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. doi: 10.1055/s-0033-1334472. Epub 2013 May 15.


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.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Dysgeusia / diagnosis*
  • Dysgeusia / etiology*
  • Dysgeusia / physiopathology
  • Eating / physiology
  • Humans
  • Male
  • Mouth / physiopathology
  • Nuts / adverse effects*
  • Pinus / adverse effects*
  • Risk Factors
  • Taste / physiology