Q:

3/27/2013
A person or child allergic to bee stings, should he or she avoid honey? Will honey cause an allergic reaction or anaphylaxis?

A:

Thank you for your inquiry.

Anaphylaxis to honey clearly occurs. It is thought that the majority of these cases are, however, related to pollen found within the honey rather than to allergens from the bee itself or bee venom. Nonetheless, allergens from bees have been found in honey and there is one report (Helbling, et al., abstract copied below) that found allergens cross-reacting with bee venom could possibly be responsible for such reactions. The majority of reactions, however, seem to be related, as noted, to pollen found in honey (Fuiano, et al. and Lombardi, et al, abstracts copied below).

In summary, anaphylaxis to honey is rare but can occur. It is thought that the majority of these episodes are related to pollen within the honey rather than bee components, but based on one study, it is conceivable that there might be allergens in honey that cross-react with bee venom. This type of cross-reactivity, if it does occur, must be quite rare.

Thank you again for your inquiry and we hope this response is helpful to you.

Allergy. 1992 Feb;47(1):41-9.
Allergy to honey: relation to pollen and honey bee allergy.
Helbling A, Peter C, Berchtold E, Bogdanov S, Müller U.
Source
Medical Division, Zieglerspital, Bern, Switzerland.
Abstract
To identify the allergenic components of honey we studied 22 patients with a history of systemic allergic symptoms following honey ingestion. The group of honey-allergic patients was compared with three control groups: 10 subjects sensitized to artemisia, 10 with honey bee venom allergy and 10 without a history of atopy or bee sting reactions. The allergological tests included skin tests and RAST with three different kinds of Swiss honey (dandelion, forest and rape), pollen of compositae species, celery tuber, extract of bee pharyngeal glands, honey bee venom and bee whole body extract. The results show that 3/4 of honey-allergics are sensitive to dandelion honey and 13 of 22 also to compositae pollen. Nine of the honey allergic patients were sensitized to honey bee venom, 3 also to bee pharyngeal glands and to bee whole body extract. Analysis of diagnostic tests and RAST inhibition studies suggest that besides compositae pollen other allergens, most likely of bee origin are important. In honey allergics primary sensitization may be due either to the honey itself, to airborne compositae pollen or even to cross-reacting bee venom components.

Allergol Immunopathol (Madr). 1998 Nov-Dec;26(6):288-90.
Allergic reactions to honey and royal jelly and their relationship with sensitization to compositae.
Lombardi C, Senna GE, Gatti B, Feligioni M, Riva G, Bonadonna P, Dama AR, Canonica GW, Passalacqua G.
Source
Dept. of Internal Medicine Sant'Orsola Hospital, Brescia, Italy.
Abstract
Honey and royal jelly are complex etherogeneous mixtures of flowers' nectar, sugars, proteins and bee's glandular secretions. The existence of a type I hypersensitivity to honey is still matter of debate, while an aetiological role of Compositae pollens in the clinical manifestations following honey ingestion has been envisaged. We describe two cases of severe systemic reactions (anaphylaxis and generalized urticaria/angioedema) due to honey and royal jelly ingestion in patients sensitized to compositae (mugwort). Both patients had a skin and RAST positivity to mugwort and a positive prick-by-prick to the offending foods. Moreover, in one of the two patients the RAST-inhibition assay showed the strong cross-reactivity between the proteins of honey and mugwort and the SDS-PAGE analysis showed that the major proteic bands from honey and mugwort extracts are largely superimposable. Both the clinical data and the laboratory analysis support the hypothesis of a strict link between sensitization to compositae and adverse reactions to honey and jelly.

Eur Ann Allergy Clin Immunol. 2006 Dec;38(10):364-5.
Anaphylaxis to honey in pollinosis to mugwort: a case report.
Fuiano N, Incorvaia C, Riario-Sforza GG, Casino G.
Source
Pediatric Allergy Service, AUSL FG1, San Severo, Italy.
Abstract
A case of anaphylaxis to honey in a 19 year old female sensitized to Compositae pollen is described. The patient suffered from summer rhinoconjunctivitis since seven years; in January 2006, ten minutes after eating bread and honey she developed angioedema of the lips and tongue, runny nose, cough, dyspnoea, and collapse, requiring hospitalization and treatment with high dose corticosteroids and anti-histamines. After two weeks, skin prick tests (SPT) with a standard panel of inhalant allergens and prick + prick with a number of kinds of honey were performed. SPTs were positive to mugwort, ragweed, dandelion, and goldenrod. Concerning honey, the prick + prick was positive to "Millefiori" (obtained from bees foraging on Compositae) and also to sunflower, limetree, and gum tree honey, while was negative for other kinds of honey, including the frequently used chestnut honey and acacia honey. The allergenic component responsible of anaphylaxis in this case seems to be a molecule occurring in Compositae pollens, as previously reported for other three reports, but also in pollen from plants of different families. Honey contains a large number of components derived from bees, such as gland secretions and wax, as well as from substances related to their foraging activity, such flower nectar and pollens (1, 2). Honey as a food has been associated to allergic reactions and particularly to anaphylaxis (3-6). Among the pollens, the role of Compositae is somewhat controversial, since its responsibility is clear in some studies (3, 5, 6) but considered negligible in others (7). Here we present the case of a patient sensitized to Compositae pollen who had an anaphylactic reaction to the ingestion of honey obtained from bees foraging on Compositae flowers and was tested with a number of different varieties of honey.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology