Relationship between blood toxin level and clinical features in patients with grayanotoxin poisoning – six clinical cases

Choi, Hanlim; Park, Kyung Hye; Park, Jung Soo; Choi, Hye Young; Kim, Hoon; Kim, Sun Moon

doi:10.1080/15563650.2017.1331448

Cited by 13 publications

(5 citation statements)

References 12 publications

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“…The occurrence of grayananes in foods other than honey derived from certain Ericaceae plants has also led to human cases of intoxications. The same characteristic symptoms as for Rhododendron honey intoxications have been described from the consumption of Rhododendron liqueur (Choi et al., 2017), of herbal teas prepared from Pieris japonica (Aleguas et al., 2008) or the leaves of Agarista salicifolia (Martinet et al., 2005) or from the consumption of blossoms of R. japonicum (Koda et al., 2016) or R. mucronulatum (Lee et al., 2007) due to misinformation on their edibility. However, none of these publications allows an estimate of the dose of grayananes ingested.…”

Section: Assessmentmentioning

confidence: 66%

“…In a small retrospective observational study aimed at determining the relationship between blood toxin level and clinical response, Choi et al ( 2017 ) measured GTX I and III in six patients (four male and two female) who had consumed Rhododendron liqueur (also known as Doo‐Gyeon Ju). Initial blood and follow‐up (20 h) levels were measured.…”

Section: Assessmentmentioning

confidence: 99%

“…However, none of these publications allows an estimate of the dose of grayananes ingested. The publication of Choi et al ( 2017 ) is not considered further due to inconsistencies in the reporting of the GTX I and GTX III concentrations in the liqueur and the subsequent calculated doses.…”

Section: Assessmentmentioning

confidence: 99%

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Risks for human health related to the presence of grayanotoxins in certain honey

Schrenk¹,

Bignami²,

Bodin³

et al. 2023

EFS2

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The European Commission asked EFSA for a scientific opinion on the risks for human health of the presence of grayanotoxins (GTXs) in ‘certain honey’ from Ericaceae plants. The risk assessment included all structurally related grayananes occurring with GTXs in ‘certain’ honey. Oral exposure is associated with acute intoxication in humans. Acute symptoms affect the muscles, nervous and cardiovascular systems. These may lead to complete atrioventricular block, convulsions, mental confusion, agitation, syncope and respiratory depression. For acute effects, the CONTAM Panel derived a reference point (RP) of 15.3 μg/kg body weight for the sum of GTX I and III based on a BMDL 10 for reduced heart rate in rats. A similar relative potency was considered for GTX I. Without chronic toxicity studies, an RP for long‐term effects could not be derived. There is evidence for genotoxicity in mice exposed to GTX III or honey containing GTX I and III, showing increased levels of chromosomal damage. The mechanism of genotoxicity is unknown. Without representative occurrence data for the sum of GTX I and III and consumption data from Ericaceae honey, acute dietary exposure was estimated based on selected concentrations for GTX I and III reflecting concentrations measured in ‘certain’ honeys. Applying a margin of exposure (MOE) approach, the estimated MOEs raised health concerns for acute toxicity. The Panel calculated the highest concentrations for GTX I and III below which no acute effects would be expected following ‘certain honey’ consumption. The Panel is 75% or more certain that the calculated highest concentration of 0.05 mg for the sum of GTX I and III per kg honey is protective for all age groups regarding acute intoxications. This value does not consider other grayananes in ‘certain honey’ and does not cover the identified genotoxicity.

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Section: Assessmentmentioning

confidence: 66%

Section: Assessmentmentioning

confidence: 99%

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Risks for human health related to the presence of grayanotoxins in certain honey

Schrenk¹,

Bignami²,

Bodin³

et al. 2023

EFS2

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“…There are 18 types of grayanotoxin found, out of which grayanotoxin 1 and 2 have been found in the honey, leaves, and flowers of Rhododendron, which are considered the most potent form of toxins 1 . In a study of clinical cases, the minimum blood level of grayanotoxin to cause hypotension was reported between 2.52 and 4.55 ng/ml 6 . A direct comparison of the amount of grayanotoxin in honey found across the world has not been done.…”

Section: Discussionmentioning

confidence: 99%

“…1 In a study of clinical cases, the minimum blood level of grayanotoxin to cause hypotension was reported between 2.52 and 4.55 ng/ml. 6 A direct comparison of the amount of grayanotoxin in honey found across the world has not been done. However, in the case of mad honey poisoning in France from honey taken from Nepal, the level of grayanotoxin 1 in Nepalese honey was measured.…”

Section: Discussionmentioning

confidence: 99%

Wild honey poisoning: A case report from western Nepal

Paudel¹,

Pokhrel²,

Gaire

et al. 2022

Clinical Case Reports

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Wild (Mad) honey poisoning is due to ingestion of honey containing a toxin known as grayanotoxin, which is also known as rhodotoxin because it is derived from the nectar of a few rhododendron species primarily found in the mountainous region of Bhutan, India, Nepal, and Turkey. 1 Mad honey is used as an alternative medicine for hypertension, diabetes, flu, gastrointestinal disorders (peptic ulcer, gastritis, dyspepsia, indigestion, and bowel disorder), and arthritis, stimulating sex (dysfunction, impotence, enhancement, and performance), viral infections, and cold. 2 Mad honey can cause dramatic side effects such as nausea, vomiting, dizziness, sweating, impaired consciousness, and various cardiac side effects like bradycardia and hypotension. 3 Ingestion honey containing grayanotoxin can result in hypotension, bradycardia, and cardiac rhythm disorders (first-, second-, and third-degree AV block, asystole, and sinus bradycardia). 4,5 Here, we present a case of mad honey poisoning, which developed bradycardia, hypotension, and dizziness. | CASE REPORTA 55-year-old woman presented to the emergency department with complaints of sudden onset of dizziness and vomiting for 2 h. Further history revealed that the symptoms appeared after 45-60 min after ingestion of 10-15 ml of wild honey. There was no history of trauma, alcohol, or drugs. The patient was a known case of hypertension under treatment with Losartan 25 mg per orally once daily

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Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication

et al. 2021

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Relationship between blood toxin level and clinical features in patients with grayanotoxin poisoning – six clinical cases

Abstract: We estimated that the minimum blood GTX-III and GTX-I levels that caused hypotension were between 17.83 and 27.3 ng/mL, and 2.52 and 4.55 ng/mL, respectively.

Cited by 13 publications

References 12 publications

Risks for human health related to the presence of grayanotoxins in certain honey

Risks for human health related to the presence of grayanotoxins in certain honey

Wild honey poisoning: A case report from western Nepal

Evaluation of Electrocardiographic Parameters and the Presence of Interatrial Block in Patients with Mad Honey Intoxication

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