Bee sting or injectable bee venom?: review and evidence analysis

Apitherapy is a therapeutic system that is based on the use of hive products in order to prevent and treat diseases. Bee venom (apitoxin) is one of them and the most frequently used in handling with apitherapy. Apitoxin is a complex substance in which can be identified more than 50 active components including peptides and biogenic amines (1).

The use of apitoxin dates back to the beginning of society. At that time the application was done by direct bee sting, this method is even used today by many professionals (2). Recently, devices have been designed that allow the extraction of apitoxin in such a way that the application is not indispensable only by means of the sting and has allowed the generation of new products to supply this substance.

The analysis of which method of application is better (bee sting or injection of previously extracted apitoxin) is controversial, some experts believe that there could be advantages with the direct sting of the bee, others with the injectable application. The main points that differentiate these application methods are mainly:

  • Apitoxin composition
  • Clinical uses and applications
  • Side effects and patient safety
  • Myths about the application with bee sting

This article addresses the main differences based on the scientific evidence currently available.

Apitoxin composition

It is a topic of great interest for more than 3 decades. The introduction of apitoxin collectors allowed efficient collection of it for different purposes. The characterization of apitoxin has shown that melitin corresponds to approximately 50% of the dry weight of the venom, other peptides such as apamine and adolapine, which are of therapeutic interest, and phospholipase A2 are also present. It is recognized that there are variations in the composition of the poison according to the geographical region where the hive and the bee sub-species are located (3,4).

The apitoxin that results from the extraction with electrical devices contains the components of therapeutic interest in proportions similar to those that result after the direct sting of the bee, however, it contains less of other enzymes that have safety implications during the application of apitoxin (5). Recently, there have even been developments that reduce the concentration of components such as phospholipase A2 responsible for several of the negative effects that occur in the application, such as pain and scratching, without compromising its therapeutic efficacy (6). This is of course an advantage since it reduces side effects and could improve adherence to treatment without compromising its therapeutic results. Taking into account that the composition of the apitoxin extracted and the direct sting of the bee is similar, in terms of what is possible to achieve from the therapeutic point of view, there are no significant differences between them, however, the application by previous extraction of venom allows the possibility of finding methods that reduce the suffering of the bee and the patient during the application.

Clinical use and application

The therapeutic utility of apitoxin is wide, different conditions have been explored at least in its preclinical research phase. Among them are: pain control (7), tissue fibrosis (8), immune system modulation (9), antiviral (10) and antineoplastic (11). However, for these conditions the same route of administration is not always used. For example, in the management of infectious diseases of viral origin, intravenous application is necessary or in some fibrosis conditions, intramuscular application is necessary. It is evident that the direct sting of the bee does not allow the administration in this type of administration routes nor the adequate control of the dose that is applied. For this reason there are advantages for the administration of injectable apitoxin over the direct sting since it allows greater versatility.

Side effects and patient safety

The application of apitoxin either by direct bee sting or with injectable apitoxin leads to the development of several side effects. Its application produces pain (90% of people), inflammation at the application site (50%) and pruritus (30% of patients). This forces all apitherapists to be properly trained in their management. Extensive descriptions of serious adverse effects have been made in patients suffering from bee stings:

Death. Recently, the case of a person in whom the apitherapy management was performed with the direct bee sting was published (12). Although the case does not accurately describe the pathophysiological mechanisms that led to this event, it allows analyzing the risks of the sting: greater composition of peptides that induces allergic response, presence of pollen granules in the stinger (which can induce allergy) and presence of fungi, bacteria or viruses. This prevents the direct sting of the bee as a test for the evaluation of allergy in people.

Infection. There are reports of severe infections after the bee sting (13,14). In some cases the bee’s stinger can be colonized by pathogenic bacteria to humans. There is no described way to control this. The bee sting is related to a greater proportion of adverse events and for this reason its application is discouraged.

Myths about the direct bee sting

Some additional aspects deserve to be mentioned:

The bee knows where to bite. There is no scientific evidence that leads us to think that the bee has a sensor that identifies whether a sting is therapeutic or not.

The bee sting heals everything. There is no evidence to suggest that the bee sting cures everything, on the contrary, it should always be used under scientific rationality.

Bee sting is better than injectable apitoxin. As previously described, there is no scientific evidence to support that claim.

Conclusion

There is controversy over whether the bee sting is better than the application of injectable apitoxin. The composition of apitoxin in terms of its therapeutic effects is similar to the sting and injectable apitoxin by various collection methods, however, the venom applied with direct sting has a greater amount of allergens. Extremely severe adverse reactions have been reported with direct bee sting. It is not advised, taking into account the available scientific evidence, the direct sting of the bee as a method of application of the venom, taking into account that there is currently the possibility of other more safe and equally effective methods of application.

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Bibliographic references

  1. Zhang S et al. Toxicon 2018; 148: 64-73.
  2. Prioreschi P. Med Hypotheses 2000; 55 (4): 319-325.
  3. Schumacher MJ et al. Am J Trop Med Hyg 1990; 43 (1): 79-86.
  4. Schumacher MJ et al. J Allergy Clin Immunol 1994; 93 (5): 831-835.
  5. Holly K et al. Toxicon 1975; 13: 145-148.
  6. Lee Y et al. Evid Based Complement Alternative Med 2018; 2018: 2353280.
  7. Lee JH et al. J Vet Med Sci 2001; 63 (3): 251-259.
  8. Lee WR et al. Toxins 2015; 7 (12): 4758-4772.
  9. Choi MS et al. Cytokine 2013; 61 (1): 251-265.
  10. Uddin MB et al. J Microbiol 2016; 54 (12): 853-866.
  11. Jagua-Gualdron A. Rev Fac Med Unal 2012; 60 (2): 79-94.
  12. Vasquez-Revuelta P et al. J Investig Allergol Clin Immunol 2018; 28 (1): 42-43.
  13. Klug R et al. Ann Intern Med 1982; 96 (3): 382.
  14. Truskinosvky AM et al. Clin Infect Dis 2011; 32 (2): E36-E38.

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