J Am Board Fam Pract: first published as 10.3122/jabfm.7.3.250 on 1 May 1994. Downloaded from Anaphylactic Reaction After Ingestion Of Bee Pollen

.fohn P GevmaJl,. MD

The nutrient value of bee pollen, as well as other another case involving a life-threatening allergic plant pollen, has been claimed around the world reaction to bee pollen, together with a brief dis­ for many centuries. Bee pollen has received par­ cussion of its pathogenesis and occurrence. ticular attention in recent years in the United States, especially in the lay press, as an unusually Case Report nutritious health food. Spurred by a growing na­ During a recent visit to Sanjuan Island in the Pa­ tional interest in alternative medicine, advocates cific Northwest, a 33-year-old man in good gen­ have claimed curative and healing properties for eral health ingested bee pollen. Within 15 min­ bee pollen for a wide range of diseases, including utes, he noted a sour taste, constriction of the respiratory tract infections, endocrine diseases, throat, and itching first on the right side of colitis, and allergies. I-3 Widely available in health his neck, then the left side. This was rapidly food stores, it is marketed in capsule, tablet, or associated with increasing swelling on both sides granule form as a "superfood," with an allegedly of his neck. Within another 10 minutes, he was complete balance of proteins, carbohydrates, fats, having acute respiratory distress. He telephoned all essential amino acids, vitamins, and minerals. 1 911 and was told to come immediately to Inter­ Therapeutic claims for bee pollen are enthusias­ Island Medical Center in Friday Harbor. He was tic; a writer in a current issue of Well Being Jour­ brought in by a friend and was seen several min­ nal,-+ for example, says that bee pollen "detoxifies utes later for emergency care. and purifies the blood stream, protecting against On initial examination, the patient had marked poisons such as carbon monoxide, other air pol­ swelling of the lateral aspect of the neck helow lutants, ozone, lead, mercury, x-rays, and unclean the angle of the mandible, about 8 cm on the right water ... "; bee pollen is also extolled for its role and 6 cm on the left. His blood pressure was as a cancer-preventive supplement. Many athletes 140/90 mmHg, heart rate 116 beats per minute, have taken hee pollen in the belief that their and respirations 24/min. He was quite anxious and

strength, health, and endurance will he im­ needed to keep his neck hyper extended to keep an http://www.jabfm.org/ proved.! Further claims of the rejuvenating and airway patent. There were no wheezes, the lungs life-prolonging effects of bee pollen have been were clear to percussion and auscultation, the skin made.s Despite these exaggerated statements, no was clear, and the remainder of the examination scientific evidence has yet been published con­ was within normal limits. He gave no history of firming the health benefits of bee pollen.6-s It ap­ allergic reactions, allergies, current medication, or pears that bee pollen is just another health fad en­ serious illnesses. He had had previous bee stings joying widespread popularity and use based on in early childhood without reaction. There was no on 29 September 2021 by guest. Protected copyright. unproven claims. family history of atopy. Except for the bee pollen, Bee pollen is energetically marketed as a safe there was no history of unusual exposure that day product within the health food industry. Its ad­ to dietary or environmental allergens. verse effects are not widely known, and no warn­ The patient was given OJ mg of 1: 1,000 aque­ ings about possible risks are attached to the prod­ ous epinephrine hydrochloride subcutaneously I. uct. There are, however, reports in the medical when first seen, followed by another 0.2 mg sub­ literature of acute, allergic reactions following in­ cutaneously 10 minutes later. An intravenous in­ gestion of bee pollen.'),IO This report describes fusion was started with a lactated Ringer solution, and 100 mg of methylprednisolone sodium suc­ cinate (Solu-Medrol) was administered intra­ Submitted 28 October 1993. venously. He was monitored closely for a 3-hour From the Inter-Island !v1edical Center, Friday Harbor, \Vash­ period, during which time his neck swellings ington. Addres5 reprint requests to John P. Geyman, ,lIviD, De­ partment of Family Medicine, HQ-30, University of Washing­ resolved almost entirely, and his blood pressure, ton, Seattle, WA 98195. heart rate, and respirations stabilized without

250 JABFP May-June 1994 Vol. 7 No.3 hypotension. His dyspnea and anxiety resolved to observe an apparent cause-and-effect relation J Am Board Fam Pract: first published as 10.3122/jabfm.7.3.250 on 1 May 1994. Downloaded from as his airway improved. He never developed between sensitivity to the nonairborne allergens a rash, wheezes, or angioedema elsewhere. He contained in bee pollen and the occurrence of was released in stable condition, without postural acute allergic reactions. Their 3 patients were found changes, 3 hours later and prescribed diphenhy­ to have immunoglobulin E~mediated sensitivity to dramine hydrochloride (Benadryl) 25 to 50 mg to bee pollen on the basis ofin vivo (cutaneous) and in be taken four times a day for the next several days. vitro (radioallergosorent test (RASTJ) techniques; He was advised to avoid any further exposures to these techniques also showed sensitivity to rag­ bee pollen and given a bee sting kit for possible weed and dandelion extracts. Cross-reactivity was future emergency treatment. Follow-up telephone documented for bee pollen, ragweed, and dande­ calls the next day and 1 week later revealed that he lion, all members of the Compositae family.9 had no further sequelae from this incident. Later reports have strengthened the case for a causal relation between bee pollen and systemic Discussion allergic reactions in susceptible individuals. In This case involving bee pollen allergy was beyond 1989, Lin and colleagues14 described a patient my previous experience and raised questions about who developed hypereosinophilia associated with its frequency, pathogenesis, treatment, and whether malaise, headache, nausea, diarrhea, abdominal any relation exists with bee venom allergy. A pain, pruritus, and memory deficit 6 weeks after MEDLINE search was carried out targeting the start of recurrent ingestion of bee pollen. No "anaphylaxis" and "bee pollen." Two reports of other cause for the patient's hypereosinophilia anaphylactic-acute allergic reactions to bee pollen was found, and skin tests were positive to the pol­ were found. The first report by Cohen and his lens contained in the bee pollen product. All colleagues9 in 1979 described three such cases; symptoms and the hypereosinophilia resolved two of the patients gave a previous history of al­ after ingestion of bee pollen was stopped, and they lergic rhinitis, and none had experienced a sys­ were all observed to recur 2 months later upon temic reaction to bee sting. Another case of ana­ challenge with bee pollen in the hospital. In 1992 phylaxis to bee pollen was reported in 1981 by Helbling and his colleagues13 reported the find­ Mansfield and Goldstein,1O who mentioned four ings of their studies of 22 patients who had a his­ other cases; none of these patients had a history of tory of systemic allergic reactions after ingestion systemic bee sting reaction, whereas some had al­ of honey. On the basis of skin and RAST tests, lergic rhinitis. Follow-up allergy and laboratory they found that three quarters of the honey-aller­ http://www.jabfm.org/ studies demonstrated sensitivity to bee pollen it­ gic patients were sensitive to dandelion honey, 13 self, which was found to vary considerably with of 22 were sensitive also to Compositae pollen, and the locale and region, as well as season in which 9 of 22 were sensitive also to honeybee venom. the pollen was collected. 1O . In recent years there have been reports of ana­ Bee pollen is a granular form of nonairborne phylactic reactions to other ingested pollens of the Compositae family, which, in addition to dan­ pollen that is collected by be~s from male seed on 29 September 2021 by guest. Protected copyright. flowers. It is mixed with secretions from the bee, delion, also includes ragweed, chrysanthemum, formed into granules, and carried on the hind sunflower, and some herbs and spices, such as legs.1O Upon return to the hive, the bee stores the chamomile.9 Noyes, et a1. 16 in 1978 described pollen as beebread for feeding the larvae.4~he 3 patients who experienced anaphylaxis after in­ pollen is collected by the beekeeper by screerung gestion of sunflower seeds; all showed reaginic the entrance to the hive, thereby forcing the pol­ sensitivity to sunflower seed on skin and RAST len granules out of the pollen sacs. IO In Sweden, reactivity. Benner and Lee17 in 1973 described a tons of bee pollen have been collected by this pro­ patient with ragweed-sensitive asthma who had cess for consumption as a health food, and it is es­ an anaphylactic reaction to chamomile tea, appar­ timated that the bee pollen industry in the United ently due to cross-reactivity within the Composi­ 9 States is of similar magnitude. tae family. On the basis of such reports, The Med­ In earlier years bee pollen was not considered to ical Letter in 1979 called attention to potential have antigenic potentI'al rOrJ: a11' ergtc reactIons.. 11 -13 toxic, even lethal, effects of many plant products In their 1979 report, Cohen, et al.9 were the first sold in health food stores. IB

Anaphylactic Reaction to Bee Pollen 251 J Am Board Fam Pract: first published as 10.3122/jabfm.7.3.250 on 1 May 1994. Downloaded from Although rarely reported, acute systemic 2. Brown R. The honeybee pollen story. Scottsdale, allergic reactions to bee pollen are seen more AZ: C.c. Pollen Company, 1980: 1-16. 3. Hcdgebeth W. Swarming to the magic of bee pollen. often than suggested by the meager literature Mainliner Magazine (United Airlines) 1972; 21: 124. on the subject. Consultation with an allergist 4. Catero M. The remarkable rejuvenating food of roy­ at the University of Washington Medical Center alty. Well Being ]ournaI1993; Sept/Oct:7. revealed that one or two cases are seen each year. 5. Wade C. Bee pollen and your health. New Canaan, No further allergy workup was recommended for CT: Keats Publishers, 1992. the patient reported here. Management consists 6. Herbert V. Nutrition cultism: facts and fictions. Phila­ delphia: George F. Stickley Co., 1980. of awareness of the problem, avoidance of the 7. Barrett S, editor. The health robbers: how to protect pollen allergens, and preparedness for the acute your money and your life. 2nd ed. Philadelphia: treatment of allergic reaction should unintentional George F. Stickley Co., 1980. exposure occur. 8. Whitney EN, Sizer FS, editors. Nutrition: concepts Although some allergists have called for warn­ and controversies. 3rd ed. New York: West Publish­ ing labels on bee pollen products for some years,9 ing Company, 1985:183-4. 9. Cohen SH, Yunginger]W, Rosenberg N, Fink]N. this step has still not taken place. Instead, bee pol­ Acute allergic reaction after composite pollen inges­ len is being aggressively marketed as a universally tion.] Allergy Clin Immunol 1979; 64:4:270-4. safe "superfood" with almost unlimited health­ 10. Mansfield LE, Goldstein GB. Anaphylactic reaction giving properties. The Institute of Medicine has after ingestion of local bee pollen. Ann Allergy 1981; recently issued a report noting the continued pro­ 47:154-6. 11. Stanley RG, Linskens HF. Pollen: biology, biochem­ liferation of health claims for many foods and is istry management. New York: Springer-Verlag, calling for more responsible labeling of food 1974; 164:81. products. 19 Progress is being made in this direc­ 12. Binding GJ. About pollen: health food and healing tion following passage of the 1990 Nutritional agents. 2nd ed. Northamptonshire, Great Britain: Labeling and Education Act. This legislation will Thorsons Publishing, Ltd, 1980. require that nutritional products claiming health 13. ]ackson]L, Houghton RP, Snider P. Bee pollen: re­ view of clinical studies and case reports. Int] Biosoc benefits be backed by "significant scientific agree­ Res 1983; 5:47. 2o ment" for such claims. 14. Lin FL, Vaughan TR, Vandewalker ML, Weber RW, Hypereosinophilia, neurologic, and gastrointestinal Summary symptoms after bee-pollen ingestion.] Allergy Clin Bee pollen allergy, although relatively rare, can Immunol1989; 83:793-6. http://www.jabfm.org/ 15. Helbling A, Peter C, Berchtold E, Bogdanov S, present a life-threatening medical emergency. Muller U. Allergy to honey: relation to pollen and Conventional treatment of anaphylaxis is indi­ honey bee allergy. Allergy 1992; 47:41-9. cated, and further allergic workup is not neces­ 16. Noyes], Boyd GK, Settipane GA. Sunflower seed sary. There is little awareness of this hazard anaphylaxis.] Allergy Clin Immunol 1978; 61: 182. among the general population. Warnings to in­ Abstract. 17. Benner MH, Lee HS. Anaphylactic reaction to chamo­

clude product labeling of potential adverse reac­ on 29 September 2021 by guest. Protected copyright. mile tea.] Allergy Clin Immunol 1973; 52:307. tions in sensitive individuals are urgently needed 18. Toxic reactions to plant products sold in health food to protect the public from this hazard. stores. Med Lett Drugs Ther 1979; 21(7):29-32. 19. Institute of Medicine. Improving America's diet and References health: from recommendations to action. Report of I. Rector-Page LG. Healthy healing: an alternative the Committee on Dietary Guidelines Implementa­ health reference. 9th ed. Sonora, CA: Healthy Heal­ tion. Food and Nutrition Board. Washington, DC: ing Publications, 1992:89. National Academy Press, 1991.

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