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Drugs and Lactation Database (LactMed) [Internet].

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Amanita Mushroom Poisoning

Last Revision: February 15, 2021.

Estimated reading time: 2 minutes

CASRN: 11030-71-0; 23109-05-9; 58250-15-0

image 135231049 in the ncbi pubchem databaseimage 134994336 in the ncbi pubchem database

Drug Levels and Effects

Summary of Use during Lactation

Amatoxins are water soluble, heat stable polypeptides found in Amanita (most often Amanita phalloides ), Galerina and some Lepiota species. The main toxin from the species A. phalloides is alpha-amanitin, a cyclic octapeptide. It is a potent inhibitor of RNA polymerases that blocks the production of mRNA and protein synthesis in liver and kidney cells.[1] Although some articles and textbooks state that amatoxins pass into breastmilk, the only two well documented cases indicate that they do not pass into milk. Nevertheless, mothers suspected of having mushroom poisoning probably should not breastfeed until they have recovered or toxicologic screening of the breastmilk has ruled out amatoxin.

Drug Levels

Maternal Levels. A 32-year-old mother shared a meal of foraged mushrooms (Amanita bisporigera), and developed symptoms 15 hours post-ingestion. Amatoxin was undetectable in the milk, although the timing of the milk sample was not stated.[2]

A 33-year-old woman picked about 200 mushrooms in the forest in France. She cooked and ate some of them, then breastfed her 5-month-old daughter 3 times a day over the next 36 hours. The mushrooms were identified as mainly Amanita phalloides along with Paxillus involutus, Amanita rubescens, and Chlorophyllum rhacodes. The mother’s urine collected in the emergency department was positive for amatoxin. A breastmilk sample collected 41 hours postingestion had no detectable amatoxin by LC-MS/MS.[3]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

A 32-year-old mother shared a meal of foraged mushrooms (Amanita bisporigera), and developed symptoms 15 hours post-ingestion. She presented to the emergency department 29 hours post-ingestion and was found to have markedly elevated liver enzymes. Her 4 month-old-daughter had breastfed 4 hours post-ingestion. The asymptomatic infant was evaluated 48 hours after breastfeeding and discharged from the emergency department with no evidence of hepatotoxicity.[2]

A 33-year-old woman picked about 200 mushrooms in a forest in France. She cooked and ate some of them, and developed nausea, vomiting and diarrhea 11 hours post-ingestion. She was admitted to the hospital for treatment and had elevated liver enzymes. She had breastfed her 5-month-old daughter 3 times a day over the 36 hours after mushroom ingestion. Her daughter was hospitalized, but did not present any symptoms, nor any biological disturbance.[3]

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.
Hydzik P, Bielanski W, Ponka M, et al. Usefulness of 13C-methacetin breath test in liver function testing in Amanita phalloides poisoning; breast feeding woman case. Clin Toxicol (Phila). 2008;46:1077–82. [PubMed: 18821093]
2.
Shively RM, Nogar JN, Rella JG, et al. Got milk? A case series of an amatoxin-exposed family, including a breastfeeding mother and infant. Clin Toxicol (Phila). 2020;58:148–9. [PubMed: 31070058]
3.
Galland J, Bourdic F, Yaouanc B, et al. Comment on Got milk? A case series of an amatoxin-exposed family, including a breastfeeding mother and infant. Clin Toxicol (Phila). 2021:1–2. [PubMed: 33475424]

Substance Identification

Substance Name

Amanita Mushroom Poisoning

CAS Registry Number

11030-71-0 23109-05-9 58250-15-0

Drug Class

Breast Feeding

Lactation

Foodborne Diseases

Poisoning

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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