title: Grayanotoxin poisoning: 'mad honey disease' and beyond.
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.
authors.affiliation: Honours Program CRU2006 Bachelor, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
authors.forename: Suze A
authors.initials: SA
authors.lastname: Jansen
authors.forename: Iris
authors.initials: I
authors.lastname: Kleerekooper
authors.forename: Zonne L M
authors.initials: ZL
authors.lastname: Hofman
authors.forename: Isabelle F P M
authors.initials: IF
authors.lastname: Kappen
authors.forename: Anna
authors.initials: A
authors.lastname: Stary-Weinzinger
authors.forename: Marcel A G
authors.initials: MA
authors.lastname: van der Heyden
mesh_terms: D000818:Animals; D054537:Atrioventricular Block / Q000139:chemically induced; D002417:Cattle; D004224:Diterpenes / Q000032:analysis / Q000378:metabolism / Q000506:poisoning / Q000633:toxicity*; D004244:Dizziness / Q000139:chemically induced; D005506:Food Contamination / Q000032:analysis; D006722:Honey / Q000032:analysis*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D010936:Plant Extracts / Q000032:analysis / Q000506:poisoning; D010947:Plants, Toxic; D029793:Rhododendron; D014118:Toxins, Biological / Q000032:analysis / Q000378:metabolism / Q000506:poisoning*
chemical_list: D004224:Diterpenes; D010936:Plant Extracts; D014118:Toxins, Biological; C001311:grayanotoxin I