A woman in Spain has achieved the sad distinction of becoming the first person known to have died as a consequence of undergoing acupuncture using bees.

The death is reported in the Journal of Investigational Allerology and Clinical Immunology, and raises questions about the safety of an increasingly popular field of alternative medicine, known as apitherapy.

The practice, which has a long tradition in Korea and China, often involves the application or consumption of bee products such as pollen and royal jelly in a quest to alleviate a wide range of symptoms. A recent literature analysis found that research into the effects of bee products is growing and spreading, with Brazil producing more papers on the subject than anywhere else.

The use of bee stings as a treatment method remains controversial, and evidence for its effectiveness is patchy.

A 2005 Korean study looked at the use of bee acupuncture to treat arthritis. The researchers, led by Jae-Dog Lee from Kyung Hee University, conducted a literature review and found a number of studies that reported anti-inflammatory and analgesic effects of bee stings in animal models.

They also found five human trials that showed the practice was effective for treating arthritis. However, they noted that none of the studies described were rigorous enough to meet baseline standards.

Hedging their bets somewhat, Lee and colleagues suggested that bee venom constituted “a promising area of future research”, but noted that there was “limited evidence” for its effectiveness.

Sometimes, too, people’s faith in the efficacy of bee stings stems from outcomes that are more apparent than real.

A case study presented earlier this year in the medical journal Cureus reported a hospital outpatient who claimed that the application of bee stings to her back cured persistent migraine.

The woman was examined by doctors at University Hospital in Ulm, Germany, who found that her back was covered in scars and lesions from the practice. Sadly, the doctors concluded that any relief gained was psychosomatic, and that the sting applications represented an extension of a long clinical history of self-harm stemming from mental illness.

There is no indication that the woman who died after bee sting acupuncture in Spain was mentally ill, or had a history of risky behaviours.

In the case report, doctors led by Paul Vazquez Revuelta of Ramon y Cajal University Hospital in Madrid report that the patient, 55, had been receiving bee acupuncture every four weeks for two years to relieve stress. She had no clinical record of disease or allergy.

During what turned out to be her final session, she suddenly developed wheezing and laboured breathing and lost consciousness. An ambulance was called. By the time it arrived she was in a coma.

Despite desperate efforts at the hospital she died several weeks later, of multiple organ failure.

“To our knowledge,” write Vazquez Revuelta and colleagues, “this is the first reported case of death by bee venom apitherapy due to complications of severe anaphylaxis in a confirmed sensitised patient who was previously tolerant.”

The doctors urge a change to regulations in Spain (and, by extension, elsewhere) to ensure that apitherapy patients are made fully aware of the potential dangers of the practice, and that apitherapy practitioners – who often do not have medical backgrounds – are fully trained in rapid allergy responses.

Given that this is likely not possible, however, the doctors conclude that bee acupuncture “is both unsafe and unadvisable”.