Mad Honey Poisoning Presenting With Anaphylaxis and Cardiovascular Instability: A Case Series

Mad honey differs from commercial honey due to contamination with grayanotoxins. These toxins are produced when honey bees extract nectar and pollen from various Rhododendron species. While cardiovascular toxicity is well-documented, anaphylactic reactions are rare and underreported.

This case series describes seven patients presenting to a rural primary care hospital in Nepal between June 2024 and January 2025. Patients were males aged 36-66 years who consumed 5-25 mL of wild honey. The clinical presentation varied: five patients presented with classic symptoms of dizziness, vomiting, bradycardia, and hypotension. Notably, two patients presented with features of anaphylaxis (angioedema, urticaria, and respiratory distress) without initial bradycardia. All patients improved within 24-48 h under supportive management, which included atropine for bradycardia and intramuscular adrenaline (1:1000 concentration) for anaphylaxis.

Mad honey poisoning can present with a spectrum of symptoms ranging from cholinergic toxicity to anaphylaxis. This series highlights the diagnostic challenge of consuming wild honey contaminated with grayanotoxins and underscores the need for clinicians to recognize anaphylaxis as a potential, albeit less common, manifestation.