Apitherapy: Limited Evidence for Clinical Efficacy and Safety Concerns
Based on current high-quality guidelines, apitherapy (bee products including honey, propolis, royal jelly, pollen, and bee venom) lacks sufficient evidence to support its use for most medical conditions and should not be recommended as a primary treatment modality. 1, 2
Evidence for Specific Bee Products
Honey and Honey-Related Products
The International Working Group on the Diabetic Foot explicitly recommends against using honey for diabetic foot ulcers due to insufficient data and high risk of bias in existing studies. 1, 2
- Multiple RCTs evaluating honey dressings versus conventional treatments (povidone-iodine, saline) showed no significant benefit in ulcer healing rates or amputation prevention 1
- Three studies examining honey added to nasal saline irrigation for rhinosinusitis found no relevant differences between honey-treated and placebo groups 1
- Studies were limited by small sample sizes, short follow-up periods, poor study design, and concurrent use of antibiotics/corticosteroids that obscured potential effects 1
- One larger unblinded study (n=338) reported higher healing rates with honey, but was deemed at high risk of bias 1
Propolis
Propolis shows minimal to no clinical benefit in controlled studies. 1
- One cohort study comparing propolis with historical controls for diabetic foot ulcers showed no difference in percentage area reduction, with the apparent healing benefit at high risk of bias 1
- For avulsed tooth storage, propolis 10% showed benefit for cell viability in one very-low-quality randomized study with only 10 extracted teeth, but this evidence is insufficient for clinical recommendations 1
Royal Jelly
Royal jelly demonstrates no therapeutic benefit in the single available RCT. 1
- One RCT found no differences in complete ulcer healing at 12 weeks compared with placebo 1
Bee Venom
Bee venom lacks adequate clinical trial data in humans, with most evidence limited to animal models. 3
- While preclinical studies suggest anti-inflammatory and antioxidant properties, these findings have not been adequately translated to human clinical trials 3
- Patient acceptance studies show bee venom, particularly live bee stings, is considered undesirable by the majority of patients 4
Safety Considerations
Bee products are generally considered safe with minimal adverse effects, but lack of standardization raises concerns about consistency and quality control. 2, 5
- No serious adverse events were reported in the beekeepers' survey (n=1059), though this represents a self-selected population 6
- Baby shampoo solutions (sometimes grouped with apitherapy additives) caused significantly more side effects and patient discontinuation compared to standard saline 1
- The absence of practice regulations and standardization protocols remains a significant issue 5
Clinical Bottom Line
Do not recommend apitherapy products as primary or adjunctive treatment for wound healing, rhinosinusitis, or other medical conditions where evidence-based alternatives exist. 1, 2
- The highest quality systematic review from the International Working Group on the Diabetic Foot (2020) found insufficient data to support honey or bee-related products for diabetic foot ulcers 1, 2
- The European Position Paper on Rhinosinusitis (2020) found no benefit for honey in nasal irrigation 1
- Resource allocation should prioritize evidence-based treatments with proven efficacy 2
Common Pitfalls to Avoid
- Do not assume traditional use equals clinical efficacy – despite centuries of use in traditional medicine, controlled trials consistently fail to demonstrate benefit 1, 6
- Do not extrapolate from in vitro or animal studies – bee venom shows promise in laboratory settings but lacks human clinical validation 3
- Do not rely on uncontrolled observational data – beekeepers report positive experiences, but this represents selection bias and lacks placebo controls 6, 4