Royal jelly is secreted from glands in the hypopharynx of worker bees and is used to nourish larvae and the queen bee. It is composed of water, crude protein, amino acids, simple sugars, and fatty acids. It also contains trace amounts of minerals and enzymes. Royal jelly has been applied topically to oral mucositis in patients undergoing chemotherapy and radiation therapy.
Erdem, O., & Gungormus, Z. (2014). The effect of royal jelly on oral mucositis in patients undergoing radiotherapy and chemotherapy. Holistic Nursing Practice, 28, 242–246.
To determine the efficacy of royal jelly on oral mucositis in patients receiving chemotherapy and radiation
Patients were divided into two groups. All patients received benzydamine hydrochloride and nystatin rinses. In the experimental group, royal jelly was swished orally for 30 seconds and then swallowed twice per day for a total of 1 g per day. Patients could not eat or drink within 30 minutes of using the royal jelly. Both groups used the mouthwash protocol or mouthwash protocol plus royal jelly until mucositis was resolved. All participants and assessors were blinded to group. Oral mucosa was divided into five sites—labial mucosa, buccal mucosa, gingivae, tongue, and soft and hard palates—and the mucositis score was determined daily by a trained researcher for each site until no further evidence of mucositis existed.
No statistical difference was seen in mucositis severity at the beginning of the study between the two groups. For grade 1 mucositis, the mean number of days to healing in the royal jelly group was 1.1 days, and in the control group it was 2.7 days (U = 64; p = 0.0001). For grade 2 mucositis, the mean number of days to healing in the control group was 5.8 days, and in the experimental group it was 3 days (U = 77; p = 0.0001). For grade 3 mucositis, those in the experimental group had a faster healing time than those in the control group (U = 59; p = 0.005).
The addition of royal jelly to a mouthwash protocol with benzydamine and nystatin rinses significantly decreased the healing time for grade 1, 2, and 3 oral mucositis.
Royal jelly should be considered as an additional intervention to promote the healing of oral mucositis caused by chemotherapy and radiation. Royal jelly, in addition to a mouthwash protocol consisting of a benzydamine and nystatin rinse, effectively reduced the number of days to complete healing of oral mucositis. The sample in this study included a wide variety of cancer types as well as a wide range of types of chemotherapy and number of chemotherapy cycles.
Yamauchi, K., Kogashiwa, Y., Moro, Y., & Kohno, N. (2014). The effect of topical application of royal jelly on chemoradiotherapy-induced mucositis in head and neck cancer: A preliminary study. International Journal of Otolaryngology, 2014, 974967.
To test the effectiveness of royal jelly on the prevention of mucositis in patients with head and neck cancer receiving chemotherapy and radiation
The royal jelly (RJ) was collected from the species Apis mellifera with a primary diet of nectar and pollen from flowers in China. Patients in the intervention group applied 1 g of royal jelly three times per day for the duration of radiation treatment (RT), and patients in the control group did not apply royal jelly. Data were collected during radiation twice per week and one month after radiation was complete.
Randomized, single-blinded (physician-blinded) trial
In the control group, 100% (six) patients experienced grade 3 oral mucositis at the end of radiation compared to the 71.4% (five) who experienced grade 3 in the RJ group and the 28.6% (two) who experienced grade 2 mucositis in the RJ group. RJ delayed the progression to grade 2 mucositis (19 ± 4.1 days in the RJ group, 25.9 ± 9.6 days in the control group, p < .001). RJ also significantly delayed the progression to grade 3 mucositis (37.4 ± 11.8 days in the RJ group, 31 ± 5.8 days in the control group, p < .001).
The results of this study suggest that the topical application of RJ is effective in preventing accelerated mucositis induced by chemoradiotherapy.
Chemoradiotherapy for head and neck cancer continues to cause significant mucositis, which is debilitating and can impact nutritional status, comfort, and often patients' ability to complete therapy without treatment breaks. The topical administration of RJ offers one intervention that could improve this side effect; however, further studies are needed to support these findings.