Anaphylactic shock following the mad honey consumption: a case report

Abstract

Introduction: Mad honey consumption is a common practice in Nepal for medicinal and consumption purposes, but it can lead to severe adverse effects. Grayanotoxin I and Grayanotoxin III isoforms found in rhododendron interfere with voltage-gated sodium channels resulting in gastrointestinal symptoms, and cardiovascular effects such as low blood pressure, abnormal heart rhythms, cardiac arrest, and abnormal electrical conduction in the heart, as well as rare central nervous system disorders. Here the authors report a case of Mad honey consumption leading to anaphylactic shock along with its investigations and management. Case presentation: The authors present a case of a 51-year-old female who developed anaphylactic shock after consuming mad honey. The patient experienced symptoms including nausea, vomiting, abdominal pain, sweating, dizziness, facial and lip swelling, but no chest pain, loss of consciousness, abnormal body movement, or dyspnoea. The patient had no prior medical conditions, regular medications, or history of allergic reactions to honey or pollen. Discussion: Mad honey intoxication is caused by grayanotoxins, with distinct cardiac effects for different types of grayanotoxins. Symptoms include bradycardia, hypotension, abdominal pain, dizziness, and nausea, which subsided within 24 h following the initial management. The presence of grayanotoxin can be detected using specialized instrumentation, but it may not be available in all medical facilities. Co-intoxication with alcohol or propolis may also occur. Conclusion: This case highlights the importance of recognizing and managing complications associated with mad honey consumption, particularly in regions where it is prevalent. Prompt medical attention is advised if unusual symptoms occur after honey consumption.