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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-.

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet].

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Bee Products: Beeswax, Bee Pollen, Propolis

Last Update: May 1, 2022.



Products made by bees that are used in alternative medicine include honey, beeswax, bee pollen, propolis and royal jelly. These natural substances have several uses, for both bees and humans, as foods, sealants, lubricants, construction material and medications. Beeswax is a secreted oily solution used by bees to build the honeycomb. Bee pollen is the mixture of various pollens collected by bees to make honey. Propolis is a mixture of beeswax and other oils and resins collected by bees and used in construction of the bee hive and in preserving honey and other perishables. Royal jelly is a secreted milky substance used to feed larvae. When used for medical purposes the products are referred to as apitherapy. The products are generally well tolerated and there is no evidence that they cause liver injury, either in the form of ALT elevations or clinically apparent liver injury.


Bees make a variety of products that they use as food, for production of honey, in construction and repair of the hive and as sealants to prevent spoilage.

Beeswax (cera alba) is the natural wax produced in the abdominal segments of worker bees which is secreted and deposited in scales and then collected and used to build the honey comb for storage of honey and protection of larvae in the hive. Beeswax consists largely of fatty acid esters of long-chain alcohols. Beeswax has been used by humans for centuries as a lubricant, glaze or polishing solution or waterproofing gel. Beeswax is edible, but is usually combined with other ingredients or used as a covering for products such as cheese for preservation and prevention of mold or fungal contamination.

Bee pollen is the mixture of plant and flower pollen with nectar and saliva that is used in honey production by bees. The pollen is collected by placing traps in the bee hive that knocks off some of the pollen collected by the bees. Its composition is highly variable but includes vitamins, minerals and carbohydrates. Bee pollen is sold as a dietary supplement and is claimed to have antiinflammatory and antibacterial activity. Bee pollen is purported to be beneficial for cancer, arthritis and to improve athletic performance, but has not been shown to have these activities. Bee pollen has been reported to cause allergic reactions in patients with asthma, atopic dermatitis and with allergies to pollen.

Propolis is a natural resinous product that is collected by bees from various plants and mixed with beeswax and salivary enzymes. Propolis is hard and breakable in cold temperatures but soft, flexible and sticky when warmed, so that it can be used to fill gaps, close holes and build the beehive. The sealant action of propolis protects the hive from microorganisms, spores and mold. Propolis has been used by humans topically for treatment of wounds, skin ulcers and rashes and in oral forms as therapy of diabetes, obesity, cancer and other conditions. Propolis is purported to have antiinflammatory, antioxidant, antidiabetic and even antineoplastic activity based upon studies in cell culture and animal models of diseases such as diabetes, obesity and cancer. None of these activities have been convincingly shown in humans with diabetes, obesity or cancer. In most clinical trials, adverse event rates have not been mentioned, but propolis is reported to be well tolerated. Propolis, like bee pollen, is highly variable with chemical compositions that differ markedly by genus of bees and geographic location (based upon local plant species). Propolis may contain contaminants, insect parts and allergens from the environment. Contact dermatitis from propolis is a well known complication of bee-keeping and can occur with topical and oral administration of propolis. Allergic reactions including angioedema and anaphylaxis from commercial sources of propolis have been reported. The allergic reactions are likely due to plant flavonoid aglycones.

Royal jelly is a milk-like secretion from the mandibular glands of worker bees that is used to feed larvae of workers and drones and, when given in larger amounts and for extended periods, for feeding and development of queen bees (fertile females). Royal jelly is collected from individual cells of queen bees and is frequently used in alternative and traditional medicine as is described in further detail in a separate chapter (Royal Jelly).


Liver injury attributable to bees products has not been reported. In clinical trials of beeswax and propolis as therapy of diabetes, obesity and cancer, side effects were rarely mentioned and ALT elevations and hepatotoxicity were not reported. Despite their availability and widespread use as an alternative therapies, there have been no published reports of liver injury attributed to bee products.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Mechanism of Injury

Bee products such as beeswax, bee pollen and propolis have many components, but none of them has been shown to be particularly hepatotoxic.

Outcome and Management

Hepatotoxicity from bee products has not been reported.

Drug Class: Herbal and Dietary Supplements



Beeswax – Generic

Bee pollen – Generic

Propolis – Generic


Herbal and Dietary Supplements


Fact Sheet at MedlinePlus, NLM [Bee Pollen]


Beeswax8012-89-3ApitherapyNot Applicable
Propolis9009-62-5ApitherapyNot Applicable


References updated: May 1, 2022

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    (Among 430 children, ages 1 to 5 years, treated with an herbal extract containing propolis, echinacea and vitamin C [Chizukit] or placebo twice daily for 6 months, respiratory illnesses were less frequent with Chizukit and adverse events were infrequent [4.2%], mild and mostly consistent with gastrointestinal intolerance).
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    (Among 856 cases of hepatotoxicity enrolled in the Spanish DILI Registry between 1994 and 2016, 32 were attributed to herbal products, the most frequent cause being green tea [n=8] and Herbalife products [n=6], while none were attributed to bee products).
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  • Afsharpour F, Javadi M, Hashemipour S, Koushan Y, Haghighian HK. Propolis supplementation improves glycemic and antioxidant status in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled study. Complement Ther Med. 2019;43:283–288. [PubMed: 30935545]
    (Among 60 patients with diabetes treated with propolis [500 mg] or placebo 3 times daily for 2 months, fasting glucose and HbA1c levels improved in the propolis treated group but not in controls; adverse events were not reported).
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    (56 year old Chinese woman developed two episodes of anaphylaxis with urticaria, pruritus, laryngeal edema, hypotension and collapse within 1 hour of consuming royal jelly and was found to have a positive skin prick test to crude extracts of royal jelly; immunoblotting with her serum identified evidence of antibodies to purified royal jelly protein 3).
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    (Among 367 cases of hepatotoxicity enrolled in the Latin American DILI Network between 2011 and 2019, 29 [8%] were attributed to herbal products, the most frequent being green tea [n=7], Herbalife products [n=5] and garcinia [n=3] while none were attributed to bee products).
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