Honey Bee Venom in the Treatment of Arthritis
Honey Bee Venom in the Treatment of Arthritis
March 1998; Volume 1: 27-30
By Vance Dietz, MD, MPH, TM
Effectively treating arthritis pain is one of the most difficult challenges clinicians can face. The pain can be debilitating and can severely restrict a patient’s activities of daily living. There are many remedies that purport to ease this pain—prescription pharmaceuticals, over-the-counter preparations, and a wide range of alternative therapies. Recent news reports have boosted interest in an unusual therapy—honey bee venom. Your patients may be asking you about this possible treatment and its possible uses for treating their pain. Following is an overview of the history of and clinical data available for this therapy. Please note, bee venom differs from bee pollen, which is commonly available in health food stores as a nutritional supplement.History
Honey bee venom therapy (BVT), particularly for gout, has reportedly been known since the time of Aristotle.1 In fact, illnesses of Charles the Great and Ivan the Terrible are said to have been cured by bee stings.2Prevalence and Claims
The actual number of users of BVT in the United States is unknown. BVT is said to be common in Romania, as well as in China and the former Soviet Union.The American Apitherapy Society has been established "for advancing the investigation of apitherapy"3 as well as monitoring adverse reactions to BVT.
Many proponents point to the benefits of BVT,4,5 claiming it possesses an anti-inflammatory effect. They claim therapeutic success in the treatment of a wide variety of illnesses such as arthritis, multiple sclerosis, Bell’s palsy, and irritable bowel syndrome.6-9 However, critics point to potentially harmful side effects and warn of its potential as a form of charlatanry.10
Mechanism of Action
Bee venom is composed of several substances, primarily phospholipase A and melittin, but also hyaluronidase, apamin, mast cell-degranulating peptide, and adolapin.11 The melittin component of bee venom has been shown to inhibit neutrophil superoxide and hydrogen peroxide production in a dose-dependent manner.12,13 This could explain some anti-inflammatory activity since oxygen radicals contribute to inflammatory tissue damage. Melittin may also inhibit macrophage production of interleukin-1.14,15It has also been postulated that bee venom may work by stimulating the adrenals to release endogenous steroids. One study showed that whole bee venom, melittin, and apamin resulted in markedly increased plasma cortisol levels when administered to dogs,16 and another suggested that bee venom did not completely suppress adjuvant arthritis in adrenalectomized rats. 17
Clinical and Laboratory Studies
No controlled clinical trials were found that assessed the efficacy of BVT on arthritis in humans.Although clinical trials on humans have not been performed, numerous studies have assessed the effect of BVT on adjuvant-induced arthritis (AID) in rodents, which is thought to be a close experimental model for human rheumatoid arthritis.18,19 These studies suggest that BVT may exert a beneficial impact on AID. For example, in one study, the daily administration of whole bee venom for 17 days, beginning the day before adjuvant injection, significantly suppressed the development of adjuvant-induced arthritis in a dose-related manner as compared with a control group of rats.20 In addition, a single dose of BVT administered on day 0 or day 1 of adjuvant administration suppressed the development of polyarthritis, and delaying the administration of bee venom was associated with a progressive decrease in the suppressive effect.
BVT has also been shown to suppress, but not abolish, Mycobacterium butyricum-induced arthritis in rats as measured by changes in hind paw diameters,17 with a stronger beneficial response noted in female rats rather than males. Purified bee venom (as opposed to whole bee venom) may not be as effective as whole bee venom in suppressing adjuvant-induced arthritis.21 It was shown to modify adjuvant-arthritis only when used in very high doses.22
Adverse Reactions
Although not studied systematically, administration of bee venom obviously carries the risk of an allergic reaction. Most allergic reactions are to common yellow jackets or wasps, though the cumulative stings of many honey bees may also provoke a reaction. The American Apitherapy Society monitors adverse reactions and requests that reports of such reactions be sent to them. Their telephone number is (937) 466-9214.Administration
BVT typically involves stinging one’s skin with live honey bees or injecting purified bee venom subcutaneously. The sting or injection is either close to the area of pain (e.g., arthritic joints) or along pressure points.23 A beekeeper collects the bees, which are then physically applied to the affected area, allowed to sting, and then removed. Some patients become skilled in self-administration and keep their own bees.Formulation
Bee venom for therapy is generally obtained by purchasing live bees from a beekeeper. The therapy is often administered by the patient himself or herself. However, it is possible to purchase purified bee venom extract for self-administration subcutaneously.Dosage
Since no clinical trials have been conducted, dosage levels are not established. Reports vary as to the number of "stings" that are required for treatment; some individuals undergo hundreds of stings over a treatment period lasting 6-12 months. This can involve dozens of stings over a particular joint, two or three times per week. It is not clear how long the stinger should be left in place.Summary
Many anecdotal reports exist about the benefits of using BVT for arthritis, a disease that affects many Americans and causes considerable disability and health care expenditures. No clinical trials in humans were found, although laboratory studies provide evidence that BVT may have a beneficial impact on arthritis, at least in animal models. Other areas for research include whether the use of bee venom extract differs from whole bee venom, and what doses of different preparations need to be used.13 From a practical standpoint, it is also argued that, since purified bee venom affects AID in rats only at very high doses, the cost for a treatment in humans with a comparable dose would be prohibitively expensive.22Conclusion
Perhaps the situation with regard to BVT and arthritis has been best described by Panush in a 1988 editorial on BVT and arthritis in the Journal of Rheumatology, "Based on accumulating evidence, venom therapies merit attention both for possible (adjunctive) clinical value and as a probe to better understand the pathogenesis of inflammatory arthritis."24 In the meantime, the use of BVT is experimental, and physicians should alert their patients that no human studies have been conducted and much remains to be learned about its use including its efficacy, appropriate dosages, and that the potential for adverse reactions exists.Physicians should warn potential users of the possibility of severe allergic reactions to bee stings, as well as how to recognize and deal with them. Furthermore, BVT users should have an allergy kit, (e.g., EPI-PEN) readily available, and they should be instructed in its use. All allergic reactions to BVT should be reported to the American Apitherapy Society. Individuals with particular, chronic medical conditions (e.g., hypertension, heart disease) should be cautious about initiating BVT without discussing the risks with their physician.
References
1. Somerfield SD. Bee venom and adjuvant arthritis. J Rheumatol 1983;10(3):522.2. Yoirish N. Curative Properties of Honey and Bee Venom. San Francisco: New Glide Publications; 1977.
3. Editorial. Bee Informed. J Am Apither Soc 1996;3(4):3.
4. Rose A. Bee in Balance: A Guide to Healing the Whole Person with Honeybees, Oriental Medicine, and Common Sense. Bethesda, MD: Starpoint Enterprises, Ltd.; 1994.
5. Malone F. Bees Don’t Get Arthritis. Rutland, VT: Academy Books; 1979.
6. Wilkinson S. Bee Venom—Cure for Arthritis? The controversy continues. Bee Informed 1996;3(1):7-8,12,18.
7. Fisher R. Bee venom and chronic inflammatory disease. NZ Med J 1986;99:281.
8. Wagner P. My experience with apitherapy. Bee Informed 1996;3:8.
9. Huai LS (Translated by McCulloch M). Chinese apitherapy in the treatment of irritable bowel syndrome. Bee Informed 1994;1(5):2-3.
10. Altomare GF, Capella GL. Bee sting therapy: The revival of a dangerous practice. Acta Derm Venereol 1994;74:409.
11. Graham EJ. The Hive and the Honey Bee. Hamilton, IL: Dadant and Sons; 1992.
12. Somerfield SD. Bee venom and arthritis: Magic, myth or medicine? NZ Med J 1986;99:281-283.
13. Somerfield SD. Bee venom and arthritis. J Rheumatol 1986;13:477.
14. Hadjipetrou-Koutounakis L, Yiangou M. Bee venom, adjuvant-induced disease and interleukin production. J Rheumatol 1988;15:1126-1128.
15. Somerfield SD, et al. Bee venom and adjuvant arthritis. J Rheumatol 1988;15;1878.
16. Vick JA, Shipman WH. Effects of whole bee venom and its fractions (apamin and melittin) on plasma cortisol levels in the dog. Toxicol 1972;10:377-380.
17. Zurier RB, Mitnick H, Bloomgarden D. Effect of bee venom on experimental arthritis. Ann Rheum Dis 1973;32:466.
18. Pearson CM. Development of arthritis, periarthritis and periostitis in rats given adjuvants. Proc Soc Exp Biol Med 1956:91:95-101.
19. Perper RS, Alvarez B, Colombo C, et al. The use of a standard adjuvant arthritis assay to differentiate between anti-inflammatory and immunosuppressive agents. Proc Soc Exp Biol Med 1971;137:506-512.
20. Chang YH, Bliven M. Anti-arthritic effect of bee venom. Agents and Actions 1979;9(2);205-211.
21. Eisemen JL, von Bredow J, Alvares AP. Effect of honeybee (Apis Mellifera) venom on the course of adjuvant-induced arthritis and depression of drug metabolism in the rat. Biochem Pharmac 1982;31:1139-1146.
22. Tannenbaum H, Greenspoon M. Bee venom therapy of adjuvant arthritis. J Rheumatol 1982;9:649.
23. Mraz C. Health and the Honeybee. Burlington, VT: Queen City Publications; 1995.
24. Panush RS. Honeybees and arthritis: Sharpening perspective on a sticky issue. Editorial. J Rheumatol 1988;15:1461-1462.
Dr. Dietz is a medical epidemiologist working with the Centers for Disease Control and Prevention in Atlanta, Georgia. Note: The information and material listed here does not represent the views of the U.S. Public Health Service nor of the CDC but only those of Dr. Dietz
March 1998; Volume 1: 27-30Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.