Lentinan is used widely in Japan and China as an adjuvant to cancer chemotherapy. It is also used for upregulating the immune system; however, the number of quality clinical trials and studies published in English language, peer-reviewed journals is limited.
Dosing
The isolated polysaccharide lentinan from shiitake culture has been used intravenously (IV) at doses of 2 to 10 mg on a weekly schedule as adjunctive therapy for HIV as well as for cancer, primarily in Japan. Oral shiitake extract was used in a trial for the treatment of prostate cancer at 8 g/day for 6 months.
Contraindications
Contraindications have not yet been identified.
Pregnancy/Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Interactions
Lentinan may decrease the serum concentration of gabapentin.
Adverse Reactions
Clinical trials report few adverse events at normal dosages. Case reports exist of allergic/contact dermatitis, asthma, rhinitis, and hypersensitivity pneumonitis in shiitake workers. Shiitake dermatitis has been described as a reaction to the ingestion of raw or partially cooked mushrooms and may be a toxic reaction to lentinan. Photosensitivity reactions have also been reported. Anaphylaxis, granulocytopenia, and elevated liver enzymes were reported after rapid (10 minutes) IV infusion in an HIV trial.
Toxicology
The shiitake mushroom is edible and has generally not been associated with toxicity. In a study in mice, high-dose shiitake resulted in increases in plasma bilirubin and plasma creatine kinase.
Scientific Family
Tricholomataceae
Botany
Lentinan is a polysaccharide derived from the vegetative parts of the edible Japanese shiitake mushroom. It is the cell wall constituent extracted from the fruiting bodies or mycelium of L. edodes. The light, amber fungi are found on fallen broad-leaf trees, such as chestnut, beech, or mulberry. They have decurrent, even, or ragged gills, a stem, and are covered with delicate white flocking. Shiitake mushrooms are commonly sold in food markets in Asia and are now widely available in the United States, Canada, and Europe.1 Synonyms include Cortinellus edodes, Armillaria edodes, Cortinellus shiitake, and Tricholomopsis edodes.
History
Shiitake has been recognized in Japan and China as a food and medicine for thousands of years. Lentinan was isolated from edible shiitake mushrooms used in traditional Asian cooking and herbal medicine. Extracts of these mushrooms are now being incorporated into over-the-counter dietary supplements designed to improve the immune system.1
Chemistry
The shiitake mushroom contains starch, fiber, chitin, and high amounts of protein.2 Lentinan is a water-soluble, high molecular weight polysaccharide in a triple helix structure, containing only glucose molecules with mostly (1-3)-beta-D-glucan linkages in the regularly branched main chain with 2 beta (1,6)-D-glucopyranoside branchings for every 5 beta-(1,3)-glucopyranoside linear linkages.1, 3 Lentinan, which is thermolabile4 is found in very low concentrations in fresh shiitake mushrooms (approximately 0.02%); at least 5 additional polysaccharides have been isolated from L. edodes.5
Other constituents of interest found in the mushroom include the antioxidant phenolic compounds gallic acid, protocatechuic acid, and catechin6; as well as eritadenine7, 8 selenium (as selenomethionine)9 ergosterol, vitamin D, and calcium.10, 11
Uses and Pharmacology
Cancer
Lentinan has demonstrated inhibition of tumor growth and stimulation of apoptosis in animal experiments and in vitro studies. Increased survival times and improved quality of life have also been reported. However, the number of quality clinical trials and studies published in English language, peer-reviewed journals is limited.12, 13, 14 Lentinan is approved in Japan as a pharmaceutical product and is commonly used as an adjuvant for the treatment of certain cancers in Japan and China.12
Animal data
Animal and in vitro studies show significant antitumor and antimetastatic activity of lentinan5, 15, 16, 17, 18, 19, 20, 21, 22 increased longevity3 and synergism with other chemotherapeutic agents.23, 24, 25
Clinical data
Case reports and open-label, nonrandomized studies form the bulk of evidence for lentinan in cancer therapy, with many of these studies being conducted in Japanese populations and commonly in combination with other therapies.26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 Data are insufficient to recommend clinical applications for lentinan but are sufficient to warrant further large scale, quality trials.12, 13 Clinical trials with negative results (ie, no effect in prostate cancer) have been published.13, 40 Resistance to lentinan chemo-immunotherapy has also been reported.41
In a controlled clinical trial (n = 50), the addition of lentinan (1 mg in 250 mL normal saline given every other day) to a traditional tegafur chemotherapy regimen (1,000 mg/day x 5 days) significantly improved general condition, signs and symptoms, and quality of life in patients with esophageal cancer. Although each of these measures improved in both the control and treatment groups, the effects were greater in the lentinan group (P < 0.01). Clinical efficacy became greater after the 2nd course of lentinan combination therapy compared with tegafur alone (P < 0.0031). Serum cytokine levels also changed significantly more with lentinan (P < 0.05).67
A 2009 meta-analysis of individual patient data compared effects of chemotherapy regimens with and without the addition of lentinan in patients with advanced unresectable or recurrent gastric cancer; studies using lentinan food products and not the pure drug were excluded. Data from 650 patients collected from 5 trials revealed a 25-day better median survival time in patients receiving chemotherapy plus lentinan versus chemotherapy alone (hazard ratio = 0.8; stratified log-rank P-value = 0.011). Most of the trials reviewed were conducted in the late 1980s.68
Immune system effects
Lentinan and other beta-glucans have demonstrated immunomodulatory properties in animal experiments and in vitro studies. Multiple pathways have been described for the effects observed in the immune system, including upregulation of T-cell, cytokine, monocyte, tumor necrosis factor, natural killer cell, complement activation and other macrophage responses.22, 27, 30, 32, 44, 45, 46, 47, 48, 49, 50, 51
Animal data
In mice pretreated with lentinan, significant reductions in parasitemia and increased survival were demonstrated against malaria.52 Similar results were found in rabbits with induced septic insult and other microbial infections.53An increased antibody titer was demonstrated in vaccinated chickens treated with sulfated lentinan for 3 days.54 Other studies report on enhanced antitumor activity by lentinan-induced multiple immune mechanisms3 but note that in vivo effects are more difficult to demonstrate than in vitro.43
Clinical data
Greater changes in serum cytokine levels occurred in esophageal cancer patients treated with lentinan plus traditional chemotherapy (tegafur) than with tegafur alone in a controlled clinical trial (n = 50). Pro-inflammatory cytokines interleukin (IL)-2, IL-6, and IL-12 levels increased, while anti-inflammatory IL-4, IL-5, and IL-10 decreased. These changes became greater following the 2nd course of therapy reflecting an up-regulation of the immune response.67
Other effects
Antimicrobial effects
A wide in vitro spectrum of activity against human pathogens has been described, including activity against staphylococcus aureus, methicillin-resistant staphylococcus aureus, 43300 and ciprofloxacin-resistant Pseudomonas strains.55 Antiviral activity has also been evaluated in vitro against HIV and vesicular stomatitis virus.56, 57, 58, 59
Cholesterol-lowering
Animal experiments have shown varying results.8, 60, 61 An effect on the lipid profile has been attributed to the ergosterol and eritadenine constituents found in the mushroom. Clinical studies are lacking.
Osteoporosis
The vitamin D and calcium content of shiitake mushrooms can be enhanced during cultivation by the addition of egg shells to the growing media and growth under ultraviolet light.10, 11 Animal experiments have shown increased femur and tibia mineralization, increased serum calcium and increased duodenal and renal calcium transport genes with enhanced shiitake diets.10, 11
Dosing
Lentinan is a high molecular weight polysaccharide, and is usually administered by the intraperitoneal route because of poor oral bioavailability and rapid metabolism.12, 14
The isolated polysaccharide lentinan from shiitake culture has been used IV at doses of 2 to 10 mg on a weekly schedule as adjunctive therapy for HIV as well as for cancer, primarily in Japan.58
Oral shiitake extract was used in a trial for the treatment of prostate cancer at 8 g/day for 6 months without significant effect on the disease progression.40
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking.13
Interactions
Gabapentin: Lentinan may decrease the serum concentration of gabapentin. No action needed.(69)
Adverse Reactions
Clinical trials report few adverse events at normal dosages.12, 15, 62 Severe events were reported (anaphylaxis, granulocytopenia, elevated liver enzymes) after rapid IV infusion in HIV patients.58
Case reports exist of allergic/contact dermatitis, asthma, and rhinitis in shiitake workers8, 63 as well as hypersensitivity pneumonitis.64 Shiitake dermatitis has been described as a reaction to the ingestion of raw or partially cooked mushrooms and may be a toxic reaction to lentinan.4, 65 Positive skin prick tests have been described in patients with shiitake-related protein contact dermatitis.63 Photosensitivity reactions13, 14 and GI upset have also been reported.66
Toxicology
The shiitake mushroom is edible and has generally not been associated with toxicity. In a study in mice, high-dose shiitake resulted in increases in plasma bilirubin and plasma creatine kinase.8
In animals, lentinan shows little toxicity. In mice, the lethal dose (LD50) is greater than 1,500 mg/kg (intraperitoneally).5
Index Terms
Armillaria edodes
Cortinellus edodes
Cortinellus shiitake
Tricholomopsis edodes
References
Disclaimer
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
1. Hobbs C. Medicinal Mushrooms. Santa Cruz, CA: Botanica Press; 1995;125.2. Dikeman CL, Bauer LL, Flickinger EA, Fahey GC Jr. Effects of stage of maturity and cooking on the chemical composition of select mushroom varieties. J Agric Food Chem. 2005;53(4):1130-1138.157130303. Zheng R, Jie S, Hanchuan D, Moucheng W. Characterization and immunomodulating activities of polysaccharide from Lentinus edodes. Int Immunopharmacol. 2005;5(5):811-820.157781174. Garg S, Cockayne SE. Shiitake dermatitis diagnosed after 16 years! Arch Dermatol. 2008;144(9):1241-1242.187944855. Chihara G, hamuro J, Maeda Y, Arai Y, Fukuoka F. Fractionation and purification of the polysaccharides with marked anititumor activity, especially lentinan, from Lentinus edodes (Berk.) Sing (an edible mushroom). Cancer Res. 1970;30(11):2776.55305616. Kim MY, Seguin P, Ahn JK, et al. Phenolic compound concentration and antioxidant activities of edible and medicinal mushrooms from Korea. J Agric Food Chem. 2008;56(16):7265-7270.186162607. Enman J, Rova U, Berglund KA. Quantification of the bioactive compound eritadenine in selected strains of shiitake mushroom (Lentinus edodes). J Agric Food Chem. 2007;55(4):1177-1180.172569588. Nieminen P, Kärjä V, Mustonen AM. Myo- and hepatotoxic effects of cultivated mushrooms in mice. Food Chem Toxicol. 2009;47(1):70-74.189766899. Ogra Y, Ishiwata K, Ruiz Encinar J, Lobiński R, Suzuki KT. Speciation of selenium in selenium-enriched shiitake mushroom, Lentinula edodes. Anal Bioanal Chem. 2004;379(5-6):861-866.1520586810. Jasinghe VJ, Perera CO, Barlow PJ. Bioavailability of vitamin D2 from irradiated mushrooms: an in vivo study. Br J Nutr. 2005;93(6):951-955.1602276611. Lee GS, Byun HS, Yoon KH, Lee JS, Choi KC, Jeung EB. Dietary calcium and vitamin D2 supplementation with enhanced Lentinula edodes improves osteoporosis-like symptoms and induces duodenal and renal active calcium transport gene expression in mice. Eur J Nutr. 2009;48(2):75-83.1909316212. Sullivan R, Smith JE, Rowan NJ. Medicinal mushrooms and cancer therapy: translating a traditional practice into Western medicine. Perspect Biol Med. 2006;49(2):159-170.1670270113. Boon H, Wong J. Botanical medicine and cancer: a review of the safety and efficacy. Expert Opin Pharmacother. 2004;5(12):2485-2501.1557146714. Yeung KS, Gubili J. Shiitake Mushroom (Lentinula edodes). J Soc Integr Oncol. 2008;6(3):134-135.1908777115. Jeannin JF, Lagadec P, Pelletier H, et al. Regression induced by lentinan, or peritoneal carcinomatoses in a model of colon cancer in rat. Int J Immunopharm. 1988;10(7):855-861.323524016. Lapis K, Timár J, Pápáy J, Paku S, Szende B, Ladányi A. Experiemental metastasis inhibition by pretreatment of the host. Arch Geschwulstforschung. 1990;60(2):97-102.211112817. Shen J, Tanida M, Fujisaki Y, Horii Y, Hashimoto K, Nagai K. Effect of the culture extract of Lentinus edodes mycelia on splenic sympathetic activity and cancer cell proliferation. Auton Neurosci. 2009;145(1-2):50-54.1905981118. Gu YH, Belury MA. Selective induction of apoptosis in murine skin carcinoma cells (CH72) by an ethanol extract of Lentinula edodes. Cancer Lett. 2005;220(1):21-28.1573768419. Zhang L, Li X, Xu X, Zeng F. Correlation between antitumor activity, molecular weight, and conformation of lentinan. Carbohydr Res. 2005;340(8):1515-1521.1588285420. Fang N, Li Q, Yu S, Zhang J, He L, Ronis MJ, Badger TM. Inhibition of growth and induction of apoptosis in human cancer cell lines by an ethyl acetate fraction from shiitake mushrooms. J Altern Complement Med. 2006;12(2):125-132.1656667121. Miyaji CK, Poersch A, Ribeiro LR, Eira AF, Cólus IM. Shiitake ( Lentinula edodes (Berkeley) Pegler) extracts as a modulator of micronuclei induced in HEp-2 cells. Toxicol In Vitro. 2006;20(8):1555-1559.1694924722. Israilides C, Kletsas D, Arapoglou D, et al. In vitro cytostatic and immunomodulatory properties of the medicinal mushroom Lentinula edodes. Phytomedicine. 2008;15(6-7):512-519.23. Hamuro J, Takatsuki F, Suga T, Kikuchi T, Suzuki M. Synergistic antimetastatic effects of lentinan and interleukin 2 with pre-and post-operative treatments. Jpn J Cancer Res. 1994;85(12):1288-1297.785219124. Yamasaki K, Sone S, Yamashita T, Ogura T. Synergistic induction of lymphokine (IL-2)-activated killer activity by IL-2 and the polysaccharide lentinan, and therapy of spontaneous pulmonary metastases. Cancer Immunol Immunother. 1989;29(2):87-92.278585225. Yang P, Liang M, Zhang Y, Shen B. Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC. Adv Ther. 2008;25(8):787-794.1867074326. Maekawa S, Saku M, Kinugasa T, et al. A case report of advanced gastric cancer remarkably responding to mitomycin C, aclacinomycin A, SF-SP and lentinan combination therapy [in Japanese]. Gan to Kagaku Ryoho. 1990;17:137-140.210508527. Tanabe H, Imai N, Takechi K. Studies on usefulness of postoperative adjuvant chemotherapy with lentinan in patients with gastrointestinal cancer [in Japanese]. Nippon Gan Chiryo Gakki Shi. 1990;25(8):1657-1667.223044828. Taguchi T. Clinical efficacy of lentinan on patients with stomach cancer: end point results of a four-year follow-up survey. Cancer Detect Prev Suppl. 1987;1:333-349.312117929. Mio H, Terabe K. Postoperative immunochemotherapy for gastric carcinoma with peritoneal disemination – the effects with the combination of CDDP, 5-FU and lentinan [in Japanese]. Gan To Kagaku Ryoho. 1994;21(13):531-534.812939530. Suzuki M, Higuchi S, Taki Y, Taki S, Miwa K, Hamuro J. Induction of endogenous lymphokine-activated killer activity by combined administration of lentinan and interleukin 2. Int J Immunopharmacol. 1990;12(6):613-623.227272631. Ogawa K, Watanabe T, Katsube T, et al. Study on intratumor admionistration of lentinan – primary changes in cancerous tissues [in Japanese]. Gan To Kagaku Ryoho. 1994;21(13):2101-2104.794441232. Hazama S, Oka M, Yoshino S, et al. Clinical effects and immunological analysis of intraabdominal and intrapleural injection of lentinan for malignant ascites and pleural effusion of gastric carcinoma [in Japanese]. Gan To Kagaku Ryoho. 1995;22(11):1595-1597.757476833. Tari K, Satake I, Nakagomi K, et al. Effect of lentinan for advanced prostate carcinoma [in Japanese]. Hinyokika Kiyo. 1994;40(2):119-123.812892034. Kosaka A, Kuzuoka M, Yamafuji K, et al. Synergistic action of lentinan (LNT) with endocrine therapy of breast cancer in rats and humans [in Japanese]. Gan To Kagaku Ryoho. 1987;14(2):516-522.310160935. Shimizu H, Inoue M, Shimizu C, et al. Augmentation of antitumor effect of recombinant interleukin-2 activated killer cells by the administration of rIL-2 and lentinan. Nippon Sanka Fujinka Gakkai Zasshi. 1988;40(12):1899-1900.326484536. Shimizu Y, Chen JT, Hirai T, et al. Augmentative effect of lentinan on immune responses of pelvic lymph node lymphocytes in patients with uterine cervical cancer. Nippon Sanka Fujinka Gakkai Zasshi. 1988;40:1557-1558.326571437. Shimizu Y, Chen JT, Shiokawa S, et al. Antigenic phenotype of the lymphocytic component of regional lymph nodes in patients with cervical cancer and its modulation by lentinan [in Japanese]. Nippon Sanka Fujinka Gakkai Zasshi. 1990;42:37-44.38. Oka M, Yoshino S, Hazama S, Shimoda K, Suzuki T. Antigenic phenotype of the lymphocytic component of regional lymph nodes in patients with cervical cancer and its modulation by lentinan. Biotherapy. 1992;5(5):107-112.152495039. Fujimoto K, Tomonaga M, Goto S. A case of recurrent ovarian cancer successfully treated with adoptive immunotherapy and lentinan. Anticancer Res. 2006;26(6A):4015-4018.1719545140. deVere White RW, Hackman RM, Soares SE, et al. Effects of a mushroom mycelium extract on the treatment of prostate cancer. Urology. 2002;60(4):640-644.1238592541. Hamuro J, Kikuchi T, Takatsuki F, Suzuki M. Cancer cell progression and chemoimmunotherapy—dual effects in the induction of resistance to therapy. Br J Cancer. 1996;73(4):465-471.859516042. Yin Y, Fu W, Fu M, He G, Traore L. The immune effects of edible fungus polysaccharides compounds in mice. Asia Pac J Clin Nutr. 2007;16(suppl 1):258-260.1739211543. Yu S, Weaver V, Martin K, Cantorna MT. The effects of whole mushrooms during inflammation. BMC Immunol. 2009;10:12.264903544. Lee JY, Kim JY, Lee YG, Rhee MH, Hong EK, Cho JY. Molecular mechanism of macrophage activation by Exopolysaccharides from liquid culture of Lentinus edodes. J Microbiol Biotechnol. 2008;18(2):355-364.18309284 45. Péter G, Károly V, Imre B, János F, Kaneko Y. Effects of lentian on cytotoxic functions of human lymphocytes. Immunopharmacol Immunotoxical. 1988;10(2):157-163.317110446. Takeshita K, Saito N, Sato Y, et al. Diversity of complement activation of lentinan, an antitumor polysaccharide, in gastric cancer patients [in Japanese]. Nippon Geka Gakkai Zasshi. 1991;92(1):5-11.201402647. Tani M, Tanimura H, Yamaue H, et al. Augmentation of lymphokine-activated killer cell activity by lentinan. Anticancer Res. 1993;13(5C):1773-1776.826738148. Tani M, Tanimura H Yamaue H, et al. In vitro generation of activated natural killer cell sand cytotoxic macrophages with lentinan. Eur J Clin Pharmacol. 1992;42(6):623-627.162390249. Arinaga S, Karimine N, Takamuku K, et al. Enhanced induction of lymphokine-activated killer activity after lentinan administration in patients with gastric carcinoma. Int J Immunopharm. 1992;14(4):535-539.152192150. Arinaga S, Karimine N, Nanbara S, et al. Enhanced production of interleukin 1 and tumor necrosis factor by peripheral monocytes after lentinan administration in patients with gastric carcinoma. Int J Immunopharm. 1992;14(1):43-47.158273351. Akamatsu S, Watanabe A, Tamesada M, et al. Hepatoprotective effect of extracts from Lentinus edodes mycelia on dimethylnitrosamine-induced liver injury. Biol Pharm Bull. 2004;27(12):1957-1960.15577212 52. Zhou LD, Zhang QH, Zhang Y, Liu J, Cao YM. The shiitake mushroom-derived immuno-stimulant lentinan protects against murine malaria blood-stage infection by evoking adaptive immune-responses. Int Immunopharmacol. 2009;9(4):455-462.1918986353. Kaneko Y, Chihara G. Potentiation of host resistance against microbial infections by lentinan and its related polysaccharides. Adv Exp Med Biol. 1992;319:201-215.141459554. Guo Z, Hu Y, Wang D, et al. Sulfated modification can enhance the adjuvanticity of lentinan and improve the immune effect of ND vaccine. Vaccine. 2009;27(5):660-665.1905644655. Hearst R, Nelson D, McCollum G, et al. An examination of antibacterial and antifungal properties of constituents of Shiitake (Lentinula edodes) and oyster (Pleurotus ostreatus) mushrooms. Complement Ther Clin Pract. 2009;15(1):5-7.1916194756. Tochikura T, Nakashima H, Kaneko Y, Kobayashi N, Yamamoto N. Suppression of human immunodeficiency virus replication by 3′-azido-3′-deoxythymidine in various human hematopoietic cell lines in vitro: augmentation of the effect by lentinan. Jpn J Cancer Res. 1987;78(6):583-589.311207457. Yoshida O, Nakashima H, Yoshida T, et al. Sulfation of the immunodulating polysacchraride lentinan: a novel strategy for antivirals to human immunodeficiency virus (HIV). Biochem Pharmacol. 1988;37(15);2887-2891.339536558. Gordon M, Bihari B, Goolsby E, et al. A placebo-controlled trial of the immune modulator, lentinan, in HIV-positive patients: a phase I/II trial. J Med. 1998;29:305-330.1050316659. Ngai PHK, Ng TB. Lentin, a novel and potent antifungal protein from shitake mushroom with inhibitory effects on activity of human immunodeficiency virus-1 reverse transcriptase and proliferation of leukemia cells. Life Sci. 2003;73(26):3363-3374.1457287860. Chibata I, Okumura K, Takeyama S, et al, Lentinacin: a new hypocholesterolemic substance in Lentinus edodes. Experientia. 1969;25:1237-1238.539188361. Rivera A, Benavides OL, Rios-Motta J. (22E)-Ergosta-6,22-diene-3beta,5alpha,8alpha-triol: a new polyhydroxysterol isolated from Lentinus edodes (Shiitake). Nat Prod Res. 2009;23(3):293-300.1923503062. Chihara G. Recent progress in immunopharmacology and therapeutic effects of polysaccharides. Dev Biol Stand. 1992;77:191-197.142666263. Aalto-Korte K, Susitaival P, Kaminska R, Mäkinen-Kiljunen S. Occupational protein contact dermatitis from shiitake mushroom and demonstration of shiitake-specific immunoglobulin E. Contact Dermatitis. 2005;53(4):211-213.1619101764. Suzuki K, Tanaka H, Sugawara H, et al. Chronic hypersensitivity pneumonitis induced by Shiitake mushroom spores associated with lung cancer. Intern Med. 2001;40(11):1132-1135.1175777065. Mak RK, Wakelin SH. Shiitake dermatitis: the first case reported from a European country. Br J Dermatol. 2006;154(4):800-801.1653684466. Levy AM, Kita H, Phillips SF, et al. Eosinophilia and gastrointestinal symptoms after ingestion of shiitake mushrooms. J of Allergy Clin Immunol. 1998;101(5):613-620.960049767. Wang JL, Bi Z, Zou JW, Gu XM. Combination therapy with lentinan improves outcomes in patients with esophageal carcinoma. Mol Med Rep. 2012;5(3):745-748.2220076368. Oba K, Kobayashi M, Matsui T, Kodera Y, Sakamoto J. Individual patient based meta-analysis of lentinan for unresectable/recurrent gastric cancer. Anticancer Res. 2009;29(7):2739-2745.1959695469. Toh DS, Limenta LM, Yee JY, et al. Effect of mushroom diet on pharmacokinetics of gabapentin in healthy Chinese subjects. Br J Clin Pharmacol. 2014;78(1):129-134.24168107
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
