Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Patients Should Be Told of the Risks Associated With Apitherapy

Dear Doctor: What on earth is bee-sting therapy -- and what is it supposed to do? I ask because apparently someone died after having it.

Dear Reader: Using bee products like honey, pollen, royal jelly and venom to treat illness and promote healing is a practice known as apitherapy. The word comes from apis, which is the genus the honeybee belongs to. References to apitherapy date back to ancient Egypt, Greece and China. Hippocrates is said to have used bee venom to ease the pain of arthritis, which is one of the primary targets of modern-day treatment. The theory is that the bee sting causes the immune system to mount an anti-inflammatory response that is beneficial to the patient. However, that same immune response can become deadly.

That's the case with a woman in Spain who had been undergoing monthly treatments in which she was stung by live bees to address muscle issues and stress. She had no adverse reactions for two years, but in that final session she developed "wheezing, dyspnea, and sudden loss of consciousness immediately after a live bee sting," according the Journal of Investigational Allergology and Clinical Immunology. Although the private clinic treated her with corticosteroids, which counter inflammation, they didn't have any epinephrine, which is used to reverse extremely low blood pressure, wheezing, hives and other symptoms of a severe allergic reaction. An ambulance reportedly took 30 minutes to arrive, and despite medical treatment at a hospital, the woman later died.

The report about the incident, which took place in 2015, was published earlier this year. But because bee sting therapy currently has a few high-profile celebrity proponents, the story has received quite a bit of attention. According to the analysis of the case, this was the first reported death due to bee venom therapy. The authors point out that although a patient may initially tolerate the venom, a hypersensitivity reaction is still possible. In fact, repeated exposure can lead to a higher risk of sensitization.

Bee venom, also known as apitoxin, is a complex mix of proteins, peptides and bioactive agents. The main ingredient is melittin, a small protein that disrupts the membranes of red blood vessels at the site of the sting, causing them to burst. Blood vessels expand in the presence of melittin, which can cause a swift drop in blood pressure. Add the presence of a second protein that causes burning pain, and histamines for itching and swelling, and a drop of bee venom delivers a world of hurt.

But it's that complex chemistry of the venom that has captured the imagination of healers for millennia. Melittin turns out to be a powerful anti-inflammatory agent. Injections of bee venom have been used successfully to fight inflammation in patients with arthritis and multiple sclerosis. In recent research, certain cancers appear to slow their rate of growth in the presence of melittin.

Still, despite its potential medicinal uses, bee venom is a toxin. Patients should be informed of potential adverse reactions. Practitioners of venom therapy must be able to identify patients who have developed sensitivity, must be properly trained in managing severe reactions and must have rapid access to emergency care.

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