English
El veneno de abejas (VA) o apitoxina es una sustancia de composición compleja. Las primeras abejas, de hecho, no tenían aguijón. Fue sólo cuando ellas comenzaron a almacenar alimentos (miel y polen) que inició el proceso evolutivo de la generación del aguijón y el veneno como mecanismo de defensa contra agresores potenciales (1).
El uso del VA con fines terapéuticos remonta a los comienzos mismos de la humanidad, aunque el conocimiento sobre su uso, mecanismos de acción y formas de aplicación se ha incrementado de forma significativa en los últimos años, esto sin duda ha llevado a una reinterpretación de muchas de las prácticas existentes a su aplicación (2).
Dentro de sus componentes se encuentran diferentes proteinas, ácidos y aminas biogénicas:
Fuente: Elaboración propia basada en (3–7).
Farmacocinética
El VA puede ser administrado a través de diferentes vías: oral, tópica y parenteral (subcutánea, intravenosa, intradérmica, intramuscular, intraarticular), por supuesto, cada una de las vías de administración utilizadas posee un perfil farmacocinético propio. El VA tiene una amplia distribución tisular y es posible identificarlo, luego de algunos minutos de su administración, en todos los tejidos del cuerpo, incluso, en el sistema nervioso central, las mayores concentraciones se logran especialmente en el hígado y riñón (8). La degradación y metabolismo de los componentes del VA ocurre principalmente por acción de la estearasa plasmática, aunque se ha descrito también la acción de los neumocitos en el metabolismo de sus proteínas. La excreción se da a través de la orina.
Administración oral. La absorción se produce principalmente de forma sublingual, en el intestino delgado y colon (9). El paso del VA por el estómago implica una desnaturalización de algunas de sus proteinas como consecuencia del ambiente ácido, sin embargo, también permite el cambio de protonación de sus proteínas facilitando su posterior absorción en el intestino delgado y colon. En buena medida el proceso de paso de los componentes del veneno de abejas hacia el cuerpo y al interior de las células donde se realizará su actividad terapéutica ocurre como parte de un proceso que no implica gasto energético pero si la integración de estos compuestos en la capa de fosfolípidos, esto gracias al funcionamiento electroquímico de los péptidos que contiene (10). La biodisponibilidad del VA por vía oral es del 10%.
Administración Tópica. El VA puede ingresar al cuerpo gracias a la acción de la hialuronidasa con biodisponibilidad de entre el 10% y 30%, su capacidad para integrarse con la membrana celular facilita su absorción, el ingreso se produce a una baja velocidad lo cual reduce la frecuencia de presentación de reacciones adversas.
Administración inyectable. Tradicionalmente se ha empleado la picadura de la abeja como método para la administración del VA, sin embargo, este no se aconseja actualmente porque no permite el control de la dosis, hay limitación de las vías de administración y existe un mayor riesgo de alergias e infecciones.
Las características farmacocinéticas del VA hacen que sea necesario, para el tratamiento de la mayoría de las enfermedades, del uso de diferentes vías de administración como parte del tratamiento:
Mecanismos de acción
Los efectos del veneno de abejas pueden agruparse en siete grandes ejes. En la puede verse un resumen de sus efectos y mecanismos de acción.
Fuente: Elaboración propia basada en (11–17).
Seguridad
Las vías de administración oral y tópica no suelen provocar eventos secundarios en las personas, la hipersensibilidad por estas vías no se ha descrito en la literatura y de llegar a ocurrir probablemente se genera como consecuencia de excipientes o vehículos empleados en la preparación. La administración inyectable del VA produce con cierta frecuencia eventos adversos, en su mayoría de severidad leve (18). La experiencia acumulada en nuestro servicio ha mostrado que el dolor de tipo ardor, prurito e inflamación son los eventos adversos más frecuentes después de la aplicación y tan sólo en el 10% de los pacientes su intensidad motiva preocupación en ellos.
El VA potencialmente puede producir dos condiciones relevantes desde el punto de vista clínico: alergias y respuesta tóxica. El tema de las alergias será revisado más adelante en otro capítulo sin embargo es buen momento para recordar la importancia de realizar previa a la aplicación del VA la prueba de alergia en todas las personas. La toxicidad o respuesta tóxica se presenta como consecuencia de la acción de los componentes del VA (principalmente fosfolipasa, hialuronidasa y melitina), esta puede presentarse de forma local o sistémica. La forma sistémica no suele presentarse en el contexto de la práctica clínica de la apiterapia y esta descrita en casos de ataques masivos de abejas sobre un individuo. El síndrome de envenenamiento por VA se caracteriza por la presentación de hemolisis, rabdiomilisis y falla hepática y renal aguda, su manejo, por supuesto, es intrahospitalario (19).
La respuesta tóxica local, como su nombre lo indica, se presenta en el o los sitios de aplicación del VA. Esta respuesta se caracteriza por la presencia de dolor e inflamación persistente en el sitio de aplicación, ocasionalmente puede acompañarse de prurito. Es importante tener en cuenta que en algunos casos su intensidad puede emular los hallazgos típicos de la inspección de un cuadro de celulitis (con excepción del incremento de la zona de eritema). La mayoría de los casos remiten sin necesidad de intervención especifica aunque eventualmente puede indicarse el uso de anti inflamatorios no esteroideos o corticoides para mitigar la intensidad sintomática (20–22).
No existen en la literatura descripciones de interacciones del VA con alimentos, suplementos dietarios, nutracéuticos o medicamentos. Desde el punto de vista teórico eventualmente el VA a dosis muy altas (dosis mayores a 0,2 mg/kg) podría generar sobre anticoagulación.
Referencias bibliográficas
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In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions……..
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions…..
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions……
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions…….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions…
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions…
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions…
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions……….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions….
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions………
In Canada, the cannabis market is fragmented and confusing. Different provinces and territories have different rules about how old you need to be to buy weed, where you can buy it, and how much you can possess. As we’ve talked about, legal weed is a term used to describe cannabis West Coast Cannabis that is cultivated and sold legally under certain regulations and conditions..
Another advantage of buying weed online is the privacy it provides. Not everyone feels comfortable going to a physical dispensary and being seen purchasing marijuana products. With online dispensaries, customers can place their orders discreetly, and have them delivered directly to their doorstep…..
One of the main benefits of using an online dispensary in Canada is the convenience it offers. Customers can browse products, place orders, and have them delivered to their doorstep, all from the comfort of their own homes. This is especially useful for those who live in remote areas, or who have mobility issues and find it difficult to travel to a physical dispensary…….
Another advantage of buying weed online is the privacy it provides. Not everyone feels comfortable going to a physical dispensary and being seen purchasing marijuana products. With online dispensaries, customers can place their orders discreetly, and have them delivered directly to their doorstep……..
A Weed dispensary is a place where consumers can purchase cannabis products such as flowers, edibles, concentrates, and topicals. These dispensaries can be found in various forms, including storefronts, mobile delivery services, and online shops. In states where cannabis is legal, these dispensaries must comply with strict regulations and undergo regular inspections to ensure they meet health and safety standards……
Another advantage of buying weed online is the privacy it provides. Not everyone feels comfortable going to a physical dispensary and being seen purchasing marijuana products. With online dispensaries, customers can place their orders discreetly, and have them delivered directly to their doorstep….
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