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Apitherapy-
Category: Natural Product
Description: Apitherapy is the "science and art" of using bee products to "maintain health" (J Altern Complementary Med 2016 Dec;22(12):1020-1022). It involves medical use of honey bee products: honey, bee pollen, propolis, royal jelly, and bee venom injections or using live bees to sting patients. According to the American Apitherapy Society, “Apitherapy is used to treat many illnesses and to alleviate pain from injuries both chronic and acute” to “attain better health through harmony with the bee hive, a true gift of nature”. Bee venom is known to contain many active components, including peptides (e.g., melittin and apamin), enzymes (e.g., phospholipase A2 (PLA2)), and small molecules (e.g., histamine). Melittin is thought to be one of the most important components of bee venom, being 50% of the total weight of the bee venom.
History: The complete history is not well documented but it can be traced back to ancient China, Greece, and Egypt. The use of honey is also mentioned in ancient Indian/Hindu scripts, and honey is found to be an ingredient in many Ayurvedic medicines. Honey was used for embalming bodies in ancient Egypt. Healing properties have been attributed to propolis (the sticky resin used by bees to seal hives) as well. The modern revival of Apitherapy is attributed to an Austrian scientist, Dr. Phillip Terc, who studied voluntary bee stings and rheumatism in 1888. The term "Bee Venom Therapy" was coined by the Hungarian physician Bodog F. Beck in 1935. In 1957 the Soviet Union approved use of bee venom therapy to treat different ailments. The American beekeeper Charles Mraz contributed to popularizing apitherapy in the US.
Touted Uses: Colds and sore throats (honey in combination with ginger or propolis alone), gum disorders (propolis), wound and burn healing (topical honey, topical propolis), rheumatoid arthritis (bee venom injections or live bee stings), psoriasis (honey), cancer (propolis- speculative, no human studies), antifungal agents (honey), antiviral (honey), eye infection healing (honey), Diarrhea (honey), allergies (bee pollen), neurologically wasting diseases (bee venom)
Protocol: For application of honey, it is done 2-3 times a day. For bee pollen, a test dose is first given since bee pollen contains many of the substances that may provoke and allergic reaction or severe asthma attack. Typically one pellet of pollen is used the first day, letting it dissolve in the mouth, then increasing the dose each day thereafter. Bee venom is injected subcutaneously, into trigger points, dermatomes or reflexology points in a mixture of 2% procaine plus bee venom 0.1ml standardized to 1mg/ml active Mellitin. It is initially injected daily then maintenance injections are given 1-2 times per week. The person injecting must be prepared to treat anaphylaxis with epinephrine and IV infusion.
Training: No degree is required to do apitherapy injections, and training may be obtained through internet courses as described on apitherapy.com Naturopathic doctors (ND) sometimes use apitherapy. Most MD or DO physicians will not provide apitherapy.
LEVELS OF EVIDENCE:
Bee Venom
Bee venom immunotherapy (use of bee venom to prevent anaphylactic reactions from bee stings) is well established as a therapeutic use. However most other purported uses remain scientifically unproven including the use of venom for rheumatic diseases and multiple sclerosis. Most human studies are published in foreign journals, are very small, were retrospective with poor reporting, used bee venom as part of a combined therapy, or were not randomized. The vast majority of studies on bee venom (99%) are zeta or omega level studies- lab or non-human studies on which conclusions for human use may not be drawn.
ALPHA LEVEL EVIDENCE: Bee venom acupuncture for Rheumatoid arthritis- Conclusion- the number of trials, low quality and small sample sizes are insufficient to draw conclusions. There were 304 studies but only one quality RCT study. (BMJ Open 2014 Nov 7;4(11):e006140)
BETA LEVEL EVIDENCE: Bee venom is ineffective in the treatment of Parkinson Disease (PLoS One 2016 Jul 12;11(7):e0158235). Bee venom therapy is ineffective in Multiple Sclerosis (Neurology 2005 Dec 13;65(11):1764-8). Bee venom therapy demonstrated significant improvement in grasp force, joint swelling, morning stiffness, pain, and tenderness compared to methotrexate/sulfasalazine/meloxicam combinations with every other day treatment of bee venom injections at Ashi points (Caution- Chinese study- results are typically not reproducible Zhen Ci Yan Jiu 2008 Jun;33(3):197-200). Bee venom vs. saline for shoulder capsulitis showed improved outcomes in shoulder pain, pain with exercise and at rest but no improvement over passive/active range of motion (J Shoulder Elbow Surg 2013 Aug;22(8):1053-62)
DELTA LEVEL EVIDENCE: Bee venom therapy twice daily improved acne by 9% at 3 weeks and 52% at 6 weeks (J Cosmet Dermatol 2016 Dec;15(4):324-329). "High effectiveness" was demonstrated in a Russian study of 104 patients with chronic non-specific pulmonary diseases (Lik Sprava 1995 Mar-Apr;(3-4):155-8). In a pilot study of 9 patients with multiple sclerosis, 4 became worse, 3 became better with the therapy, effectively an indeterminate study (Allergy Asthma Proc 2005 Nov-Dec;26(6):470-6). Bee venom modestly decreased symptoms of chemotherapy induced peripheral neuropathy in a small pilot study (J Acupunct Meridian Stud 2012 Aug;5(4):156-65)
ZETA LEVEL EVIDENCE (Lab studies): Several studies show inhibitory actions of bee venom on both cancer and inflammation but these have not been extended to humans.
Note: The conclusion of the American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed) pp 704-708 were that "Bee venom or other honeybee products are ineffective for the treatment or prevention of cancer".
Bee Pollen
Despite hundreds of published scientific papers on bee pollen, there are virtually no human therapeutic studies of bee pollens although they have been used since antiquity to cure colds, flu, ulcers, premature aging, anemia and colitis. There are some notations of positive results in non-peer reviewed conference presentations (in other words- I did this to patients and they got better) and a tendency of proponents to intentionally misrepresent cellular and lab studies as human outcomes (Evid Based Complement Alternat Med 2015;2015:297425). A rather comical human study outcome using bee pollen in honey vs honey alone (the placebo) for treatment of hot flashes found both were significantly effective with nearly 70% of the patients improving in both groups, signifying a profound placebo response when subjective non-measurable symptoms are studied (Mol Clin Oncol 2015 Jul;3(4):869-874).
HARMS: A case report of renal failure associated with bee pollen (Ther Apher Dial 2010 Feb;14(1):93-7). Those taking bee pollen may have higher lead levels (24% higher) than non herbal users. Higher lead levels are associated with early cardiovascular deaths. (J Gen Intern Med 2009;24(11):1175-82). Multiple cases of anaphylaxis (shock, cardiovascular collapse, airway constriction) have been reported with bee pollen (J Am Board Fam Pract. 1994 May-Jun;7(3):250-2), (Ann Allergy. 1981 Sep;47(3):154-6). Bee pollen has been associated with production of abdominal pain in children when their mothers give it to them as a "nutritional aid" causing severe elevation of eosinophils throughout the stomach and blood (Turk Pediatri Ars 2015 Sep 1;50(3):189-92).
Organizations: American Apitherapy Society www.apitherapy.org