The Black Sea coastal area of Turkey is prone to bouts of an unusual type of food poisoning from "mad" honey, reveals research in Emergency Medicine Journal.
But honey poisoning is likely to become more common elsewhere because of the increase in the consumption of imported unprocessed honey, warn the authors.
The researchers detail 19 patients who all required emergency care in 2002 after eating local Turkish honey. The patients, whose ages ranged from 22 to 61, all had symptoms of nausea, vomiting, low blood pressure, slowed heart rate and fainting. Four of them had also sustained head injuries after falling.
Their relatives confirmed that they had eaten between 30 and 180 grams of honey several hours before being admitted to hospital.
After 24 hours of monitoring on the coronary unit and treatment with atropine, their heart rate and blood pressure returned to normal and they made a full recovery.
Andromedotoxins, also known as acetylandromedol or grayanotoxin, are found in the leaves and flowers of ericaceous plants, such as rhododendrons and azaleas, and extracted by bees. Grayanotoxin I, one of 18 types of grayanotoxin, is responsible for honey poisoning.
Fifteen of the patients had previously been diagnosed with a duodenal ulcer. And "mad honey" is used in the Black Sea region as an alternative medicine to treat stomach and bowel problems and high blood pressure.
The threshold for toxicity is not known, but the authors point out that in some cases a teaspoon is sufficient. Usually the severity of symptoms tends to reflect the amount of honey eaten, and can also include sweating, salivation, dizziness, weakness, blurred vision, chills and cyanosis (turning blue).
The authors point out that theirs are not the first cases of honey poisoning to be reported.