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Munk MD. Pine mouth (pine nut) syndrome: description of the toxidrome, preliminary case definition, and best evidence regarding an apparent etiology. Semin Neurol. 2012 Nov;32(5):525-7.
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.
Ballin NZ. A trial investigating the symptoms related to pine nut syndrome. J Med Toxicol. 2012 Sep;8(3):278-80.
During the last few years, thousands of cases of pine nut-related dysgeusia have been reported. The symptoms involved are predominantly related to taste disturbances such as a constant bitter or metallic taste. The taste disturbance has been reported to occur 1-2 days after ingestion of pine nuts from the species of Pinus armandii. This paper describes a small trial where six volunteers consumed six to eight pine nuts suspected to cause dysgeusia. Incubation periods, symptoms and their duration were recorded. The trial showed that all subjects had developed symptoms of pine nut-related dysgeusia. Four out of six subjects experienced the classical bitter and metallic taste 1-2 days after ingestion. Two subjects experienced minor symptoms such as dryness and a sensation of enlarged tonsils. After the disappearance of symptoms, laboratory tests determined the pine nuts to originate from the species of P. armandii. A follow-up conversation with the subjects after 1 year showed no recurrent symptoms.
Kobler H, Monakhova YB, Kuballa T, Tschiersch C, Vancutsem J, Thielert G, Mohring A, Lachenmeier DW. Nuclear magnetic resonance spectroscopy and chemometrics to identify pine nuts that cause taste disturbance. J Agric Food Chem. 2011 Jul 13;59(13):6877-81.
Nontargeted 400 MHz (13)C and (1)H nuclear magnetic resonance (NMR) spectroscopy was used in the context of food surveillance to reveal Pinus species whose nuts cause taste disturbance following their consumption, the so-called pine nut syndrome (PNS). Using principal component analysis, three groups of pine nuts were distinguished. PNS-causing products were found in only one of the groups, which however also included some normal products. Sensory analysis was still required to confirm PNS, but NMR allowed the sorting of 53% of 57 samples, which belong to the two groups not containing PNS species. Furthermore, soft independent modeling of class analogy was able to classify the samples between the three groups. NMR spectroscopy was judged as suitable for the screening of pine nuts for PNS. This process may be advantageous as a means of importation control that will allow the identification of samples suitable for direct clearance and those that require further sensory analysis.