D2.229 - Hypersensitivity reactions associated with the use of food supplements containing propolis. Analysis of observations reported to the French National Agency for Food, Environmental and Occupational Health Safety (Anses)

The nutrivigilance system set up by the French National Agency for Food, Environmental and Occupational Health Safety (Anses) investigates reports of adverse reactions (ARs), especially those linked to the consumption of food supplements (FS) (1).

Objectives : To analyse hypersensitivity-type ARs linked to the consumption of FS containing propolis.

Reported cases were analyzed by expert physicians and pharmacists. Severity was graded from S1 (mild) to S3 (severe) with or without life-threatening reaction (LTR). The imputability of FS in the occurrence of reactions was graded from I0 (excluded) to I4 (very likely). In this study, only cases with an imputability greater than I2 (possible) were selected.

114 cases of ARs linked to the consumption of FS containing propolis have been reported since 2009. 22 were included according to the selected criteria. Among those, 14 ARs occurred after an ingestion of FS: 2 anaphylaxis (S3 with LTR) (1 in an individual with atopic disorder, 1 with Kounis syndrome), 1 lingual angioedema (S3 with LTR) in an individual with an atopic background, 1 immediate skin rash (S1), 10 delayed reactions: 6 skin rashes (S1 or S2), 1 glossitis (S3), 3 angioedema (S1 or S2).

8 ARs occurred after using a mouth spray with an alcoholic propolis solution: 6 immediate pharyngolaryngeal reactions (S2) in subjects suffering from asthma or atopic disease (4 pollinosis), 2 rashes (S1): 1 immediate and 1 delayed reactions.

These observations draw attention to 3 immediate life-threatening reactions after ingestion of FS containing propolis (14% of cases), while cases of life-threatening anaphylaxis reported in the literature are rare (3, 4), and to the frequency of immediate reactions of the upper airways by pharyngeal spraying (27% of cases) in cases of asthma or atopic background. Hypersensitivity reactions linked to the use of FS containing propolis stresses the need to take precautions in their use.

References:

1. Anses : nutrivigilance https://.anses.fr/fr/content/tout-savoir-sur-le-dispositif-de-nutrivigilance
2. Anses : nutrivigilance video abstract
3. Menniti-Ippolito et al. Surveillance of Suspected Adverse Reactions to Natural Health Products. The Case of Propolis. Drug Safety 2008
4. Jarlot Chevaux et al. Anaphylaxie alimentaire aux produits de la ruche. Rev Fr. Allergol. 2022