Plants contain calcium oxalate crystals packaged into bundles known as raphides. In addition to the calcium oxalate crystals, these plants also contain preoteolytic enzymes with antitrypsin-like activity that stimulate the release of histamine and bradykinin. It riains unclear why some plants such as schefflera, which also contain calcium oxalate crystals, are completely nontoxic. Children who chew the leaves develop immediate burning and irritation of the oral mucosa. Cases of severe swelling, drooling, dysphagia, and respiratory compromise have been reported, but are not common. In a large retrospective study of 188 patients suffering oxalate exposure, all cases were minor and resolved with little or no treatment.11 Diulcifying agents such as cold milk or ice cream may help. Analgesics may be necessary. Steroids may be beneficial for severe cases, although there have been no controlled trials.
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