‘Elf and safety’: Live Christmas trees can bring on unfestive issues for some

Dr Muiris Houston: For those who are sensitive, prolonged indoor exposure to live Christmas trees can lead to respiratory and skin health issues

Have you decorated a natural Christmas tree in the last few days? And have you developed a runny nose and eyes, started to cough and wheeze, and feel like you may be coming down with the flu, or worse, Covid?

Well, medics from Nottingham Trent University have come up with an alternative, non-infectious cause for such afflictions. “Some people who decide to get a real tree may find that after it has been decorated they begin to experience cold-like symptoms... the culprit may actually be a little-known condition called Christmas tree syndrome,” they write in a recent edition of The Conversation.

Apparently, it’s all due to exposure to the allergens found on live Christmas trees. For those who are sensitive, prolonged exposure to live Christmas trees can lead to respiratory and skin health issues.

The main symptoms of Christmas tree syndrome include a stuffy or runny nose, sneezing, irritated eyes, coughing, wheezing and itchy throat. Asthma symptoms may also worsen. Skin-related symptoms include redness, swelling and itching.


This phenomenon happens thanks to the ecology of live trees in the form of pollen and fungi. Fungi grow steadily in cold, damp Christmas tree farms and garden centres. Live Christmas trees can also carry mould. Notably, a single Christmas tree can host more than 50 species of mould.

Researchers who have measured mould counts in rooms containing live Christmas trees found that, during the first three days of the tree being indoors, mould spore counts measure about 800 spores per cubic metre of air. On the fourth day, however, spore counts begin rising, eventually reaching 5,000 spores per cubic metre within two weeks. Mould grows best in warm, wet and humid conditions. So when the tree is brought indoors, the warmer climate significantly increases mould production.

Certain people are at higher risk of experiencing Christmas tree syndrome. People with asthma or chronic obstructive pulmonary syndrome (COPD) may be more sensitive to allergens, and these allergens exacerbate symptoms such as coughing and wheezing.

According to the Nottingham Trent University doctors, people who suffer from allergies are also at greater risk – with research showing 7 per cent of allergy sufferers experienced a spike in symptoms when they had a Christmas tree in their home. People with skin issues (such as contact dermatitis and itching) may also find that their symptoms worsen.

Of course, decorating a Christmas tree can be risky in other ways. According to research by the United States Consumer Product Safety Commission, for instance, from November 2016 to the end of January 2017, some 18,400 injuries dealt with in US emergency departments were associated with holiday decorating. The most frequent of these incidents involved falls (38 per cent), lacerations (14 per cent), and strains or sprains (18 per cent). There were two deaths involving falls from ladders.

Some of the more notable cases brought to hospital included:

  • A 36-year-old man putting up Christmas decorations looking up and sneezing, accidentally swallowing a drawing pin.
  • A 50-year-old woman standing on a chair hanging Christmas lights falling and striking her rectum on tree branches. She was diagnosed with a rectal tear.
  • A four-year-old girl found with a metal bell in her ear. She told the doctor that she wanted to “hear jingle bells”.

But for those wary of the possibility of Christmas tree syndrome, the Nottingham doctors have some words of advice to help reduce your risk: select a tree with lower allergenic potential – fir trees, such as Douglas and Fraser, are known for producing fewer allergens compared to spruce or pine; regularly water live trees to prevent dehydration, as this can lead to mould growth; and try to avoid direct contact when decorating the tree to reduce the risk of skin-related reactions.

Of course there is more to Christmas than “elf and safety”. Wishing readers a most enjoyable festive season.