Pine Mouth (Pine Nut) Syndrome: Description of the Toxidrome, Preliminary Case Definition, and Best Evidence Regarding an Apparent Etiology
15 May 2013 (online)
Pine mouth syndrome (PMS), otherwise known as pine nut syndrome, is a relatively new condition. At least several thousand cases have now been described in the literature. The author describes the PMS toxidrome, offers a preliminary case definition, and discusses current best evidence regarding the etiology and risk factors related to the development of PMS.
A clinically compatible case of PMS must include taste disturbance, usually characterized as bitter or metallic, following the ingestion of affected pine nuts by 1 to 3 days. Affected nuts would appear to include all, or some portion, of nuts harvested from species Pinus armandii (Chinese white pine), but could include nuts from other species. The specific toxin that is apparently present in affected nuts has not yet been isolated, and the mechanism of toxicity and factors determining PMS susceptibility need to be further detailed. There are no proven therapies for PMS. The only treatment is to cease ingesting implicated nuts and to wait for symptoms to abate.
- 1 Munk MD. “Pine mouth” syndrome: cacogeusia following ingestion of pine nuts (genus: pinus). An emerging problem?. J Med Toxicol 2010; 6 (2) 158-159
- 2 Mostin M. Taste disturbances after pine nut ingestion. (Abstract) Eur J Emerg Med 2001; 8 (1) 76
- 3 Flesch F, Rigaux-Barry F, Saviuc P , et al. Dysgeusia following consumption of pine nuts: more than 3000 cases in France. Clin Toxicol (Phila) 2011; 49 (7) 668-670
- 4 Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR 1997; 46 (RR10) 1-55
- 5 Destaillats F, Cruz-Hernandez C, Giuffrida F, Dionisi F. Identification of the botanical origin of pine nuts found in food products by gas-liquid chromatography analysis of fatty acid profile. J Agric Food Chem 2010; 58 (4) 2082-2087
- 6 Food and Agriculture Organization of the United Nations. Seeds, fruits and cones. In: Non-Wood Forest Products from Conifers. Rome, Italy: Food and Agriculture Organization of the United Nations; 1995. . Available at: www.fao.org/docrep/X0453E/X0453e00.htm . Accessed February 11, 2013
- 7 Tan Hui Shan G. Investigating the Pine Nut Syndrome – The Mystery of Delayed Taste Disturbances Caused by Pine Nuts [master's thesis]. Netherlands: Wageningen University; 2011
- 8 Picard F, Landis BN. Pine nut-induced dysgeusia: an emerging problem!. Am J Med 2010; 123 (11) e3
- 9 Destaillats F, Cruz-Hernandez C, Giuffrida F, Dionisi F, Mostin M, Verstegen G. Identification of the botanical origin of commercial pine nuts responsible for dysgeusia by gas-liquid chromatography analysis of fatty acid profile. J Toxicol 2011; 2011: 316789
- 10 Kobler H, Monakhova YB, Kuballa T , et al. Nuclear magnetic resonance spectroscopy and chemometrics to identify pine nuts that cause taste disturbance. J Agric Food Chem 2011; 59 (13) 6877-6881
- 11 Hampton R, Scully C, Ellison S. Pine mouth. Br Dent J 2011; 210 (4) 151
- 12 16 Countries report pine nut mouth - product not meeting specifications, responsible companies. 2010. Available at: http://pinenut.com/blog . Accessed February 15, 2012