OVERVIEW

PRODUCT INFORMATION

REPRESENTATIVE TRADE NAMES

Beeswax – Generic

Bee pollen – Generic

Propolis – Generic

DRUG CLASS

Herbal and Dietary Supplements

SUMMARY INFORMATION

Fact Sheet at MedlinePlus, NLM [Bee Pollen]

CHEMICAL FORMULA AND STRUCTURE

ANNOTATED BIBLIOGRAPHY

References updated: May 1, 2022

• Zimmerman HJ. Unconventional drugs. Miscellaneous drugs and diagnostic chemicals. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott,1999: pp. 731-4.

  (Expert review of hepatotoxicity published in 1999; several herbal medications are discussed, but not bee products).
• Liu LU, Schiano TD. Hepatotoxicity of herbal medicines, vitamins and natural hepatotoxins. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 2nd ed. New York: Informa Healthcare USA, 2007, pp. 733-54.

  (Review of hepatotoxicity of herbal and dietary supplements [HDS] published in 2007; no mention of bee products).
• Hausen BM, Wollenweber E, Senff H, Post B. Propolis allergy. (I). Origin, properties, usage and literature review. Contact Dermatitis. 1987;17:163–70. [PubMed: 3315436]

  (Review of the clinical features of propolis contact dermatitis, nearly 200 cases of which have been described in the literature).
• Hausen BM, Wollenweber E, Senff H, Post B. Propolis allergy. (II). The sensitizing properties of 1,1-dimethylallyl caffeic acid ester. Contact Dermatitis. 1987;17:171–7. [PubMed: 3677659]

  (Analysis of the sensitizing properties of constituents of propolis suggested that the hypersensitivity reactions are due to flavonoid aglycones found in buds of poplar trees, possibly dimethylallyl caffeic acid ester).
• Greenberger PA, Flais MJ. Bee pollen-induced anaphylactic reaction in an unknowingly sensitized subject. Ann Allergy Asthma Immunol. 2001;86:239–42. [PubMed: 11258697]

  (56 year old woman with a history of allergic rhinitis and previous desensitization developed urticaria, pruritus, dyspnea and throat tightness within minutes of drinking a “smoothie” that included bee pollen, analysis of which demonstrated ragweed pollen).
• Cohen HA, Varsano I. Kah an E, Sarrell EM, Uziel Y. Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med. 2004;158:217–21. [PubMed: 14993078]

  (Among 430 children, ages 1 to 5 years, treated with an herbal extract containing propolis, echinacea and vitamin C [Chizukit] or placebo twice daily for 6 months, respiratory illnesses were less frequent with Chizukit and adverse events were infrequent [4.2%], mild and mostly consistent with gastrointestinal intolerance).
• Menniti-Ippolito F, Mazzanti G, Santuccio C, Moro PA, Calapai G, Firenzuoli F, Valeri A, et al. Surveillance of suspected adverse reactions to natural health products in Italy. Pharmacoepidemiol Drug Saf. 2008;17:626–35. [PubMed: 18327867]

  (Among 223 spontaneous reports of adverse reactions to natural products reported over a 5 year period to an Italian national registry, 14 were attributed to propolis, 12 of which were allergic reactions, 4 requiring hospitalization).
• Jacobsson I, Jönsson AK, Gerdén B, Hägg S. Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. Pharmacoepidemiol Drug Saf. 2009;18:1039–47. [PubMed: 19650152]

  (Review of 778 spontaneous reports of adverse reactions to herbals to Swedish Registry found none attributed to beeswax, bee pollen, royal jelly or propolis).
• Reuben A, Koch DG, Lee WM., Acute Liver Failure Study Group. Drug-induced acute liver failure: results of a U.S. multicenter, prospective study. Hepatology. 2010;52:2065–76. [PMC free article: PMC3992250] [PubMed: 20949552]

  (Among 1198 patients with acute liver failure enrolled in a US prospective study between 1998 and 2007, 133 [11%] were attributed to drug induced liver injury of which 12 [9%] were due to herbals, including several herbal mixtures, usnic acid, Ma Huang, black cohosh, and Hydroxycut, but not bee products).
• Teschke R, Wolff A, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: a tabular compilation of reported cases. Liver Int. 2012;32:1543–56. [PubMed: 22928722]

  (A systematic compilation of all publications on the hepatotoxicity of specific herbals identified 185 publications on 60 different herbs, herbal drugs and supplements does not include any attributed to bee products).
• Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, et al. Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network. Hepatology. 2014;60:1399–408. [PMC free article: PMC4293199] [PubMed: 25043597]

  (Among 839 cases of liver injury from drugs collected in the US between 2004 and 2013, 130 were due to HDS products, including 45 from body building agents [probably anabolic steroids] and 85 from diverse HDS products, but none were attributed to bee products).
• Seeff LB, Bonkovsky HL, Navarro VJ, Wang G. Herbal products and the liver: a review of adverse effects and mechanisms. Gastroenterology. 2015;148:517–532.e3. [PubMed: 25500423]

  (Extensive review of herbal associated liver injury does not discuss bee products).
• Lambrinoudaki I, Augoulea A, Rizos D, Politi M, Tsoltos N, Moros M, Chinou I, et al. Greek-origin royal jelly improves the lipid profile of postmenopausal women. Gynecol Endocrinol. 2016;32:835–839. [PubMed: 27227757]

  (Among 36 postmenopausal women treated with oral royal jelly [150 mg] daily for 3 months, serum HDL cholesterol levels increased [60 to 65 mg/dL] while LDL cholesterol decreased slightly [144 to 136 mg/dL]; no mention of adverse events or changes in serum ALT levels).
• Medina-Caliz I, Garcia-Cortes M, Gonzalez-Jimenez A, Cabello MR, Robles-Diaz M, Sanabria-Cabrera J, Sanjuan-Jimenez R, et al. Spanish DILI Registry. Herbal and dietary supplement-induced liver injuries in the Spanish DILI Registry. Clin Gastroenterol Hepatol. 2018;16:1495–1502. [PubMed: 29307848]

  (Among 856 cases of hepatotoxicity enrolled in the Spanish DILI Registry between 1994 and 2016, 32 were attributed to herbal products, the most frequent cause being green tea [n=8] and Herbalife products [n=6], while none were attributed to bee products).
• Sharif SN, Darsareh F. Effect of royal jelly on menopausal symptoms: A randomized placebo-controlled clinical trial. Complement Ther Clin Pract. 2019;37:47–50. [PubMed: 31470366]

  (Among 200 postmenopausal woman treated with royal jelly [1000 mg] or placebo once daily for 8 weeks, menopausal symptoms improved with royal jelly therapy but not placebo; no mention of adverse events).
• Afsharpour F, Javadi M, Hashemipour S, Koushan Y, Haghighian HK. Propolis supplementation improves glycemic and antioxidant status in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled study. Complement Ther Med. 2019;43:283–288. [PubMed: 30935545]

  (Among 60 patients with diabetes treated with propolis [500 mg] or placebo 3 times daily for 2 months, fasting glucose and HbA1c levels improved in the propolis treated group but not in controls; adverse events were not reported).
• Lima WG, Brito JCM, da Cruz Nizer WS. Bee products as a source of promising therapeutic and chemoprophylaxis strategies against COVID-19 (SARS-CoV-2). Phytother Res. 2021;35:743–750. [PMC free article: PMC7536959] [PubMed: 32945590]

  (Review of the preclinical and clinical evidence for the activity of bee products [including royal jelly, beeswax, bee pollen, bee venom and propolis] against SARS-CoV-2; no mention of adverse events).
• Matsushita H, Shimizu S, Morita N, Watanabe K, Wakatsuki A. Effects of royal jelly on bone metabolism in postmenopausal women: a randomized, controlled study. Climacteric. 2021;24:164–170. [PubMed: 32880201]

  (Among 72 postmenopausal women treated with royal jelly [3000 mg daily] or placebo for 6 months, bone mineral density did not change in those receiving royal jelly but decreased to some extent in those on placebo; no mention of adverse events).
• Ballotin VR, Bigarella LG, Brandão ABM, Balbinot RA, Balbinot SS, Soldera J. Herb-induced liver injury: Systematic review and meta-analysis. World J Clin Cases. 2021;9:5490–5513. [PMC free article: PMC8281430] [PubMed: 34307603]

  (Systematic review of the literature on herb-induced liver injury identified 446 references describing 936 cases due to 79 different herbal products, the most common being He Shou Wu [Fo-Ti: n=91], green tea [90], Herbalife products [64], kava kava [62], greater celandine [48] and aloe vera [22], among others; bee products were not mentioned).
• Li JD, Cui L, Xu YY, Guan K. A case of anaphylaxis caused by major royal jelly protein 3 of royal jelly and its cross-reactivity with honeycomb. J Asthma Allergy. 2021;14:1555–1557. [PMC free article: PMC8866983] [PubMed: 35221696]

  (56 year old Chinese woman developed two episodes of anaphylaxis with urticaria, pruritus, laryngeal edema, hypotension and collapse within 1 hour of consuming royal jelly and was found to have a positive skin prick test to crude extracts of royal jelly; immunoblotting with her serum identified evidence of antibodies to purified royal jelly protein 3).
• Bessone F, García-Cortés M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, et al. Herbal and dietary supplements-induced liver injury in Latin America: experience from the LATINDILI Network. Clin Gastroenterol Hepatol. 2022;20:e548–e563. [PubMed: 33434654]

  (Among 367 cases of hepatotoxicity enrolled in the Latin American DILI Network between 2011 and 2019, 29 [8%] were attributed to herbal products, the most frequent being green tea [n=7], Herbalife products [n=5] and garcinia [n=3] while none were attributed to bee products).
• El-Seedi HR, Eid N, Abd El-Wahed AA, Rateb ME, Afifi HS, Algethami AF, Zhao C, et al. Honey bee products: preclinical and clinical studies of their anti-inflammatory and immunomodulatory properties. Front Nutr. 2022;8:761267. [PMC free article: PMC8762236] [PubMed: 35047540]

  (Extensive review of the preclinical and clinical studies of honey bee products including royal jelly, bees wax, bee pollen and propolis; no mention of adverse event rates or hepatotoxicity).