Drug information of Bee venom

Bee venom

Drug group:

Anaphylaxis to insect stings is a relatively uncommon problem, affecting approximately 0.4% of the general United States population. It is the cause of an estimated 40 deaths per year in the United States. 

The allergic reactions are mediated by immunoglobulin E (IgE) antibodies directed at constituents of honeybee, yellow jacket, hornet, and wasp venoms. In order to minimize allergic reactions, hyposensitization immunotherapy techniques have been developed in which small doses of the venom are administered under controlled conditions over a period of months to years. Patients allergic to honeybee venom may be particularly sensitive to hymenoptera venoms in general and have been found to be at a higher risk of developing systemic adverse reactions to venom immunotherapy than patients who are sensitive to yellow jacket venom
More recently, it has been suggested that honeybee venom may alleviate the symptoms and slow the progression of immune-modulated diseases such as arthritis and multiple sclerosis

Mechanism of effect

Bee venoms are complex mixtures of enzymes and polysaccharides. They are collected from the insects and diluted to standardized concentrations. Melittin, a phospholipase activating protein in bee venom, has been shown to induce neutrophil degranulation and to increase or inhibit the formation of superoxide. This variation in activity appears to depend upon the test method employed. Melittin induces neutrophil degranulation with subsequent superoxide formation in vitro; however, melittin binds to calmodulin, an effect associated with inhibition of superoxide production
The polypeptide adolapin isolated from bee venom inhibits inflammation (carrageenan, prostaglandin, and adjuvant rat paw edema models) and appears to inhibit the prostaglandin synthase systems

Drug indications

Bee venom is used to hyposensitize individuals highly sensitive to bee stings. There is some evidence that it might also help inhibit or suppress arthritis and multiple sclerosis


There is no recent clinical evidence to guide dosage of bee venom.

Drug contraindications

Contraindications have not been identified.

Side effects

Various adverse reactions may occur to bee venom, the severity of which depends on the number of stings sustained
Immediate effects after multiple stings include localized pain, swelling, and erythema at individual sting sites. Stings to the eyes can result in corneal edema and ulceration. When bees are swallowed, life-threatening pharyngeal edema and respiratory obstruction may occur. Early systemic symptoms after large-volume envenomation include fatigue, dizziness, nausea, vomiting, and diarrhea. Within 24 hours, hemolysis, hemoglobinuria, rhabdomyolysis, and hepatic transaminase enzyme elevations may develop. Subendocardial damage and cardiac enzyme elevations seen in human case reports and animal studies may result from direct venom effects in the absence of anaphylaxis and hypotension. Renal insufficiency and electrolyte abnormalities such as hyperkalemia may occur secondary to rhabdomyolysis, hemolysis, and acute tubular necrosis. Nonanaphylactic responses to multiple stings often will be apparent within the first several hours; however, severe systemic signs and symptoms have been delayed for up to 24 hours or more


None well documented


Bee stings cause human reactions in 2 distinct patterns. One or a few stings may induce allergic responses that are sometimes severe or fatal. On the other hand, massive attacks with hundreds to thousands of stings can cause severe systemic injury affecting many different organs, resulting in high mortality. Melittin has been shown to be the main lethal component in bee venom

Signs and symptoms of multiple stings include urticaria (hives), nausea, vomiting, diarrhea, hypotension, confusion, seizures, and renal failure. Treatment is supportive, with attention to blood pressure, renal function, and maintenance of an open airway. Stingers should be removed with gentle scraping to prevent further venom injection. Mass inoculation of bee venom may induce acute renal failure (ARF), adult respiratory distress syndrome, liver injury, cardiac damage, pancreatitis, skin necrosis, shock hypertension, bleeding, thrombocytopenia, hemolysis, and rhabdomyolysis. Bee venom-induced ARF after multiple stinging has been sporadically reported in Europe, Africa, and Asia

Animal studies have shown a decrease in glomerular filtration rate and urinary volume after bee venom infusion. In the same way, venom caused a sharp and immediate decrease in renal blood flow. Experimental injection of bee venom caused a reaction similar to that observed in patients with bee venom-induced ARF

Because cardiac levels of noradrenaline have increased dramatically in animals following bee venom injection, it is suggested that all patients, regardless of sensitivity history, have cardiac monitoring if they are victims of multiple bee stings. Rare cases of anuria and rhabdomyolysis/rhabdomyonecrosis have been reported

Points of recommendation

A single bee sting can produce anaphylaxis in sensitive individuals. Regardless of history, monitor any patient with multiple stings

Honeybee venom is obtained from A. mellifera, the common honeybee. Other venoms are derived from related members of the hymenoptera

Pregnancy level

Documented adverse reactions. Avoid use.

Breast feeding warning

Documented adverse reactions. Avoid use.

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