (in some cases, it might be due to a fake aerosol smell used to make pine trees smell better).
  2. It is also possible there is a relationship to other pollen. The original study showed increased levels of other pollen in homes with Christmas trees… although it is unclear exactly how that pollen got there.

Typical skin-allergy symptoms

While most people have typical allergy symptoms with Christmas tree syndrome, some people experienced only skin symptoms (which included rash, hives, or skin itching… which we will now collectively call “spots” to honor the original research).

These spots have a few different possible causes:

  1. If you have contact with mold that is on the pine tree’s bark or embedded in sap, then mold might trigger an allergic reaction.
  2. It is also possible you can have an irritant reaction with the sap itself, causing your spots
  3. Third, as Dr Grinch et al posted in their letter, it is also possible that your skin reaction could be due to the effect from the pine needle itself (scratching or puncturing the top layer of your skin).

What is important is that with these above causes, we can now create a plan to help you treat Christmas tree syndrome!

How to Treat Christmas Tree Syndrome

As I’ve mentioned in prior articles, the number one way to treat allergies is to avoid the irritant/allergen or reduce exposure reduction. This is not always possible (particularly with seasonal allergies) but it is still the first step toward any good treatment plan.

For some people, the treatment is to buy an artificial Christmas tree and never experience this problem again.

But there are a lot of people who believe that a fake Christmas tree is the first step of a slippery slope to communism, brussel sprouts and living in a Mad Max world. In fact, I am probably perpetuating the War on Christmas just by suggesting an artificial tree.

So for you, I have written treatment. But if you need treatment right now, you can download this Christmas tree syndrome emergency plan and start feeling better right away.

Treating nasal/eye symptoms

Not knowing if your nose/eye reaction is due to an allergic or an irritant cause, your best bet is to start as comprehensive of a treatment plan as possible. For the nose/eye symptoms of Christmas tree syndrome I would recommend:

  1. Start a sinus rinse and use it during the holidays.
    • This will help remove any dirt, pollen, spores, or anything else that might be irritating your nose by making the nose less reactive.
    • Also, a sinus rinse is NOT a medication. So it’s a great first line treatment.
    • And for those of you who hate sinus rinses, I have written an article on the tips and tricks to make a sinus rinse more comfortable.
  2. The second best step is to start a nasal steroid 2-4 weeks BEFORE you get your Christmas tree.
    • Remember it takes 2-4 weeks for a nasal steroid to reach full strength
    • Continue this until the Christmas tree is out of your house (January 2nd for most people and May for a few others)
  3. The third step would be to start an antihistamine.
  4. If you are having eye symptoms AFTER you do all of the above, it is best to add an eye drop.
    • Zaditor (ketotifen) is a great first choice if you’re looking for an over-the-counter treatment
    • A topical antihistamine (Olopatadine or Azelastine) is a great prescription of choice
    • If you want to read more about eye allergies, I discuss it in this article about Treating Eye Allergies.

Treating skin reactions

Since the skin reactions can be a topical/localized effect, a contact urticaria/hive, or a possible contact/allergic dermatitis you need a treatment plan that will work for as many of these causes as possible:

  1. Wash your hands and any skin that comes in contact with the Christmas tree and, if you are able, wear long sleeves when handling the tree.
  2. If you develop hives, your best treatment would be to start an antihistamine or diphenhydramine (Benadryl) as this is the treatment that works for hives.
  3. If you develop a rash, your best treatment is to start an over-the-counter hydrocortisone cream.
  4. Topical antihistamines (topical Benadryl) are probably not very effective for any of these, but it won’t hurt so if you have it go ahead and slap it on your skin (figuratively).

Emergency treatment

I recognize it is very possible and likely that if you’re reading this when I wrote it you likely already have a Christmas tree up or have been to someone’s house who has one. In this case, I know you need more and you needed it yesterday.

For you, I have two plans:

  1. Like my Facebook page so that you can find this article before next year when all the prevention steps will help you the most.
  2. Download my emergency treatment plan below.
    DOWNLOAD you Emergency Plan for Christmas Tree Syndrome

Summary

I know that this article probably isn’t going to save Christmas for Whoville or help John McClane in Nakatomi Plaza.

But I hope it helps a few of you with Christmas tree syndrome and was an entertaining read for everyone else. And if it ever Christmas tree syndrome ever comes up on trivia night, you’ll know the answer for nasal/eye symptoms is mold (and a suspicious increase in pollen) and skin “spots” are caused by sap, mold, or pine needles.

If you do know anyone who has this, forward them this article along with a big “Here’s your gift: knowledge” sticker.

And to everyone else, I hope you have a happy holiday.  And enjoy this amazing Christmas light video made by someone who has their S&*t together a lot more than me.

https://www.youtube.com/watch?v=-TSKcNlX7_o

Questions?

If you have any questions, please email me or send a comment on my Facebook page. I’ll answer them as soon as I can.

Resources

  1. Wyse, DM and D. Malloch. Christmas tree allergy: mould and pollen studies. Can Med Assoc J. Dec 5; 103(12):1272-6. 1970.
  2. Richards, R.N. Christmas Tree Allergy. Can Med Assoc J. Mar 20; 104(6): 533. 1971.

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