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Honeybees and Your Health
Inverness Beekeepers
March 2011
Honeybees and Your Health
Topics
• Stings
• Allergy
• Anaphylaxis
• Moving and handling
• Health benefits from beekeeping and
honey
Honeybees and Your Health
Health benefits from beekeeping and honey
• Community
• Interaction with nature and science
• Financial
• Honey as a treatment
Honeybees and Your Health
Bee Stings
Treatment
The first step in treatment following a bee sting is removal of the stinger itself. The stinger should be removed
as fast as possible without regard to method: studies have shown the amount of venom delivered does not
differ if the sting is pinched or scraped off and even a delay of a few seconds leads to more venom being
injected.
Honeybees and Your Health
Honey bees and your health
Bee venom (apitoxin)
• Unlike many other insect venoms, bee venom is water soluble, not fat
soluble, and so must be injected into moist tissue to be effective. It is
haemorrhagic, unlike snake venom, which is a coagulant
• Bee venom is a mixture of histamine, pheromones, enzymes, peptides,
amino acids and other acids, with 63 components in total. The main
enzymes present are phospholipase A, hyaluronidase, and lecithinase;
while the main peptides are mellitin, apamin and peptide 401. Bee venom is
cytotoxic (ie. cell-destroying)
Honeybees and your health
LOCAL REACTIONS
• Local reactions consist of symptoms that are confined to the tissues directly
surrounding the sting site. They are usually mild and transient, although some
patients develop large local reactions or secondary bacterial infections.
• Uncomplicated local reactions — A typical local reaction to a bee sting is redness
and an area of painful swelling (1 to 5 cm) at the site of the sting that develops within
minutes and resolves within a few hours Occasionally, swelling may last 1 to 2 days.
Uncomplicated local reactions may be treated with cold compresses.
Honeybees and Your Health
• Large local reactions — Approximately 10 percent of individuals develop
exaggerated redness and swelling at the site of the sting that gradually enlarges over
one to two days. This response is called a large local reaction (LLR). LLRs peak at
approximately 48 hours and then gradually resolve over 5 to 10 days. The area of
swelling typically measures about 10 cm in diameter.
Treatment of LLRs is based upon symptoms. :
• Cold compresses are soothing acutely. The limb should be elevated if the sting is on
an extremity.
• Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain.
• Itch can be treated with oral antihistamines and topical corticoid steroids.
Honeybees and Your Health
Initial treatment of bee stings
• Many traditional remedies have been suggested for bee stings including damp pastes of tobacco,
salt, baking soda, meat tenderizer, toothpaste, clay, garlic, urine, onions, aspirin and even
application of copper coins.
• As bee venom is acidic it is logical to try and neutralize the pH.
• This is unlikely to be effective however as the venom is injected under the skin and deep into the
tissues, where a topically applied alkali is unable to reach, so neutralization is unlikely to occur.
• In any case, the amount of venom injected is typically very small (between 5 and 50 micrograms
of fluid) and placing large amounts of alkali near the sting site is unlikely to produce a perfectly
neutral pH to stop the pain.
• A randomized trial of aspirin paste and topical ice packs showed that aspirin was not effective in
reducing the duration of swelling or pain in bee and wasp stings, and significantly increased the
duration of redness The study concluded that ice alone is better treatment for bee and wasp stings
than aspirin.
• The sting may be painful for a few hours. Swelling and itching may persist for a week. The area
should not be scratched as it will only increase the itching and swelling. If a reaction persists for
over a week or covers an area greater than 7-10 cm (3 or 4 inches), medical attention should be
sought.
Honeybees and Your Health
Allergic reactions to bee stings
Cells involved in allergic disease
• Mast cells and basophils
• Monocytes, macrophages, and lymphocytes
Honeybees and Your Health
The mediators of allergic disease
• Histamine
• Eicosanoids
• Platelet-activating factor
• Kinins
Honeybees and Your Health
Allergic reactions
Stages of an allergic reaction 1: Sensitization. The initial meeting of an allergen and the immune
system yields no symptoms; it may prepare the body to react promptly to future encounters with the
substance. The sensitization process begins when macrophages degrade the allergen and display the
resulting fragments to T lymphocytes (bottom left). Following this, in a process involving secretion of
interleukin 4 by T cells, B lymphocytes mature into plasma cells able to secrete allergen-specific molecules
known as immunoglobulin E (IgE) antibodies. These antibodies attach to receptors on mast cells in tissue
and on basophils circulating in blood.
Honeybees and Your Health
Allergic reactions
Stages of an allergic reaction 2: Activation of mast cells. On further exposure
between the allergen and the immune system, allergen molecules bind to IgE
antibodies on mast cells (top left). When one such molecule connects with two IgE
molecules on the cell surface, it draws together the attached IgE receptors, thereby
directly or indirectly activating various enzymes in the cell membrane. Cascades of
chemicals and enzymes are released from intracellular granules These cascades
also appear to promote the synthesis and release of chemicals known as cytokines
The various chemicals released by mast cells are responsible for many allergic
symptoms.
Honeybees and Your Health
Allergic reactions
Stages of an allergic reaction 3: Prolonged immune activity. Chemicals emitted by
activated mast cells and their neighbours in tissue may induce basophils, eosinophils,
and other cells flowing through blood vessels (right) to migrate into that tissue. The
chemicals facilitate migration by promoting the expression and activity of adhesion
molecules on the circulating cells and on vascular endothelial cells. The circulating
cells then attach to the endothelial cells, roll along them, and eventually, cross
between them into the surrounding matrix. These recruited cells secrete chemicals of
their own , which can sustain immune activity and damage tissue.
Honeybees and your health
Beyond the basic sting reaction
• Systemic allergic reactions
• Urticaria
• Angioedema
Honeybees and Your Health
Urticaria
Honeybees and Your Health
Urticaria
• Urticaria is characterized by well-defined areas of transient pruritic dermal oedema, demarcated
by a red border, which usually resolve spontaneously within a few hours, although episodes may
continue for days. If the oedema spreads through the underlying epidermis, then it is called angio-
oedema. The latter occurs mostly in the periorbital regions, the lips, the tongue, and the
oropharynx and does not itch. In these instances, the possibility of pharyngeal obstruction may
develop rapidly. Urticaria is probably due to mast cell degranulation, whether this is
immunologically or non-immunologically mediated. Basophils may play a role in the longer
episodes.
• Acute urticaria usually resolves within hours or days. If attacks of urticaria are recurrent and
without obvious precipitating factors, patients should keep a diary to document food, beverage,
and drug intake. In this way, triggers may be identified. It should also be remembered that urticaria
sometimes is associated with systemic diseases such as lymphoma or systemic lupus
erythematosis.
• Treatment at first is with antihistamines, and since they may have to be used quite vigorously, the
non-sedating antihistamines are probably preferable. Systemic corticosteroids may be required in
very severe cases that do not respond to other treatments.
Honeybees and Your Health
Angioedema
• Similar to urticaria, but involving mucosal surfaces, often around face, ie the
mouth and eyes, larynx, can sometimes involve bowel.
• Caused by fluid leaking from vessels.
Honeybees and Your Health
Anaphylaxis
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity
reaction.
Anaphylaxis is likely when all of the following 3 criteria are met:
• Sudden onset and rapid progression of symptoms
• Life-threatening Airway and/or Breathing and/or Circulation problems
• Skin and/or mucosal changes (flushing, urticaria, angioedema)
Exposure to a known allergen for the patient supports the diagnosis:
Remember:
• Skin or mucosal changes alone are not a sign of an anaphylactic reaction
• Skin and mucosal changes can be subtle or absent in up to 20% of reactions (some
patients can have only a decrease in blood pressure,i.e., a Circulation problem)
Honeybees and Your Health
Time course for fatal anaphylactic reactions
• When anaphylaxis is fatal, death usually occurs very soon after contact with the
trigger. From a case-series, fatal food reactions cause respiratory arrest typically after
30–35 minutes; insect stings cause collapse from shock after 10–15 minutes;and
deaths caused by intravenous medication occur most commonly within five minutes.
• Death never occurred more than six hours after contact with the trigger
Honeybees and Your Health
Time to cardiac arrest following exposure to triggering agent
From
Resuscitation Council UK
website
Honeybees and Your Health
Table 1. Suspected triggers for fatal anaphylactic reactions in the
UK between 1992-2001 (from Resuscitation Council UK
website)
Stings 47 29 wasp, 4 bee, 14 unknown
Nuts 32 10 peanut, 6 walnut, 2 almond, 2 brazil, 1 hazel,
11 mixed or unknown
Food 13 5 milk, 2 fish, 2 chickpea, 2 crustacean, 1 banana,
1 snail
Food possible cause 17 5 during meal, 3 milk, 3 nut, 1 each - fish, yeast,
sherbet, nectarine, grape, strawberry
Antibiotics 27 11 penicillin, 12 cephalosporin, 2 amphotericin,
1 ciprofloxacin, 1 vancomycin
Anaesthetic drugs 39 19 suxamethonium, 7 vecuronium, 6 atracurium,
7 at induction
Other drugs 24 6 NSAID, 3 ACEI, 5 gelatins, 2 protamine,
2 vitamin K, 1 each - etoposide, acetazolamide,
pethidine, local anaesthetic, diamorphine,
streptokinase
Contrast media 11 9 iodinated, 1 technetium, 1 fluorescein
Other 3 1 latex, 1 hair dye, 1 hydatid
Honeybees and Your Health
• Hospital admission rates for anaphylaxis, 1990 to 2004, England
ICD – International Classification of Diseases (www.who.int/classifications/icd/en)
from Resuscitation
Council UK website
Honeybees and Your Health
Anaphylaxis
Confusion arises because some patients have systemic allergic reactions that are
less severe, crucially it is the combination of these 3 criteria.
• Sudden onset and rapid progression of symptoms
• Life-threatening Airway and/or Breathing and/or Circulation problems
• Skin and/or mucosal changes (flushing, urticaria, angioedema)
1 Sudden onset and rapid progression of symptoms
• The individual will feel and look unwell.
• Most reactions occur over several minutes. Rarely, reactions may be slower
in onset.
• The time of onset of an anaphylactic reaction depends on the type of trigger.
An intravenous trigger will cause a more rapid onset of reaction than stings
which, in turn, tend to cause a more rapid onset than orally ingested triggers
• The patient is usually anxious and can experience a “sense of impending Doom”
Honeybees and Your Health
Anaphylaxis
1 Sudden onset and rapid progression of symptoms
2 Life-threatening Airway and/or Breathing and/or Circulation problems
3 Skin and/or mucosal changes (flushing, urticaria, angioedema)
Life-threatening Airway and/or Breathing and/or Circulation problems
Airway problems:
• Airway swelling, e.g., throat and tongue swelling (pharyngeal/laryngeal
oedema). The patient has difficulty in breathing and swallowing and feels that the throat is closing up.
• Hoarse voice.
• Stridor – this is a high-pitched inspiratory noise caused by upper airway obstruction.
Breathing problems:
• Shortness of breath – increased respiratory rate.
• Wheeze.
• Patient becoming tired.
• Confusion caused by hypoxia.
• Cyanosis (appears blue) – this is usually a late sign.
Honeybees and Your Health
Anaphylaxis
1 Sudden onset and rapid progression of symptoms
2 Life-threatening Airway and/or Breathing and/or Circulation problems
3 Skin and/or mucosal changes (flushing, urticaria, angioedema)
2 - Circulation problems:
• Signs of shock – pale, clammy.
• Increased pulse rate (tachycardia).
• Low blood pressure (hypotension) – feeling faint (dizziness), collapse.
• Decreased conscious level or loss of consciousness.
• Cardiac arrest.
Circulation problems (often referred to as anaphylactic shock) can be caused by
direct myocardial depression, vasodilation and capillary leak, and loss of fluid from
the circulation.
Patients with anaphylaxis can deteriorate if made to sit up or stand up.
The above Airway, Breathing and Circulation problems can all alter the patient’s
neurological status because of decreased brain perfusion.
This can present as confusion, agitation and loss of consciousness.
Patients can also have gastro-intestinal symptoms
Honeybees and Your Health
Anaphylaxis
1 Sudden onset and rapid progression of symptoms
2 Life-threatening Airway and/or Breathing and/or Circulation
problems
3 Skin and/or mucosal changes (flushing, urticaria,
angioedema)
3 Skin and/or mucosal changes
• They are often the first feature and present in over 80% of anaphylactic reactions.
• They can be subtle or dramatic.
• There may be just skin, just mucosal, or both skin and mucosal changes.
• There may be erythema – a patchy, or generalised, red rash.
• There may be urticaria (also called hives, nettle rash, weals or welts), which
can appear anywhere on the body. They are usually itchy.
• Angioedema may occur
Although skin changes can be worrying or distressing for patients and those treating
them, skin changes without life-threatening airway, breathing or circulation problems
do not signify an anaphylactic reaction. Reassuringly, most patients who have skin
changes caused by allergy do not go on to develop an anaphylactic reaction.
Honeybees and Your Health
• Signs and symptoms of anaphylaxis
Skin Feeling of warmth, flushing [erythema], itching [may begin on palms and
soles], urticaria, angioedema, morbilliform rash, and "hair standing on end"
[piloerection]
Oral Itching or tingling of lips, tongue, or palate Edema of lips, tongue, uvula,
metallic taste
Gastrointestinal Nausea, abdominal pain [colic, cramps], vomiting [large amounts of
"stringy" mucus], and diarrhea Difficulty swallowing
Respiratory Laryngeal - pruritus and "tightness" in the throat, dysphagia, dysphonia
and hoarseness, and sensation of itching in the external auditory canals
Lung - shortness of breath, dyspnea, chest tightness, deep or repetitive
cough, and wheezing
Nose - itching, congestion, rhinorrhea, and sneezing
Cardiovascular Feeling of faintness or dizziness; syncope, chest pain, palpitations, and/or
hypotension (tunnel vision, difficulty hearing
Neurologic Anxiety, apprehension, sense of impending doom, seizures, headache,
confusion
Ocular: Periorbital itching, erythema and edema, tearing, and conjunctival erythema
Honeybees and Your Health
Mortality from anaphylaxis
• The overall prognosis of anaphylaxis is good, with a case fatality ratio of less
than1% reported in most population-based studies.
Risk of death is, however, increased in those with pre-existing asthma,
particularly if the asthma is poorly controlled or in those asthmatics who fail to use, or delay
treatment with adrenaline.
There are approximately 20 anaphylaxis deaths reported each year in the UK, although this may be a
substantial under-estimate.
Risk of recurrence
• The risk of an individual suffering recurrent anaphylactic reaction appears to be
quite substantial, being estimated at approximately 1 in 12 per year.
Trends over time
• There are very limited data on trends in anaphylaxis internationally, but data indicate
a dramatic increase in the rate of hospital admissions for anaphylaxis, this
increasing from 0.5 to 3.6 admissions per 100,000 between 1990 and 2004: an
increase of 700%
Honeybees and your health
Treatment of anaphylaxis
• Recognize
• ABC
• Lie flat
• Call for help
• Adrenaline
Honeybees and Your Health
Non life-threatening conditions that may mimic anaphylaxis
(these usually respond to simple measures):
• Faint (vasovagal episode).
• Panic attack.
• Breath-holding episode in child.
• Idiopathic (non-allergic) urticaria or angioedema.
Honeybees and your health
Venom Immunotherapy (VIT)
Clinical Immunology
Part of national guidelines of treatment of anaphylaxis
• From NHS UK website
• “Following treatment for an insect sting, you may be referred to an allergy clinic, or immunologist
(a specialist on the immune system). If you have had a severe or potentially life threatening
allergic reaction, it is very likely that you will be referred.
• Your GP may also suggest venom immunotherapy treatment, which is sometimes known as
hyposensitisation. This involves having injections on a weekly basis with small doses of venom,
and being observed for about an hour or so to check for an allergic reaction.
• The regular injections will desensitise you to the venom (make you used to it), as well as
encouraging your body to make antibodies to stop further reactions. The injections will carry on
with increasing amounts of venom and will change to monthly appointments when a high enough
dose has been reached. The injections could last a further two or three years.
• The actual amount of venom injected and the length of time that the injections continue for will be
decided by your immunologist. This will depend on your initial allergic reaction and your response
to the treatment.”
Honeybees and Your Health
VIT
• The production of venom-specific IgG - Venom-specific IgG typically increases,
peaking at two to four months after starting VIT and then remaining fairly constant
over five to six years of treatment. These IgG antibodies are referred to as "blocking"
antibodies, because they are capable of blocking mediator release from allergen
stimulated mast cells and basophils.
• IgE levels decline over the course of therapy, presumably as a consequence of
above.
Honeybees and Your Health
Multiple stings
Mass envenomation:
• Occasionally, a person is stung many times. Depending on the number of stings, the
person may be in pain, feel sick, or very unwell. Humans can be killed if stung
enough times in a single incident. With honey bees the toxic dose (LD50) of the
venom is estimated to be 8.6 stings per pound of body weight 2.8mg/kg. Obviously,
children are at a greater risk than are adults. Most deaths caused by multiple stings
have occurred in men in their 70s or 80s who were known to have underlying health
issues.
Renal insufficiency:
• can occur later as an effect of immune complexes damaging renal tissue
Honeybees and Your Health
Infant botulism
• Number of cases in UK ; 11 in last 33 years
(Health Protection Agency figures 28 05 2010)
• 9 England
• 1 Wales had consumed honey
• 1 Scotland had consumed honey and C botulism spores in honey jar, not sure if same strain
• 2 in 2007 in England had consumed honey, but no C botulism spore in honey, one had C botulism
in dust
• 2 in 2009 were 8 weeks old
• No fatalities.
• Prevalence in California; Infantile botulism shows geographical variation. The U.S. has much
higher rates 1.9 per 100,000 live births, 47.2% of which are in California. Although honey has
been implicated as a risk factor for infection, it is household dust that is the major source of
spores. Therefore the risk honey poses to infant health is small, and uncertain.
Honeybees and Your Health
Toxic honey
• Toxic honey may result when bees are proximate to tutu bushes (Coriaria arborea) and
the vine hopper insect (Scolypopa australis). Both are found throughout New Zealand.
Bees gather honeydew produced by the vine hopper insects feeding on the tutu plant. This
introduces the poison tutin into honey. Fortunately only a few areas in New Zealand
(Coromandel Peninsula, Eastern Bay of Plenty and the Marlborough Sound) frequently
produce toxic honey.
• Honey producing areas; Coromandel beekeepers took precautions to prevent a toxin
linked with causing stupors and violent convulsions infecting their honey supply that
summer. The tutin poison, produced by bees feeding on the native tutu bush, was blamed
for poisoning 22 people who purchased comb honey from a Whangamata hobbyist
beekeeper in 2008.
Honeybees and Your Health
• The order of common sense
Honeybees and Your Health
Moving and Handling
There are general guidelines - or maximum weights - for men and women.
If applying these, no man should attempt to lift anything heavier than 25kg and
a woman’s maximum limit is 16kg.
• But it is important to take into account other factors which can change the maximum
safe weight –such as how high an object will need to be lifted.
When You Should Take Extra Care:
• Stacking items above shoulder height
• Carrying items up or down stairs
• Carrying items for long distances
• Lifting in a small work space – this could mean you have to twist
or stoop
• Things to Check:
• Is the weight of the item within your physical capability?
• Is there adequate space to lift safely?
• Can lifting be shared
Honeybees and Your Health
Honeybees and Your Health
Honeybees and Your Health
Therapeutic Uses for bee venom
• Bee venom has recently found a use in a form of complementary therapy. In bee venom therapy,
bees may be induced to sting the affected area, or the venom may be applied by intramuscular
injection. The venom stimulates the release of cortisol, and so biologically it may be expected to
bee effective in the treatment of rheumatic disorders such as Multiple Sclerosis, rheumatoid
arthritis and gout. There is no clinical evidence for this however.
Bee venom therapy is one aspect of apitherapy - use of bee products for curing disease.
• Bee venom acupuncture. Used in Korea
• Melittin also exhibits potent anti-microbial activity. For example, Melittin has been shown to exert
"profound inhibitory effects" on Borrelia Burgdorfereii, the bacteria that causes lyme disease.
Again not necessarily clinically relevant yet. Do Not look to being stung if you find a tic
attached to you !!!
Melittin has also been shown to kill the yeast Candida albicans and to suppress Mycoplasma
hominis and Chlamydia trachomatis infections
• Mellitin is also being investigated as an anti-cancer agent. By modifying the mellitin molecule to
prevent allergic reaction, and attaching a cancer-specific antibody (this combination of toxin and
antibody is called an immunotoxin), researchers hope to produce a ‘magic bullet’ treatment - so
called because it would only destroy cancer cells (unlike conventional chemotherapy agents,
which destroy all types of cell, causing unpleasant side effects such as vomiting and hair loss).
Honeybees and Your Health
The Quran
'And thy Lord taught the bee to build its cells in hills, on trees and in
(men's) habitations..... there issues from within their bodies a drink of
varying colours, wherein is healing for mankind. Verily in this is a Sign
for those who give thought'.
(Translation of Quran 16:68-69)
Honeybees and your health
• Conclusion/Summary
• Benefits from beekeeping
• Safe moving and handling
• First aid principles for stings, allergic reactions
• First aid for severe allergic reactions
Honeybees and your health
Conclusion/Summary
• Benefits from beekeeping
Honeybees and your health
Conclusion/Summary
• Safe moving and
handling
Phone a fred
Honeybees and your health
Conclusion/Summary
• First aid principles for stings
Honeybees and your health
Conclusion/Summary
First aid for severe allergic reactions
• Recognition
• Lie down, elevate legs
• Call for help
Honeybees and Your Health
Inverness Beekeepers
March 2011
Honeybees and Your Health
www.resus.org.uk/pages/reaction.pdf
www.hpa.org.uk/hpr/archives/2010
