Allergic Reaction to Royal Jelly Mistakenly Attributed to Antibiotic

Severe Anaphylaxis to Royal Jelly Attributed to Cefonicid
J Investig Allergol Clin Immunol, 2007; Vol. 17(4): 277-285

Royal jelly, a secretion of the hypopharyngeal and mandibular glands of worker honey bees (Apis mellifera), is a creamy yellow–white, acidic material made up of proteins, free amino acids, fatty acids, sugars, vitamins, and some minerals.

It is the only food of female bee larvae during early stages of development, but once other larvae have developed into sexually immature worker bees, only the queen bee continues to receive this diet.

Although imprecisely defined chemically and generally not standardized, royal jelly is widely used as a health tonic and “alternative” medicine but its beneficial effect in humans is unproven and severe allergic reactions, especially asthma, have occurred following its ingestion.

We report the case of a 28-year-old man who presented with a 25-year history of asthma that had worsened in recent months to a level of 2 attacks per week and frequent use of salbutamol (up to 15 inhalations per day)…

Five months later, the patient was referred to our department in order to identify a safe alternative antibiotic drug. He underwent skin prick tests with standard aeroallergens (Stallergénes S.A., Antony Cedex, France) and positive results were obtained with grass pollen, house dust mite, Alternaria, and cat dander.

Negative results were obtained in immunoassays to determine the presence of immunoglobulin (Ig) E specific to penicilloyl G and V, ampicilloyl, and amoxicilloyl (UniCAP Pharmacia, Uppsala, Sweden) and in a homemade assay of serum specific IgE to cefonicid using epoxy-activated Sepharose as the solid phase [3].

Total serum IgE concentration was 346 kU/L. However, it emerged during the diagnostic procedure that the patient had ingested royal jelly after each injection of cefonicid. In light of this information, further tests were planned in order to investigate the role of royal jelly in producing the systemic reaction.

A prick-to-prick test with royal jelly gave a positive result with a wheal diameter of 10 mm. The same test was negative in a group of 10 healthy subjects who never ate royal jelly. The presence of serum specific IgE to royal jelly was demonstrated with a homemade radioallergosorbent test using nitrocellulose as the solid phase [4]…

Many people who have experienced an adverse reaction while taking an antibiotic are classified as allergic to the drug without any further investigation. However, over diagnosis is common due to a fear of anaphylaxis, and as a result, nonallergic patients may be deprived of potentially useful drugs. It is therefore important to diagnose allergic reactions to antibiotics.

The findings in the described case show that when an adverse drug reaction is suspected a thorough clinical history and allergy evaluation is needed, and that this should not only include drug allergy tests but also assessment of other allergens such as food…