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Review
. 2012 Sep;12(3):208-15.
doi: 10.1007/s12012-012-9162-2.

Grayanotoxin poisoning: 'mad honey disease' and beyond

Suze A Jansen  1 , Iris Kleerekooper, Zonne L M Hofman, Isabelle F P M Kappen, Anna Stary-Weinzinger, Marcel A G van der Heyden
Affiliations
Review

Grayanotoxin poisoning: 'mad honey disease' and beyond

Suze A Jansen et al. Cardiovasc Toxicol. 2012 Sep.

Abstract

Many plants of the Ericaceae family, Rhododendron, Pieris, Agarista and Kalmia, contain diterpene grayanotoxins. Consumption of grayanotoxin containing leaves, flowers or secondary products as honey may result in intoxication specifically characterized by dizziness, hypotension and atrial-ventricular block. Symptoms are caused by an inability to inactivate neural sodium ion channels resulting in continuous increased vagal tone. Grayanotoxin containing products are currently sold online, which may pose an increasing risk. In humans, intoxication is rarely lethal, in contrast to cattle and pet poisoning cases. Scientific evidence for the medicinal properties of grayanotoxin containing preparations, such as honey or herbal preparation in use in folk medicine, is scarce, and such use may even be harmful.

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Figures

Fig. 1
Fig. 1
Structure formulas (left panel) and 3-D representations (right panel) of grayanotoxins 1, 2 and 3. Color code gray hydrogen atoms, red oxygen atoms, green carbon atoms
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