15

General safety guidelines

CHAPTER CONTENTS
First aid

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Signs and symptoms of toxicity . . . . . . . . . . . . 649

Reporting adverse events . . . . . . . . . . . . . . . . 649
Safety in healthcare

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Adverse skin reactions . .

Child safety . . . . . . . . . .
Patient safety . . . . . . . .
Practitioner safety . . . . .
General safety measures

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Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . 651
Storage and quality control . . . . . . . . . . . . . . . 654
Waste disposal . . . . . . . . . . . . . . . . . . . . . . . 654

especially if undiluted oils are used. If essential oils get into the
eyes, reddening and lacrimation are likely to occur, and a child
may rub their eyes. If essential oils have been instilled nasally,
signs and symptoms of airway irritation are likely, ranging from
nasal irritation through various degrees of respiratory edema
and distress to respiratory arrest. If sufficient amounts are
absorbed by this route, systemic poisoning may result, as for oral
ingestion.
The advice given to doctors dealing with essential oil
poisoning following oral ingestion is that the initial effects generally include mucosal irritation, epigastric pain, vomiting and
diarrhea, and that convulsions, CNS depression and hepatic
and renal failure may follow (Riordan et al 2002). Table 15.1
gives a summary of common signs and symptoms of poisoning
by essential oils. Many published cases of poisoning are detailed
in the appropriate essential oil profile in Chapter 13.

First aid
If you or someone you are with is suffering a serious adverse
event, seek immediate help from your local poison center or
hospital.
Most adverse reactions to essential oils are without any serious
consequence, but if young children ingest any amount, medical
attention should be sought urgently. After suspected ingestion
of an essential oil, asymptomatic children are normally observed
for six hours, and drinking of water is encouraged. Symptomatic
children require hospital admission (Riordan et al 2002). Activated charcoal is regarded as ineffective for treating essential
oil poisoning (Jepsen & Ryan 2005). A summary of first aid procedures for essential oil toxicity is given in Box 15.1.

Signs and symptoms of toxicity

Topical exposure to some essential oils may cause local skin reactions including irritation, allergic reaction, and photosensitization,

2014 Robert Tisserand and Rodney Young.

http://dx.doi.org/10.1016/B978-0-443-06241-4.00015-1

Reporting adverse events

In the US, consumers and health professionals can report
adverse events from essential oils electronically by visiting the
FDAs Medwatch site at https://www.accessdata.fda.gov/
scripts/medwatch/medwatch-online.htm (accessed August
28th 2012).
In Canada, essential oil reactions can be reported to Health
Canada, by visiting http://www.hc-sc.gc.ca/ahc-asc/media/
advisories-avis/reaction-eng.php#Consumer (accessed August
28th 2012).
In the UK, the equivalent body is the MHRA, and their website can be accessed at http://www.mhra.gov.uk/index.htm
(accessed August 28th 2012). However, there is no provision
for reporting reactions to essential oils.
In Australia, adverse events can be reported to the Therapeutic Goods Administration http://www.tga.gov.au (accessed
August 28th 2012).

Essential Oil Safety

Box 15.1
General first aid procedures in cases of adverse reactions following exposure to essential oils by different routes
Ingestion
Do not induce vomiting (corrosive chemicals may destroy
mucous membranes, and there is a risk of aspiration into the
victims lungs during vomiting)
If the person is conscious and not convulsing, rinse mouth with
water and immediately call a hospital or poison center. Avoid
alcohol
If the person is convulsing or unconscious do not give anything
by mouth. Ensure their airway is open and lay them on their side
with the head lower than the body
Transport the person to a hospital as soon as possible

Inhalation
Remove person to fresh air
If not breathing, give artificial respiration, preferably mouth-tomouth
Seek medical attention

Eye contact
Flush eye(s) with water for at least 15 minutes. If there are
contact lenses, remove them after the first 5 minutes, then
continue rinsing eye(s)

Ensure adequate flushing of the eyes by separating the eyelids with

fingers
Seek medical advice if irritation persists

Skin contact
Remove any contaminated clothing.
Wash the skin gently with (preferably unperfumed) soap and water
for at least 10 minutes
Expose the skin to the air (but not to direct sunlight) to encourage
evaporation of remaining essential oil.
Lukewarm oatmeal baths may help soothe reactions spread over
large areas of skin.
Application of a simple barrier cream, or a mild corticosteroid
cream is the normal medical approach (although ACD to topical
corticosteroids is possible).
Oral antihistamines may help reduce itching (topical antihistamines
should be avoided because of the risk of ACD).
Seek medical attention if irritation persists.
(Partly adapted from safety data sheets for essential oils.)

Table 15.1 Poisoning from specific essential oils after acute oral ingestion

Essential oil

Signs and symptoms

Camphor

Initially CNS stimulation (delirium, convulsions), followed by depression (ataxia, coma)

Possibly nausea, vomiting, vertigo, confusion, respiratory failure

Cinnamon bark

A burning sensation in the mouth, chest and stomach, dizziness, double vision, nausea, vomiting, collapse

Citronella

Vomiting, shock, frothing at the mouth, fever, deep and rapid respiration, cyanosis, convulsions

Clove

Acidosis, deteriorating liver function, CNS depression, deep coma, convulsions, ketonuria, low blood glucose

Eucalyptus

CNS depression (drowsiness, coma), abnormal respiration (shallow or labored breathing), pinpoint pupils, ataxia, vertigo,
epigastric pain, vomiting, weakness in the legs, cold sweats, headache

Hyssop

Convulsions

Parsley/apiole

Fever, severe abdominal pain, vaginal bleeding, vomiting, diarrhea

Pennyroyal

Fever, delirium, nausea, vomiting, dizziness, coma, tingling and numbness of the extremities, hemorrhage

Pine

Drowsiness, delirium, headache, nausea, ataxia, tachycardia, paresis, gastroenteritis, toxic nephritis, renal failure

Sage (Dalmatian)

Convulsions

Thuja

Convulsions, gastroenteritis, flatulence, hypotension

Sassafras

Principally shock, vomiting. CNS depression causing inadequacy of respiration and blood circulation. Similar clinical picture
to that of eucalyptus, except for pinpoint pupils

Tea tree

Convulsions, ataxia, drowsiness

Wintergreen/methyl salicylate

Convulsions, vomiting, fever, rapid and labored breathing, cyanosis, tachycardia, respiratory alkalosis, tinnitus, deafness

Wormseed

Generalized edema, skin and mucous membrane irritation, headache, vertigo, tinnitus, double vision, nausea, vomiting,
constipation, deafness, blindness

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General safety guidelines

Safety in healthcare
The following are guidelines for preventing or managing adverse
reactions.

CHAPTER 15

practitioners should label clearly the contents and

concentrations in every bottle of essential oil dispensed,
including whether the oils are undiluted or diluted with an
excipient and if so, by how much
practitioners should be aware of safety issues concerning
photosensitivity, pregnancy, contraindications, etc.

Adverse skin reactions

do not apply undiluted essential oils to any part of the body
before applying to the skin, essential oils should be
appropriately diluted, depending on the oils used
adding undiluted essential oils to bathwater is inadvisable
individuals with a personal or family history of atopic
dermatitis, with a history of skin contact allergy or perfume
allergy, or with a current skin condition, may be at greater
risk of adverse skin reactions.

Child safety
do not allow children to ingest essential oils
do not add undiluted essential oils to the bathwater of
children
keep essential oils out of reach of children
if possible, purchase bottles of essential oils with childresistant caps
do not apply essential oils to or near a childs face
do not place essential oils or preparations containing them
into the nose of a child
do not expose children of five years or less to strong essential
oil vapors.

Patient safety
for general aromatherapy massage, it is recommended that
essential oils are diluted to less than 3% by volume
for children younger than 15 years, lower concentrations
should be used (see Table 4.5)
see Table 4.6 for how to calculate concentrations
for pregnant women, certain essential oils should be avoided
completely (Table 11.1)
patch testing may be useful occasionally if there are doubts
about the safety of a proposed treatment protocol. It is
described on Ch. 5, p. 74
if there is uncertainty about a possible reaction, a 1%
concentration should be used initially for treatment, and
increased in subsequent sessions if prudent
we caution the direct inhalation of essential oil vapors by
those with diagnosed asthma, or anyone reporting airway
hyper-reactivity to fragrances, paint fumes or turpentine.
A guideline maximum of 1% of essential oil for aromatherapy
massage is recommended for this group
a patient should not ingest essential oils unless advised to do
so by a practitioner who is qualified/licensed to prescribe
essential oils in this way

Practitioner safety
the working space used by aromatherapists performing
massage must have adequate ventilation, especially if it is
small
conditions of low relative humidity can exacerbate terpene
airway irritation, which is an occupational risk in
aromatherapy. In very dry climates, or where indoor heating
is being used, a humidifier may be helpful
ozone can exacerbate terpene airway irritation. Indoor
concentrations of ozone in aromatherapy treatment rooms
should therefore be minimized by removing sources of it
such as photocopying machines, laser printers and ozonegenerating air cleaners
hand dermatitis is an occupational risk for aromatherapists
who use massage. If you start to develop hand dermatitis, you
should consider wearing thin plastic disposable gloves for
massage until it subsides. In the meantime, visit a
dermatologist to find out which essential oils may be
causative
individuals with a history of atopic dermatitis should be wary
of a career involving regular skin contact with essential oils, as
they are statistically more prone to adverse skin reactions
frequent hand washing with detergents increases the risk of
hand dermatitis, so their use should be minimized. Most
liquid soaps are made with detergents
the regular use of hand cream is recommended to counteract
the increased roughness and dryness caused by frequent hand
washing.

General safety measures

The most toxic essential oils should not be sold (Table 15.2).
Restrictions already apply in some regions to some of these.

Packaging
To minimize the risk of serious accidental poisoning from essential oils:
undiluted essential oils should only be bought, sold and
dispensed in bottles fitted with integral drop-dispensers
child-resistant bottle closures (caps) should be used for the
more toxic essential oils (Table 15.3).
The following or similar warnings should be included on the
labels of all bottles of undiluted essential oils:
keep away from children
for external use only. Do not ingest
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Essential Oil Safety

Table 15.2 Essential oils that present a high risk of acute toxicity or carcinogenicity

Essential oila

Source

Botanical name

Almond oil (bitter, unrectified)

Kernels

Prunus dulcis (Mill.) var. amara

Boldo oil

Leaves

Peumus boldus Molina

Cade oil (unrectified)

Wood

Juniperus oxycedrus L.

Horseradish oil

Roots

Armoracia rusticana P. Gaertn. et al.

Mustard oil

Seeds

Brassica nigra L., Brassica juncea (L.) Czern.

Pine oil (huon)

Wood

Dacrydium franklinii J. D. Hook.

Sassafras oil

Roots

Sassafras albidum (Nutt.) Nees

Sassafras oil (Brazilian)

Roots

Nectandra sanguinea Rol. Ex Rottb., Ocotea odorifera (Vell.) Rohwer

Sassafras oil (Chinese)

Roots

Cinnamomum porrectum (Roxb.), Cinnamomum rigidissimum H.T. Chang

Snakeroot oil

Roots, rhizomes

Asarum canadense L.

Tea tree oil (black)

Leaves

Melaleuca bracteata F. von Muller

Wormseed oil

Seeds

Chenopodium ambrosioides L., Chenopodium ambrosioides L. var. anthelminticum L.

These essential oils should not be sold in a retail environment, used by aromatherapists, or included in aromatherapy products

Table 15.3 Essential oils that present a known or probable risk of acute toxicity if ingested by children of 6 years or under

Essential oila

Source

Botanical name

Ajowan oil

Seeds

Trachyspermum ammi L.

Basil oil

Leaves

Ocimum gratissimum L., Ocimum tenuiflorum L.

Birch oil (sweet)

Bark

Betula lenta L.

Birch tar oil

Bark & wood

Betula lenta L, Betula pendula Roth., Betula pubescens Ehrh.

Buchu oil (diosphenol CT)

Leaves

Agathosma betulina Bergius

Buchu oil (pulegone CT)

Leaves

Agathosma crenulata L.

Cajuput oil

Leaves & twigs

Melaleuca cajuputi Powell

Calamint (lesser)

Herb

Calamintha nepeta L. subsp. glandulosa Req.

Cassia oil

Bark or leaves

Cinnamomum cassia Blume

Cinnamon oil

Bark

Cinnamomum verum J. Presl.

Cinnamon oil

Leaves

Cinnamomum verum J. Presl.

Clove oil

Buds, leaves or stems

Syzygium aromaticum (L.) Merill et L.M. Perry

Cornmint oil

Leaves

Mentha arvensis L.

Eucalyptus oil

Leaves

Various Eucalyptus species

Feverfew oil

Leaves

Tanacetum parthenium L.

Garlic oil

Bulb

Allium sativum L.

Genipi

Herb

Artemisia genepi Weber syn.

Ho leaf (camphor CT)

Leaves

Cinnamomum camphora L.

Hyssop oil (pinocamphone CT)

Leaves & flowering tops

Hyssopus officinalis L.
Continued

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General safety guidelines

CHAPTER 15

Table 15.3 Essential oils that present a known or probable risk of acute toxicity if ingested by children of 6 years or underContd

Essential oil

Source

Botanical name

Lanyana oil

Leaves and stems

Artemisia afra von Jacquin

Lavender oil (Spanish)

Flowering tops

Lavandula stoechas L. ssp. stoechas

Leek oil

Herb

Allium porrum L.

Mugwort oil (great)

Herb

Artemisia arborescens L.

Niaouli oil (cineole CT)

Leaves

Melaleuca quinquenervia Cav.

Nutmeg oil

Kernels

Myristica fragrans Houtt.

Onion oil

Seeds

Allium cepa L.

Oregano oil

Leaves

Lippia graveolens HBK, Origanum onites L. Origanum vulgare

L. subsp. Hirtum Link, Thymbra capitata L.

Parsley oil

Leaves or seeds

Petroselinum crispum Mill.

Pennyroyal oil

Leaves

Hedeoma pulegioides L., Mentha pulegium L.

Peppermint oil

Leaves

Mentha x piperita L.

Perilla oil

Leaves & flowering tops

Perilla frutescens L.

Pimento oil

Berries or leaves

Pimenta dioica L.

Rosemary oil

Leaves

Rosmarinus officinalis L.

Sage oil (Dalmatian)

Leaves

Salvia officinalis L.

Sage oil (Spanish)

Leaves

Salvia lavandulifolia Vahl.

Savory oil

Herb

Satureia hortensis L., Satureia montana L.

Southernwood oil

Herb

Artemisia abrotanum L.

Spike lavender oil

Flowering tops

Lavandula latifolia Medic.

Tansy oil

Herb

Tanacetum vulgare L.

Tea tree oil

Leaves

Melaleuca alternifolia Cheel

Tejpat oil

Leaves

Cinnamomum tamala Buch.-Ham.

Thuja oil

Leaves

Thuja occidentalis L.

Thyme oil

Leaves

Thymbra spicata L., Thymus serpyllum L.,

Thymus vulgaris L., Thymus zygis L.

Western red cedar

Leaves

Thuja plicata Donn ex D. Don

Wintergreen oil

Leaves

Gaultheria fragrantissima Wall., Gaultheria procumbens L.

Wormwood oil

Leaves & flowering tops

Artemisia absinthium L.

Wormwood oil (sea)

Leaves & flowering tops

Artemisia maritima L.

Wormwood oil (white)

Leaves & flowering tops

Artemisia herba-alba Asso

We believe that these essential oils should only be sold in bottles with child-resistant closures if sold to consumers

do not apply undiluted to any part of the body

essential oils are flammable. Keep away from naked flames.
The label should also include:
the botanical name of the plant source and the part of the
plant used.
appropriate use by or sell by dates or times.

Specific warnings should also be included for essential oils that

are potentially phototoxic (Box 5.4), or that should be avoided
in pregnancy (Table 11.1):
this essential oil may burn the skin if applied in any dilution
or amount up to 12 hours before exposure to UV light
(sunbed or strong sunlight)
do not use if pregnant.
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Essential Oil Safety

The American Herbal Products Association trade guideline

policy for essential oil labelling can be found here: http://
www.ahpa.org/Default.aspx?tabid224#section_undiluted_oils
(accessed August 28th 2012).

keep essential oils away from sources of heat and direct

sunlight
keep essential oils away from naked flames, e.g., candles and
vaporizers. Essential oils are flammable and many have flash
points of 5060 C.

Storage and quality control

The quality of essential oils changes with continual use and over
time (see Chapter 2 for details of degradation). The following
advice is therefore given to suppliers, retailers, health practitioners and others who use essential oils:
keep essential oils cool, preferably in a refrigerator
replace bottle caps immediately after use and return the
bottle to a child-safe place
observe use by dates. If there are none, use within
12 months of purchase, or of first opening
discard oxidation-prone essential oils that are more than
6 months old (after purchase or first opening) or when the
bottle is about 90% empty (see Box 5.2 or individual oil
profiles)

654

Waste disposal
essential oil waste is a fire hazard
spills should be wiped up with a paper towel and placed in a
closed metal waste container with a lid and a plastic liner
used tissues, paper towels, empty bottles, etc., should be
placed in a metal waste container
waste containers should be emptied daily
towels that have been used for aromatherapy massage have
been known to self-combust in a tumble dryer. It is
important to launder them at temperatures of at least 40 C
in order to remove any oil residues http://www.wiltsfire.gov.
uk/media/press_releases/2011/jul/media_press_releases_
270711-2.html (accessed August 27th 2012).