Substance Info: (and synonyms)

Background Info:

More than 300 types of honey are recognised, the most common being buckwheat and clover. The flavour can vary season to season, and area to area. Other factors that influence taste are the plant of origin, the climate, soil, and various weather factors. Honey is composed of glucose and fructose sugars.

Honey has been used by earliest mankind as a food and a medicine, and honey found in Pharaohs' tombs has still been edible.

In rare cases, honey results in allergic reactions due to contamination with pollen allergens. These pollens may vary from region to region. Some authors suggest that honey should be considered in any patient with unresolved food allergy. Honey is made from many plant sources, and any of the "parent" plants' pollen may be found in the honey. Possible sources of plant nectar include: Acacia, Bluegum, Citrus, Clover, Cosmos, Eucalyptus, Heather, Cape Fynbos, Grape, Lucerne, Sunflower, and other wild flowers. Other exotic varieties include Avocado, Litchi and Mango.


Adverse Reactions:


[ 1 / 26 ]

Six patients who described systemic allergic reactions after ingestion of honey are presented. Three of the six patients had experienced anaphylaxis. Honey-specific IgE was measured and skin-prick tests for honey were performed to diagnose honey allergy. The results of honey-specific IgE of all patients were positive. Four patients had high serum-specific IgE for honey bee venom and two of five patients had also experienced anaphylaxis due to bee stings. Skin-prick tests with honey and pollens were positive in five patients. Specific IgE and skin-prick tests are helpful for the diagnosis of honey allergy. (Vezir 2014 ref.29467 4)

Vezir E, Kaya A, Toyran M, Azkur D, Dibek ME, Kocabas CN. Anaphylaxis/angioedema caused by honey ingestion. Allergy Asthma Proc 2014 Jan;35(1):71-74

[ 2 / 26 ]

A 14-month-old boy presented with anaphylaxis after honey ingestion. He was given approximately one teaspoon of honey several times until he was six months old. When he was 14 months old, his mother gave him approximately five teaspoons of honey. After five minutes, his lips were swollen and within 10 minutes urticaria, angio-oedema, cough and wheezing occurred. Five weeks after this episode of anaphylaxis, prick-to-prick skin test was performed for the honey that was eaten and for another two species which are frequently consumed in Turkey. Honey which was eaten was found positive, flower honey was negative, and honey composed of mixed flower and pine honey was weak positive. Skin prick tests with common pollens and pinus pollen were also negative. (Tuncel 2011 ref.26210 3)

Tuncel T, Uysal P, Hocaoglu AB, Erge DO, Firinci F, Karaman O, Uzuner N. Anaphylaxis caused by honey ingestion in an infant. Allergol Immunopathol (Madr ) 2011 Mar;39(2):112-113

[ 3 / 26 ]

In an overview of the role of hidden allergens in allergic reactions in a geographical area of Spain, the other 12 reactions recorded were due to foods consumed in very small amounts (flavourings, honey, cinnamon, lupin, grasspea) that usually act as hidden allergens, thus making diagnosis difficult. The flavourings involved were mustard, present in gravy at restaurants, mayonnaise (3 cases) and paprika present in sausages (5 cases). We must also highlight the case of a patient diagnosed with anaphylaxis due to honey that suffered two episodes of urticaria after the ingestion of white coffee probably due to contamination by incomplete cleaning of the containers previously used for serving infusions containing honey. (Anibarro 2007 ref.20813 3)

Añíbarro B, Seoane FJ, Múgica MV. Involvement of hidden allergens in food allergic reactions. J Investig Allergol Clin Immunol 2007;17(3):168-172

[ 4 / 26 ]

Anaphylaxis to honey in a 19 year old female with rhinoconjunctivitis and sensitized to Compositae pollen is described. Ten minutes after eating bread and honey she developed angioedema of the lips and tongue, runny nose, cough, dyspnoea, and collapse, requiring hospitalization. SPTs were positive to mugwort, ragweed, dandelion, and goldenrod. The prick to prick test was positive to 'Millefiori' (obtained from bees foraging on Compositae) and also to sunflower, limetree, and gum tree honey, while was negative for other kinds of honey, including the frequently used chestnut honey and acacia honey. The allergenic component responsible of anaphylaxis in this case seems to be a molecule occurring in Compositae pollens, but also in pollen from plants of different families. Honey contains a large number of components derived from bees, such as gland secretions and wax, as well as from substances related to their foraging activity, such flower nectar and pollens. (Fuiano 2006 ref.16401 7)

Fuiano N, Incorvaia C, Riario-Sforza GG, Casino G. Anaphylaxis to honey in pollinosis to mugwort: a case report. Allerg Immunol (Paris) 2006 Dec;38(10):364-365

[ 5 / 26 ]

Allergic contact cheilitis induced by repeated contact with propolis-enriched honey. (Pasolini 2004 ref.10933 5)

Pasolini G, Semenza D, Capezzera R, Sala R, Zane C, Rodella R, Calzavara-Pinton P. Allergic contact cheilitis induced by repeated contact with propolis-enriched honey. Contact Dermatitis 2004;50(5):322-3

[ 6 / 26 ]

Allergy to honey is very uncommon but is a commonly self-reported allergy. (Eriksson 2004 ref.9457 4)

Eriksson NE, Möller C, Werner S, Magnusson J, Bengtsson U, Zolubas M. Self-reported food hypersensitivity in Sweden, Denmark, Estonia, Lithuania, and Russia. J Investig Allergol Clin Immunol 2004;14(1):70-9

[ 7 / 26 ]

This study reports on a 47-year-old man suffering with perennial rhinitis, asthma and rhinoconjunctivitis, who presented on several occasions, with oral and cutaneous symptoms and angioedema due to contact with rose or intake of honey or other products. Finally, he had an anaphylactic reaction on drinking dew collected in the tulips of a rose that possibly contained rose pollen. Specific IgE was evaluated with Rosa rugosa extract and was 30.3 IU. (Karakaya 2003 ref.7754 4)

Karakaya G, Kalyoncu AF. A case of anaphylaxis due to rose pollen ingestion. Allergol Immunopathol (Madr) 2003;31(2):91-3

[ 8 / 26 ]

This study does not confirm the widely held belief that honey relieves the symptoms of allergic rhinoconjunctivitis. (Rajan 2002 ref.6706 7)

Rajan TV, Tennen H, Lindquist RL, Cohen L, Clive J. Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Ann Allergy Asthma Immunol 2002;88(2):198-203

[ 9 / 26 ]

Infant botulism and honey in Europe. (Aureli 2002 ref.10940 6)

Aureli P, Franciosa G, Fenicia L. Infant botulism and honey in Europe: a commentary. Pediatr Infect Dis J 2002;21(9):866-8

[ 10 / 26 ]

A 12-year-old patient with two different episodes of angioedema with dysphagia, dysphonia, and dyspnea a few minutes after the ingestion of honey. IgE antibody to honey and bee venom could not be found, but prick-by-prick with artisan honey was positive. (Ibero 2002 ref.5979 6)

Ibero M, Castillo MJ, Pineda F, Palacios R, Martinez J. Whole bee for diagnosis of honey allergy. Allergy 2002;57(6):557-8

[ 11 / 26 ]

A 42-year-old woman was employed as a quality-control worker in a company producing breakfast cereal, experienced intermittent wheeze, cough, dyspnoea, and generalized rash. These would begin within 1h of the spraying of the vanilla and honey mixture and resolve over 2 days. Between episodes, she was asymptomatic. A mixture of vanilla, honey, and water was sprayed onto some of the manufactured cereal. During this process, clouds of the mixture could be seen in the air and would settle on the worker's clothes and exposed skin. Monitoring of PEFR at work demonstrated up to 19% daily variation with deterioration from a daily mean after exposure to the sprayed vanilla and honey. Skin testing with vanilla extract was negative and a positive reaction for honey. She developed a dual asthmatic reaction to a dilution of honey extract. During the night after being challenged with honey, she required salbutamol on two occasions and developed a generalized rash. A specific challenge test with honey was repeated three weeks later and she again developed a dual asthmatic reaction. Serum specific IgE for honey was 43.6 ug/l.
Honey may contain pollen, beebody components, mould spores, and algae. (Johnson 1999 ref.10957 5)

Johnson A, Dittrick M, Chan-Yeung M. Occupational asthma caused by honey. Allergy 1999;54(2):189-90

[ 12 / 26 ]

A report of 5 cases of honey allergy. A 68-year old housewife complaining of abdominal pain after eating honey since her childhood. Accompanying urticaria became a recent feature. She was able to eat forest honey but not flower honey but recently was unable to tolerate either. Serum specific IgE was negative. A 46-year-old woman described acute urticaria and nasal discharge after eating coconut, vanilla and honey. Skin and serum specific IgE to honey was negative. A 63-year-old man developed recurrent generalised urticaria and angioedema while on chemotherapeutic agents. The reactions were associated with the ingestion of honey and royal jelly. Skin and serum IgE to honey was negative and the reactions stopped with cessation of honey and royal jelly. A 50-year-old man experienced acute angioedema after tasting honey each of 3 times. A 60-year old male experienced chronic diarrhoea for 25 years with no aetiology being found. He had experienced 4-5 episodes of acute urticaria with honey previously. (Karakaya 1999 ref.10954 6)

Karakaya G, Fuat Kalyoncu A. Honey allergy in adult allergy practice. Allergol Immunopathol (Madr) 1999;27(5):271-2

[ 13 / 26 ]

Honey and royal jelly are complex etherogeneous mixtures of flowers' nectar, sugars, proteins and bee's glandular secretions. This study describes two cases of severe systemic reactions (anaphylaxis and generalized urticaria/angioedema) due to honey and royal jelly ingestion in patients sensitized to compositae (mugwort). Both patients had a skin and RAST positivity to mugwort and a positive prick-by-prick to the offending foods. Moreover, in one of the two patients the RAST-inhibition assay showed the strong cross-reactivity between the proteins of honey and mugwort and the SDS-PAGE analysis showed that the major proteic bands from honey and mugwort extracts are largely superimposable. (Lombardi 1998 ref.5322 6)

Lombardi C, Senna GE, Gatti B, Feligioni M, Riva G, Bonadonna P, Dama AR, Canonica GW, Passalacqua G. Allergic reactions to honey and royal jelly and their relationship with sensitization to compositae. Allergol Immunopathol (Madr) 1998;26(6):288-90

[ 14 / 26 ]

Three patients, all showing the same pattern of honey sensitization with clinical history, cutaneous test and specific IgE clearly positive to honey crude extract but not to pollen proteins or glandular proteins from Hymenoplera insects . Attempts to identify these proteins with the most common honey allergens failed, leaving open the question on the origin of protein allergens in cases of honey allergy. (de la Torre 1997 ref.646 3)

de la Torre F, Garcia JC, Martinez A, Martinez J, Palacios R. IgE binding proteins in honey: discussion on their origin. J Invest Allergol Clin Immunol 1997;7(2):83-9

[ 15 / 26 ]

Anaphylaxis, rhinitis, pharyngeal pruritis, laryngeal and lip oedema, and GIT complaints. Three of 448 patients with rhinoconjunctivitis had honey allergy. (Kalyoncu 1997 ref.749 02)

Kalyoncu AF. Honey allergy and rhinitis in Ankara, Turkey. Allergy 1997;52(8)876-7

[ 16 / 26 ]

Serum of 23 patients allergic to honey were investigated to characterize the allergenic components of honey. All displayed allergic symptoms after ingestion of honey or honey-containing products, ranging from itching in the oral mucosa to severe systemic symptoms to anaphylactic shock. (Bauer 1996 ref.710 43)

Bauer L, Kohlich A, Hirschwehr R, Siemann U, Ebner H, Scheiner O, Kraft D, Ebner C. Food allergy to honey: pollen or bee products? Characterization of allergenic proteins in honey by means of immunoblotting. J Allergy Clin Immunol 1996;97(1 Pt 1):65-73

[ 17 / 26 ]

In 23 patients allergic to honey, including sunflower honey, with symptoms ranging from itching in the oral mucosa to severe systemic symptoms to anaphylactic shock, proteins derived from secretions of pharyngeal and salivary glands of honeybee heads and pollen proteins were found in the honey which were responsible for causing allergic reactions to honey. Sensitization to honey usually causes gastrointestinal, dermatologic, or systemic, anaphylactic reactions on ingestion. (Bauer 1996 ref.710 54)

Bauer L, Kohlich A, Hirschwehr R, Siemann U, Ebner H, Scheiner O, Kraft D, Ebner C. Food allergy to honey: pollen or bee products? Characterization of allergenic proteins in honey by means of immunoblotting. J Allergy Clin Immunol 1996;97(1 Pt 1):65-73

[ 18 / 26 ]

Allergic reaction due to pollen allergens in honey. 9 patients with hay fever, with or without asthma, who experienced systemic allergic reactions after ingestion of natural honeys from two local areas (Andujar and Granada) and/or camomile tea. Pollen analysis showed a high level in sunflower pollen (23.6% of pollen grains) in the honey from Andujar but not in that from Granada. Conjunctival challenge with camomile extract also gave positive results. These tests and inhibition studies carried out, suggest that pollen of Compositae may be responsible for allergic reactions to certain natural foods and that the reactions are mediated by an IgE-related mechanism. (Florido 1995 ref.728 28)

Florido-Lopez JF, Gonzalez-Delgado P, Saenz de San Pedro B, Perez-Miranda C, Arias de Saavedra JM, Marin-Pozo JF. Allergy to natural honeys and camomile tea. Int Arch Allergy Immunol 1995;108(2):170-4

[ 19 / 26 ]

Honey allergy is rare in patients sensitive to pollens. 46 pollen-allergic patients were challenged with 30 g of honey and another 32 patients with a placebo (30 g of syrup). Minor, mostly subjective, symptoms were seen in or reported by 26% of those challenged with honey and 41% of those challenged with placebo. In no case could the symptoms with certainty be related to the challenge. (Kiistala 1995 ref.1291 3)

Kiistala R, Hannuksela M, Mäkinen-Kiljunen S, Niinimäki A, Haahtela T. Honey allergy is rare in patients sensitive to pollens. Allergy 1995;50(10):844-7

[ 20 / 26 ]

To identify the allergenic components of honey we studied 22 patients with a history of systemic allergic symptoms following honey ingestion. Tests included skin tests and RAST with three different kinds of Swiss honey (dandelion, forest and rape), pollen of compositae species, celery tuber, extract of bee pharyngeal glands, honey bee venom and bee whole body extract. The results show that 3/4 of honey-allergics are sensitive to dandelion honey and 13 of 22 also to compositae pollen. Nine of the honey allergic patients were sensitized to honey bee venom, 3 also to bee pharyngeal glands and to bee whole body extract. (Helbling 1992 ref.70 780)

Helbling A, Peter C, Berchtold E, Bogdanov S, Müller U. Allergy to honey: relation to pollen and honey bee allergy. Allergy 1992;47:41-49

[ 21 / 26 ]

In a study of 22 patients with honey allergy, analysis of diagnostic tests and RAST inhibition studies suggest that besides compositae pollen other allergens, most likely of bee origin are important. In honey allergics primary sensitization may be due either to the honey itself, to airborne pollens (in particular those from the Compositae family) or glandular secretions and body material. (Helbling 1992 ref.70 780)

Helbling A, Peter C, Berchtold E, Bogdanov S, Müller U. Allergy to honey: relation to pollen and honey bee allergy. Allergy 1992;47:41-49

[ 22 / 26 ]

In this study, 102 patients with the initial diagnosis of idiopathic anaphylaxis were evaluated with a battery of 79 food-antigen skin prick tests selected to include foods reported or suspected of provoking anaphylaxis. Thirty-two patients (31%) had positive tests to one or more food antigens. In five of these patients, subsequently eating a food that elicited a positive test provoked an anaphylactic reaction. Two patients eliminated the foods completely, stopped having reactions, and refused challenge. In these seven patients, 10 different antigens provoked anaphylaxis: aniseed, cashew nut, celery, flaxseed, hops, mustard, mushroom, shrimp, sunflower, and walnut. We conclude that a battery of selected food-antigen skin prick tests provided a useful method for identifying an offending antigen in these patients and that some (7% in our series) cases of "idiopathic" anaphylaxis by history are not truly idiopathic.
The 10 antigens with positive clinical correlation
Antigens A B C
Aniseed 1 5 20
Cashew nut 1 2 50
Celery 2 4 50
Flaxseed 1 1 100
Hops 1 2 50
Mushroom 1 3 33
Mustard 2 3 66
Shrimp 1 3 33
Sunflower seed 1 3 33
Walnut 1 1 100
A = Total No. of positive skin tests with positive correlation
B = Total No. of positive skin tests
C = Percent of positive skin tests with positive correlation

Total number of positive skin prick tests.
2 - Almond
5 - Aniseed
1 - Artichoke
1 - Baker's yeast
1 - Beet
1 - Brazil nut
2 - Brewer's yeast
1 - Caraway seed
2 - Cashew nut
5 - Castor bean
4 - Celery
8 - Chamomile
2 - Chestnut
1 - Chicory
1 - Clam
2 - Coconut
1 - Cottonseed
2 - Crab
1 - Fennel
4 - Filbert (hazelnut)
I - Flaxseed
1 - Garbanzo bean
2 - Ginger
1 - Halibut
1 - Honey
2 - Hops
3 - Horseradish
1 - Lentil
1 - Lima beans
2 - Lobster
2 - Mango
1 - Milk
5 - Millet
3 - Mushroom
3 - Mustard
1 - Nutmeg
2 - Pea
1 - Pistachio
3 - Poppy seed
2 - Sesame seed
3 - Shrimp
3 - Sunflower
1 - Thyme
1 - Tumeric
1 - Walnut
None for Allspice, Apple, Banana, Bay leaf, Black pepper, Buckwheat, Cantaloupe, Chicken, Chili pepper, Chocolate, Cinnamon, Clove, Cod, Corn, Cumin seed, Dill seed, Egg, Garlic, Juniper berry, Orange, Oyster, Peach, Peanut, Potato, Psyllium seed, Raspberry, Sage, Salmon, Soybean, Strawberry, Sweet potato, Tangerine, Tapioca, Vanilla.
7 patients with positive clinical correlation to a SPT
1 : Aniseed
2 : Shrimp
3 : Mustard, flaxseed
4 : Celery, hops
5 : Celery, mustard, sunflower
6 : Walnut, cashew nut
7 : Mushroom
(Stricker 1986 ref.9 3606)

Stricker WE, Anorve Lopez E, Reed CE. Food skin testing in patients with "idiopathic anaphylaxis". J Allergy Clin Immunol 1986;77:516-519

[ 23 / 26 ]

A 24-yr-old man developed rhinitis and conjunctivitis over 5 yr of occupational exposure to sunflower pollens, and asthma developed during the fifth year. All respiratory and occular symptoms disappeared after he was removed from exposure, but he had a food allergic reaction while he was eating honey containing 30% sunflower pollens. (Bousquet 1985 ref.69 825)

Bousquet J, Dhivert H, Clauzel AM, Hewitt B, Michel FB. Occupational allergy to sunflower pollen. J Allergy Clin Immunol 1985;75:70-74

[ 24 / 26 ]

The sunflower belongs to the Compositeae family. A 24-yr-old man developed rhinitis and conjunctivitis over 5 yr of exposure to sunflower pollens. All respiratory and occular symptoms disappeared after he was removed from exposure, but he had a food allergic reaction while he was eating honey containing 30% sunflower pollens. The honey that elicited food intolerance was demonstrated to inhibit significantly sunflower pollen RAST. (Bousquet 1985 ref.69 115)

Bousquet J, Dhivert H, Clauzel AM, Hewitt B, Michel FB. Occupational allergy to sunflower pollen. J Allergy Clin Immunol 1985;75:70-74

[ 25 / 26 ]

Contact urticaria from fish, honey and peach skin. (Lombardi 1983 ref.531 2)

Lombardi P, Campolmi P, Giorgini S, Spallanzani P, Sertoli A. Contact Urticaria from fish, honey and peach skin. Contact Dermatitis 1983;9:422-423

[ 26 / 26 ]

Anaphylaxis due to mesquite pollen found in honey. (Mansfield 1981 ref.1106 2)

Mansfield LE, Goldstein GB. Anaphylactic reaction after ingestion of local bee pollen. Ann Allergy 1981;47(3):154-6

Non-Immune reactions

[ 1 ]

Food poisoning is commonly seen in the Black Sea coast of Turkey attributable to andromedotoxin containing toxic honey ingestion. This study describes 19 patients admitted to an emergency department poisoned by "mad" honey. (Ozhan 2004 ref.11000 0)

Ozhan H, Akdemir R, Yazici M, Gunduz H, Duran S, Uyan C. Cardiac emergencies caused by honey ingestion: a single centre experience. Emerg Med J 2004;21(6):742-4

[ 2 ]

A number of antibacterial drugs (antibiotics) like sulfonamides, tetracyclines and streptomycin are used for the treatment of bacterial diseases in beehives. Yet, the finding of sulfanilamide residues in some 15 Swiss honeys out of some 350 samples could not be explained by such apicultural practice. Bees occasionally collect nectar from meadows treated with the herbicide asulam. Such honey is not only contaminated by asulam, but also by its degradation product sulfanilamide. This is the first report that the use of a herbicide causes the appearance of residues of an antibacterial active metabolite belonging to the category of sulfonamide drugs in food. The relevance of this finding lies in the fact that the use of the herbicide asulam might cause unacceptable residue levels of sulfanilamide in a product for human consumption. (Kaufmann 2004 ref.10934 6)

Kaufmann A, Kaenzig A. Contamination of honey by the herbicide asulam and its antibacterial active metabolite sulfanilamide. Food Addit Contam 2004;21(6):564-71.

[ 3 ]

A young male patient of Turkish origin developed a syncope after the consumption of so-called "pontic honey" from the black sea coast. Further symptoms were sinus bradycardia, hypotension and gastrointestinal problems. Intoxication caused by grayanotoxins was presumed. (Gerke 2003 ref.10935 2)

Gerke R, Fahrenkrog U, Lollgen H. Syncope in a young man of Turkish origin. [German] Internist (Berl) 2003;44(10):1308-12.

[ 4 ]

Honey from China contaminated with low levels of chloramphenicol. (FDA 2002 ref.10938 6)

FDA Contaminated honey imports. FDA Consum 2002;36(6):3

[ 5 ]

Numerous studies have shown that the ingestion of honey is linked with infant botulism. In addition, honey samples across the United States have tested positive for Clostridium botulinum spores and toxins. Such substantial evidence led the CDC to recommend that honey not be given to infants younger than 12 months old. (Tanzi 2002 ref.10939 7)

Tanzi MG, Gabay MP. Association between honey consumption and infant botulism. Pharmacotherapy 2002;22(11):1479-83

[ 6 ]

Pyrrolizidine alkaloid-containing plants are a significant source of honey worldwide, which leads to the conclusion that some honey is a potential threat to health, especially for infants and fetuses. (Edgar 2002 ref.10943 4)

Edgar JA, Roeder E, Molyneux RJ. Honey from plants containing pyrrolizidine alkaloids: a potential threat to health. J Agric Food Chem 2002;50(10):2719-30

[ 7 ]

Fifteen persons developed atropine poisoning following consumption of wasp honey. Clinical signs, antidotal response and the presence of Datura plants near the wasp nests supported that the intoxications were caused by ingestion of atropine-contaminated honey. Two deaths occurred from heatstroke because of the poisoning and high environment temperatures and intensive physical activity. (Ramirez 1999 ref.10959 2)

Ramirez M, Rivera E, Ereu C. Fifteen cases of atropine poisoning after honey ingestion. Vet Hum Toxicol 1999;41(1):19-20

[ 8 ]

In a German study, 100 honey samples from various countries from Eurasia, Oceania, and the Americas were analysed for tetracyclines, streptomycin, and sulfathiazole. A total of 42% of the samples was found positive. In the EIA for tetracyclines, 26% were positive, with 12 samples exceeding a level of 50 micrograms kg-1 (tetracycline equivalents). In the EIA for streptomycin, 19% were positive, with a mean concentration of 19 +/- 12 micrograms kg-1. In the sulfathiazole EIA, 16% of the samples were positive, with 13 samples exceeding a level of 100 micrograms kg-1 (sulfathiazole equivalents). However, when samples which were positive in the sulfathiazole EIA were reanalysed for sulfonamides by HPLC, no sulfa drugs could be detected. Experimental heating (40 degrees C) of honey spiked with sulfathiazole indicated that the sulfa drug(s) responsible for positive EIA results could be present a sugar derivatives. (Heering 1998 ref.10955 6)

Heering W, Usleber E, Dietrich R, Martlbauer E. Immunochemical screening for antimicrobial drug residues in commercial honey. Analyst 1998;123(12):2759-62.

[ 9 ]

A three-month-old boy of Norwegian origin who had been fed Argentinian honey developed symptoms of botulism. The diagnosis was confirmed by the demonstration of Clostridium botulinum type A neurotoxin in the faeces. (Tollofsrud 1998 ref.10960 2)

Tollofsrud PA, Kvittingen EA, Granum PE, Vollo A. Botulism in newborn infants. [Norwegian] Tidsskr Nor Laegeforen 1998;118(28):4355-6

[ 10 ]

Five cases of infant botulism which occurred in San Luis, Argentina, are reported. C. botulinum was not detected in samples of honey which had been given to two of the patients. (Puig 1998 ref.10963 6)

Puig de Centorbi O, Centorbi HJ, Demo N, Pujales G, Fernandez R. Infant botulism during a one year period in San Luis, Argentina. Zentralbl Bakteriol 1998;287(1-2):61-6

[ 11 ]

A 34-year-old Spanish woman with a lifelong history of seasonal rhinoconjunctivitis and honey intolerance (pyrosis and abdominal pain) developed, 3 weeks after starting ingestion of bee pollen, astenia, anorexia, abdominal pain, diarrhoea, peripheral blood hypereosinophilia and elevated serum total IgE levels. A duodenal biopsy showed eosinophilic infiltration of the mucosal layer. (Puente 1997 ref.10966 6)

Puente S, Iniguez A, Subirats M, Alonso MJ, Polo F, Moneo I. Eosinophilic gastroenteritis caused by bee pollen sensitization. [Spanish] Med Clin (Barc) 1997;108(18):698-700

[ 12 ]

A 3-month-old Danish boy developed constipation, lethargy, feeding difficulties and descending, severe, symmetric weakness. C. botulinum was identified in a jar of honey of the same brand as the honey fed to the patient. (Balslev 1997 ref.10964 7)

Balslev T, Ostergaard E, Madsen IK, Wandall DA. Infant botulism. The first culture-confirmed Danish case. Neuropediatrics 1997;28(5):287-8

[ 13 ]

A 49-year-old Turkish man, previously well, suddenly developed severe vertigo and a feeling of retrosternal compression. The symptoms had set in within one hour of eating Turkish wild honey. Turkish honey from the Black Sea coast occasionally contains concentrations of acetylandromedol (formerly called andromedotoxin) high enough to cause poisoning. The substance is obtained by bees from some species of Rhododendron which they then incorporate into their honey. (von Malottki 1996 ref.10969 3)

von Malottki K, Wiechmann HW. Acute life-threatening bradycardia: food poisoning by Turkish wild honey. [German] Dtsch Med Wochenschr 1996;121(30):936-8

[ 14 ]

A six-month-old girl in Japan with constipation and poor feeding developed generalized weakness, poor head control, difficulties in sucking and swallowing, and cranial nerve dysfunction within a few days with Clostridium botulinum type B isolated. (Kakinuma 1996 ref.10968 0)

Kakinuma H, Maruyama H, Takahashi H, Yamakawa K, Nakamura S. The first case of type B infant botulism in Japan. Acta Paediatr Jpn 1996;38(5):541-3.

[ 15 ]

Honey contains fructose in excess of glucose, which may lead to incomplete fructose absorption associated with abdominal symptoms and/or diarrhea. This hypothesis was investigated in 20 healthy volunteers. Each subject drank the following aqueous solutions in random order: 20 g lactulose, 100 g honey, 50 g honey, and 35 g each of a glucose and fructose mixture. Breath-hydrogen concentrations increased by 52, 30, 20, and 4 ppm after each of the four test solutions, respectively. Within 10 h after the ingestion of 100 g honey, 50 g honey, and the glucose-fructose mixture, six, three and none of the volunteers, respectively, reported loose stools. The results of this study suggest that carbohydrate malabsorption after ordinary doses of honey is frequent in healthy adults and may be associated with abdominal complaints. (Ladas 1995 ref.10970 7)

Ladas SD, Haritos DN, Raptis SA. Honey may have a laxative effect on normal subjects because of incomplete fructose absorption. Am J Clin Nutr 1995;62(6):1212-5

[ 16 ]

Toxic honey made by bees from Rhododendron species. R. luteum and R. ponticum are the two species which grow in the north regions of Turkey. Grayanotoxins, mainly Grayanotoxin I (Andromedotoxin) occurring only in Ericaceae plants, are the compounds responsible for poisoning. This study reports on 11 cases of poisoning. (Sutlupinar 1993 ref.10976 3)

Sutlupinar N, Mat A, Satganoglu Y. Poisoning by toxic honey in Turkey. Arch Toxicol 1993;67(2):148-50

[ 17 ]

In a Swiss study, about 8 cases of honey-induced poisoning were reported per year at one particular hospital. Most prominent symptoms are loss of consciousness, weakness, severe salivation, sweating, vomiting and diarrhea. Beside these symptoms circumoral paresthesias and bradyarrhythmia may occur. Intoxication is induced by certain diterpenes, so called gray-anotoxins, that appear in flowers of different species of rhododendron. (Geroulanos 1992 ref.10977 4)

Geroulanos S, Attinger B, Cakmakci M. Honey-induced poisoning. [German] Schweiz Rundsch Med Prax 1992;81(17):535-40

[ 18 ]

Besides Rhododendron, moutain laurel or azaleas can cause nausea and vomiting. Honey made from the pollen of plants of the nightshade family contains belladona which can cause dry mouth, blurred vision, fever, hypertension, mania and delirium. (Mirkin 1991 ref.10978 7)

Mirkin G. Side effects of raw honey. JAMA 1991;266(19):2766

[ 19 ]

Grayanotoxins are known to occur in the honey produced from the nectar of Rhododendron ponticum growing on the mountains of the eastern Black Sea region of Turkey and also in Japan, Nepal, Brazil, and some parts of North America and Europe. Two cases of honey intoxication are presented here. (Onat 1991 ref.10980 6)

Onat FY, Yegen BC, Lawrence R, Oktay A, Oktay S. Mad honey poisoning in man and rat. Rev Environ Health 1991;9(1):3-9

[ 20 ]

Elevatated levels of liver enzymes can occur. (Lampe 1988 ref.11155 2)

Lampe KF. Rhododendrons, mountain laurel, and mad honey. JAMA 1988;259:2009

[ 21 ]

Pyrrolizidine alkaloids in honey from Echium plantagineum L. (Culvenor 1981 ref.10983 6)

Culvenor CC, Edgar JA, Smith LW. Pyrrolizidine alkaloids in honey from Echium plantagineum L. J Agric Food Chem 1981;29(5):958-60

[ 22 ]

This 1977 article states that the hepatotoxic alkaloids known to occur in tansy ragwort may pose health hazards to the human consumer when present in honey produced from the nectar of this species (Deinzer 1977 ref.3142 2). No subsequent reports have been found in the literature.

Deinzer ML, Thomson PA, Burgett DM, Isaacson DL Pyrrolizidine alkaloids: their occurrence in honey from tansy ragwort. Science 1977;195(4277):497-9

[ 23 ]

The hepatotoxic alkaloids known to occur in tansy ragwort (Senecio jacobaea L.) are also present in honey produced from the nectar of this species. These alkaloids, which inclued senecionine, seneciphylline, jacoline, jaconine, jacobine, and jacozine. (Deinzer 1977 ref.10987 4)

Deinzer ML, Thomson PA, Burgett DM, Isaacson DL. Pyrrolizidine alkaloids: their occurrence in honey from tansy ragwort (Senecio jacobaea L.) Science 1977;195(4277):497-9

[ 24 ]

Poisoning caused by spring bee honey. (Glushkov 1966 ref.10990 5) (Palmer-Jones 1965 ref.10991 2) (Popova 1960 ref.10994 2)

Glushkov PM. Poisoning caused by spring bee honey. [Russian] Gig Sanit 1966;31(1):78-9

[ 25 ]

Repeated atropine poisoning. (Lehrner 1955 ref.10998 6)

Lehrner L. Repeated atropine poisoning after consumption of honey. [Hungarian] Nepegeszseguegy 1955;36(9):315

Occupational reactions

[ 1 ]

Occupational asthma caused by honey. A 42 year old woman working as a quality control worker for 8 years in a company producing breakfast cereal, developed an intermittent wheeze, cough, dyspnoea, and generalized rash starting within 1 h of the spraying of the vanilla and honey mixture onto the cereal. Spraying was intermittent, approximately once a month, for 2 years. During this process, clouds of the mixture could be seen in the air and would settle on the worker's clothes and exposed skin. Skin testing for 24 common allergens was negative, but a positive test was elicited to honey. Specific inhalational challenges with the honey extract resulted in a dual asthmatic reaction. Serum specific IgE to honey was significantly high. (Johnson 1999 ref.10957 6)

Johnson A, Dittrick M, Chan-Yeung M. Occupational asthma caused by honey. Allergy 1999;54(2):189-90

[ 2 ]

A 48-year-old woman working in a honey-processing plant, was found to be allergic to honeybee body parts. Her symptoms were seasonal coughing and wheezing but had no reactivity to honey ingestion and bee stings. (O'Neil 1990 ref.10981 0)

O'Neil C. Occupational respiratory diseases resulting from exposure to eggs, honey, spices, and mushrooms. Allergy Proc 1990;11(2):69-70

[ 3 ]

Occupational allergy to honeybee-body dust in a honey-processing plant. A honey-plant employee who developed severe asthma coincident with the seasonal honey-packing process. Symptoms correlated with duration of exposure inside the plant during the honey pack and improved in other environments during that season. Skin test, RAST, and bronchial provocation test with honeybee whole body extract were positive. These studies data support an IgE-mediated, seasonal, occupational sensitivity to honeybee-body dust. (Ostrom 1986 ref.10958 2)

Ostrom NK, Swanson MC, Agarwal MK, Yunginger JW. Occupational allergy to honeybee-body dust in a honey-processing plant. J Allergy Clin Immunol 1986;77(5):736-40

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