The practice of using bees or bee products for the treatment of medical conditions is known as apitherapy. These products can include bee venom. Apitherapy has been practiced in many cultures. It was even used by Hippocrates, who used bee venom therapy for the treatment of arthritis. “Bee” is a general term that refers to insects in the family of insects known as Hymenoptera. Honeybees, yellow jackets, hornets, and wasps belong to this family, and all have the ability to inject venom through a painful sting. Honeybees are the species typically used for bee venom therapy.
Bee venom is a mixture of many substances. The pain and swelling of the sting are caused by histamine, dopamine, serotonin, and norephinephrine. Several toxins are also present, including apamin, melittin, monamine, and mast-cell degranulating peptide. Lastly, the substances responsible for the allergic response include hyaluronidase and phospholipase-A2, enzymes that work to activate immune cells and produce immunoglobulin E (IgE). Bee venom is a complex mixture, and it is not known how its components affect the human body or interact with autoimmune conditions such as MS.
In recent years, bee venom therapy has increased in popularity. It is now used in the treatment of many autoimmune diseases, including rheumatoid arthritis, lupus, scleroderma, and MS. Currently, up to 10,000 people with MS are undergoing this type of treatment. Popularity in the United States can largely be attributed to Charles Mraz, “The Bee Man,” who first advocated bee venom therapy in the 1930s. He recommended the treatment to arthritis sufferers, after using it to effectively treat his own arthritis. He claimed the anti-inflammatory response mounted against the bee sting worked to reduce other inflammatory processes throughout the body. Recently, Pat Wagner, who has MS, has come to be known as “The Bee Woman” by advocating bee venom therapy and claiming to have effectively treated herself.
In a typical treatment session, 20-40 bees are used. The bee in grasped with tweezers and placed on a specific body part. After the sting, the stinger is allowed to remain for 10 to 15 minutes. To reduce pain, ice is sometimes used to numb the area before and after the sting.
Evaluation in MS and Other Conditions
Many of the components of bee venom have been studied, some of which produce biological effects that could be of consequence to people with MS. Various studies have evaluated the components of bee venom and have found that these components have inflammatory as well as anti-inflammatory effects.
Apamin, one component of bee venom, has theoreticaly beneficial effects. It acts to inhibit the potassium channel, the same part of the nerve cell inhibited by the experimental drug 4-aminopyridine (4-AP). This drug has shown promising results for MS-associated fatigue, leg weakness, and walking difficulty. However, it is unclear if bee venom produces high enough levels of apamin in the central nervous system to have a significant effect on potassium channels.
Bee venom studies have been done in an animal model of MS, experimental allergic encephalomyelitis (EAE). These studies, done in mice, involved three injections of bee venom a week – each equivalent to between 4 and 160 stings. The bee venom produced no measurable benefit, and, in some instances, appeared to have negative effects.
Although there are isolated reports of people with MS experiencing beneficial effects with bee venom therapy, larger studies do not indicate any therapeutic benefit from this treatment. In the Netherlands in 2004, a high-quality clinical study of bee venom therapy was conducted. Extensive clinical and MRI measures were used to determine the effectiveness of bee venom. Although the participants tolerated the treatment well, no benefits were seen on MRI measures, attacks, progression of disability, fatigue, or quality of life.
Generally, treatment is well tolerated. Swelling, tenderness, and redness at the sting sites are the most common complaints. One-fifth of people experience hives, itching, anxiety, or fatigue. Flu-like symptoms may also occur. Fatality resulting from bee venom is very rare but possible. In the United States, approximately 40 people die yearly from bee stings. Most of these deaths are a result of anaphylaxis, a severe allergic reaction. However, it is also possible that some of these deaths are due to heart attacks, resulting from the stress of mild allergic reactions combined with dehydration, heat, or preexisting cardiac conditions. Even in individuals with no history of allergic reactions to bee stings, severe reactions are possible. To prepare for this possibility, a bee sting kit or Epi-Pen Autoinjector should be available during treatment.
Another rare side effect, and one of particular concern to those with MS, is bee venom-induced central nervous system inflammation. Similar to the inflammation seen in MS, acute disseminated encephalomyelitis (ADEM) andoptic neuritis have been observed after bee stings. The former affects multiple areas of the brain and spinal cord, whereas the latter is localized to the nerve that joins the eye to the brain. Optic neuritis is common in people with MS and results in mild to severe visual impairment. Although it is sometimes suggested that bee sting treatments should be used on the eyebrow and temple to treat visual problems in people with MS, the evidence suggests that all people should avoid bee stings near the eye. Among people who do not have MS, there have been reports of optic neuritis developing after bee stings in these areas.
No formal studies have looked at long-term safety issues of bee venom therapy. Thus, it is not known if toxic effects are possible with chronic use.
No evidence exists at this time that suggests bee venom is a beneficial treatment option for people with MS. Furthermore, this treatment has the potential to produce rare, but very serious side effects, including optic neuritis, inflammation of the central nervous system, severe allergic reactions, and heart attack. Precautions should be taken to minimize risk associated with this treatment.
References and Additional Reading
Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos Medical Publishing, 2007, pp. 55-61.
Cassileth BR. The Alternative Medicine Handbook. New York: W.W. Norton, 1998:155-158.
Fetrow CW, Avila JR. Professional’s Handbook of Complementary and Alternative Medicines. Philadelphia: Lippincott, Williams, and Wilkins. 2004, pp. 79–81, 718–720.
Jellin JM, Batz F, Hitchens K. Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Faculty, 2005, pp. 103–104, 681–683, 1034–1035, 1088–1089.
Kowalak JP, Mills EJ, eds. Professional Guide to Complementary and Alternative Therapies. Springhouse, PA: Springhouse Publishing, 2001, pp. 47–48.
Boz C, Velioglu S, Ozmenoglu M. Acute disseminated encephalomyelitis after bee sting. Neurol Sci 2003;23:313–315.
Ilhan A, Akyol O, Gurel A, et al. Protective effects of caffeic phenethyl ester against experimental allergic encephalomyelitis-induced oxidative stress in rats. Free Radic Biol Med 2004;37:386–394.
Lublin FD, Oshinsky RJ, Perreault, M, et al. Effect of honey bee venom on EAE. Neurology 1998;50:A424.
Nam KW, Je KH, Lee JH, et al. Inhibition of COX-2 activity and proinflammatory cytokines (TNF-alpha and IL-1beta) production by water-soluble subfractionated parts from bee (Apis mellifera) venom. Arch Pharm Res 2003; 26:383–388.
Song H-S, Wray SH. Bee sting optic neuritis. J Clin Neuro-opth 1991;11:45–49. Wesselius T, Heersema DJ, Mostert JP, et al. A randomized crossover study of bee sting therapy for multiple sclerosis. Neurology 2005;65:1764–1768.