Apitherapy: An overview of bee products for wound healing including clinical use guidelines
The burden of treating chronic wounds is growing rapidly due to increasing health care costs, an aging population and, in the United States and beyond, a sharp rise in the incidence of diabetes and obesity worldwide. It is claimed that an excess of $25 billion is spent annually on treatment of chronic wounds.
Prevalence of diabetes represents a major impact on wound healing outcome. In 2004, according to the World Health Organization, more than 150 million people worldwide suffered from diabetes. Its incidence is increasing rapidly and it is estimated that by the year 2025, this number will double. It is estimated that up to 25% of all diabetics will develop a diabetic foot ulcer.
Because of the widespread development of antibiotic‐resistant bacteria, chronic wound healing is a challenging problem. This has led to a re-examination of honey and its by-products as therapeutic agents. Honey, propolis, royal jelly, and bee venom have strong antibacterial activity.
The wound healing properties of honey include stimulation of tissue growth, enhanced epithelialization, and minimized scar formation. These effects are ascribed to honey’s acidity, hydrogen peroxide content, osmotic effect, nutritional and antioxidant contents, stimulation of immunity, and to unidentified compounds. Prostaglandins and nitric oxide play a major role in inflammation, microbial killing, and the healing process. Honey was found to lower prostaglandin levels and elevate nitric oxide end products.
Studies show that honey dressing applied to infected diabetic foot wounds showed beneficial changes in grade and stage of wounds, when using the University of Texas Diabetic Wound Classification index. One study utilizing honey dressing for infected diabetic foot wounds for a three month period achieved complete healing in 43.3% of ulcers while decrease in size and healthy granulation was significantly observed in another 43% of study participants. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing.
The effects of bee products on bacteria vary considerably by the type of product and among varieties of the same product. Botanical origin is a major determinant of the honey’s antibacterial activity. Propolis has been found to have the strongest action against bacteria. Honey does not allow vegetative bacteria to survive; however, it does contain viable spores, including clostridia. Honey products should be filtered or otherwise checked for clostridia spores when used in an antimicrobial or topical manner. As a dressing on wounds, honey provides a moist healing environment, rapidly clears infection, deodorizes, and reduces inflammation, edema, and exudation.
Learning Areas:Chronic disease management and prevention
Other professions or practice related to public health
Assess the growing incidence of wound management issues worldwide, including diabetic and geriatric populations. Discuss briefly wound pathophysiology. List three phases of wound healing. Compare endogenous (pathophysiology) and exogenous (microorganisms) factors involved in wound healing. Discuss the origin of the most commonly used bee products for wound management: honey, bee pollen, propolis, and royal jelly. Differentiate the properties of antibiotics versus antimicrobial peptides for management of a broad spectrum of pathogens. Compare and contrast the inhibitory activity of royal jelly versus antibiotics against bacteria (Streptomyces strains, Staphylococcus aureus and Escherichia coli) using zone diameter testing (drop plate method) Discuss and compare effects of honey application on specific wound types. Evaluate specific clinical research trials assessing honey products and their healing actions: diabetic foot ulcers, burns, MRSA, Candida. Define specific clinical protocol for incorporating honey into wound healing therapies. List steps to do so.
Keyword(s): Diabetes, Aging
Qualified on the content I am responsible for because: I researched and wrote 2 CEU powerpoints on this topic presented at Midwest College of Oriental Medicine, Chicago: Apitherapy and Autoimmune Diseases: Investigation, Differentiation and Treatment Options; Applications of Honey Products for Wound Healing. I authored 3 articles on this and related topics for Oriental Medicine Journal, Winter 2015: The Healing Power of Bee Products; Overview of Bee Venom Therapy Literature; Our Rapidly Disappearing Bee Populations. I am a member of the American Apitherapy Association.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.