[Complementary or alternative medicine in oncology : Chances or risks?] / Komplementäre oder alternative Medizin in der Onkologie : Chancen oder Risiken?

BACKGROUND: Approximately half of all cancer patients use complementary or alternative medicine. AIM: The results of the German S3 guidelines on complementary oncology are presented and placed into the context of patient consultation. MATERIAL AND METHODS: The core recommendations of the S3 guidelines are summarized including an overview of the evidence. RESULTS: Selected methods of complementary medicine can be used with the aim of improving the quality of life and reducing side effects. Comprehensive data are available for physical activity with respect to survival, quality of life and supportive therapy. For most other methods the evidence is relatively low. Therefore, weighing up the benefits and risks more frequently resulted in negative recommendations in the guidelines, especially for methods based on substances. Exceptions to this are three micronutrients (vitamins B12, D and selenium), as even in the case of a well-balanced diet, deficiency symptoms are possible. Therefore, routine measurement of the blood levels of these micronutrients is recommended. CONCLUSION: The questions from patients on what they can do by themselves should be answered respectfully and based on evidence. The benefits and risks of complementary methods must be carefully considered. To do this, regular questioning of patients on the interest in complementary methods is recommended. The decisive benefit of complementary medicine is the chance for patients to become active themselves. Therefore, all recommendations refer to the discussion with the patient, which do not formulate a therapy but are consultation recommendations: should be recommended instead of should be done.

A Systematic Review of the Benefit of B-Vitamins as a Complementary Treatment in Cancer Patients.

B-vitamins act as enzymatic co-factors in immune functions, therefore they are considered to reduce chemotherapy-induced side effects in cancer patients. We conducted a systematic search, screening five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies on the effectiveness and potential harm of B-vitamin therapy on cancer patients. Out of the 7465 search results, 11 RCTs about vitamin B6, B12 and B-vitamins in combination were included in this systematic review. A total of 1546 patients with diverse types of cancer were evaluated. Overall, most studies were of acceptable quality and reported consistent results. Studies examining the effectiveness of vitamin B6 reported that there is no significant impact on decreasing the incidence and severity of chemotherapy-induced side effects (e.g., hand-foot syndrome), the necessity of chemotherapy dose-modifications or improving patients' quality of life, tumor response/progression, and overall survival. Two studies reported that vitamin B12 could be effective in the alleviation of symptoms resulting from chemotherapy; it might decrease motor, sensory and pain symptoms of peripheral neuropathy. However, a combination of B vitamins may not reduce the incidence of chemotherapy-induced peripheral neuropathy. All in all, the evidence on B-vitamins in cancer patients is low and supplementation cannot be recommended.

Impact of patients' refusal to undergo adjuvant treatment measures on survival.

PURPOSE: Breast cancer patients receive treatment recommendations from multidisciplinary tumour boards. To determine the consequences of patients' refusal of such recommendations, we analysed the database of the Centre for Breast Cancer at the Ortenau Clinic in Offenburg, Germany. METHODS: A total of 4315 patients with non-metastatic primary breast cancer, treated between 1997 and 2019, were analysed with descriptive analyses, Kaplan-Meier survival analyses, and Cox regression analyses regarding the effects of their refusal. RESULTS: About 10.7% of the patients rejected the treatment advice. These were significantly elderly (F = 74.4; p < 0.001; one-way ANOVA), with greater tumour size (F = 36.7; p < 0.001; one-way ANOVA), a higher number of affected lymph nodes (F = 4.2; p = .039; one-way ANOVA), and more poorly differentiated tumours (χ2 = 16.8; df = 2; p < 0.001). The refusal of adjuvant treatment resulted in higher rates of local recurrences (χ2radiotherapy = 109.1; df = 1; p < 0.001, χ2chemotherapy = 18.3; df = 1; p < 0.001, χ2endocrine = 32.5; df = 1; p < 0.001) and poorer overall survival (χ2radiotherapy = 184.9; df = 6; p < 0.001; χ2chemotherapy = 191.8; df = 6; p < 0.001). CONCLUSIONS: All parts of the adjuvant treatment of breast cancer are clearly associated with improvements regarding disease-free and overall survival. To answer open questions about the background of patients' refusal, an analysis of prospective data collections seems necessary. In addition, patient communication should be improved so that patients understand the background of the multidisciplinary tumour board and the potential consequences of their refusal.

A Pilot Study of Side Effects of Cancer Therapies and their Impact on Satisfaction with Life.

This survey aimed at getting a first insight into diverse side effects and their association with satisfaction with life as well as the use of complementary and alternative medicine (CAM) in cancer patients. A total of 100 patients in a German University Hospital were included. General side effects like fatigue, fever, headache, limb pain and sleep disorders had a significant influence on the patients' satisfaction with life (p = .034 and p = .032, respectively). Concerning CAM, we could not detect any association between the frequency of side effects and the use of CAM. Improving the treatment of side effects may have a strong impact on patients' satisfaction with life.

Complementary and alternative medicine (CAM) in obstetrics and gynaecology: a survey of office-based obstetricians and gynaecologists regarding attitudes towards CAM, its provision and cooperation with other CAM providers in the state of Hesse, Germany.

PURPOSE: Whereas we have some information on complementary medicine in the field of oncology, little is known about complementary medicine in the field of obstetrics and gynaecology especially outside of hospitals. METHODS: All office-based obstetricians and gynaecologists in the state of Hesse, Germany, were contacted and asked to fill in an assessment form regarding cooperation in the field of complementary and alternative medicine (CAM), as well as the perceived efficacy of various CAM methods for a number of pathological conditions in the field of obstetrics and gynaecology. RESULTS: It was found that more than half of Hessian office-based obstetricians and gynaecologists had existing cooperation regarding CAM, especially with colleagues, but also midwives, pharmacists, physiotherapists, and health practitioners. The probability of cooperation was significantly inversely associated with age. It was found that the probability for advising CAM differed between various health problems. The following CAM methods were considered reasonable for the treatment of different conditions: phytotherapy for climacteric complaints and premenstrual syndrome; homoeopathy for puerperal problems; acupuncture and traditional Chinese medicine for complaints during pregnancy; and dietary supplements for the side effects of cancer therapy. CONCLUSIONS: The analysis shows that there is much cooperation in the field of CAM. Comparison between physicians' perceived efficacy of CAM methods and objective findings shows that there is a need for the provision of valid information in the field.

Patients with advanced cancer and their usage of complementary and alternative medicine.

PURPOSE: A total of 40 % of cancer patients use complementary and alternative medicine (CAM), and patients with advanced cancer use CAM more often than others. The aim of our study was to gather data on CAM use and reasons to use CAM of patients with advanced cancer being admitted for residential palliative care and their relatives. METHODS: Structured interviews were carried out with 25 patients and 25 relatives of those patients, respectively, of a German comprehensive cancer center based on a standardized questionnaire of the working group Prevention and Integrative Oncology of the German Cancer Society. RESULTS: Median age of patients was 64.5 years (relatives: 53.5); 15 patients were male and 10 were female (relatives: 7 and 18). In total, 40 % of all patients used some CAM method at the time of the study, supplements and prayer being the most frequent method. Main reasons for using CAM were to sustain one's own strength (52 % for patients and 72 % for relatives) and to be able to do something by oneself (36 and 40 %). Sources of information were television/radio (48 and 28 %) and family/friends (40 and 48 %). Relatives also use the Internet (40 %). CONCLUSIONS: Also for patients in palliative care and their relatives, CAM is important. Reasons for using CAM are similar for patients with less advanced cancer. As most patients do not discuss using CAM with their physician, side effects and interactions of biologically based treatments may be dangerous. The desire of patients to act autonomously should be encouraged. Yet, physicians should ensure safe administration of complementary methods by including CAM in their communication with the patient and the family.

[Information on complementary and alternative medicine at homepages of German cancer self-help]. / Informationen zur komplementären und alternativen Medizin auf den Internetseiten deutscher Selbsthilfegruppen für Tumorpatienten.

INTRODUCTION: Complementary and alternative medicine (CAM) is important for cancer patients. The internet has a rising relevance of source of health information. Patient set strong confidence in websites from patient advocacy groups. The websites of German patient advocacy groups were analysed regarding information on CAM. METHODS: An analysis on the homepages of the most important self-help organizations for cancer patients in Germany was performed. A descriptive analysis of the contents at a cutoff date (20.12.2011) listing the contents was done using an instrument based on the HonCode criteria. RESULTS: The homepages of the self-help groups are heterogeneous concerning CAM. Only few sites provide more information. The differences between the self-help groups do not correlate with the known user rate of patients with different kinds of cancer. Most homepages dealing with the topic also point to the associated problems of side effects and interactions. All homepages make a clear difference between information and opinion. Influences from outside were not detected. CONCLUSION: In spite of a high number of patients using CAM the topic is only infrequently represented on the homepages. This could be due to difficult and contradictory data on KAM. As websites of patient advocacy are well suited to provide information on CAM the patient version of a S3 guideline in the German national guideline program in oncology could provide a fundament.

Male and Female Physicians in Hospital Gynaecology Departments - Analysis of the Impact of "Feminisation" from the Viewpoint of Medical Directors.

Introduction: At present the topic "feminisation" in medicine, in other words the increasing number of female staff members is under heavy discussion; however, there are only few data upon the basis of which a scientific discussion can be held. The question arises as to the possibility of problems arising therefrom for the specialty gynaecology and obstetrics. Methods: With the help of a questionnaire the directors of departments of gynaecology and obstetrics were questioned about the various aspects of the topic feminisation in gynaecology and obstetrics. Results: Among current applications the proportion of female applicants is estimated to be 84.2 %. Reasons given most frequently for the feminisation in the specialty include low income, loss of face of the medical profession and the poor career chances. Among the spontaneously mentioned reasons were the increasingly female dominated image of gynaecology and the working conditions in hospitals. Whereas the taking on of surgical duties and of directing functions was less markedly desired by women than by men, the questioned directors found that male and female staff members were equally motivated to take on duties outside of their working hours or to engage in research work. Discussion: Feminisation in medicine represents a challenge. It seems to be important to evaluate and investigate the motivation of staff members with regard to their wishes in professional life and thus to be able to offer an appropriate working environment based on the survey results.

Small Cell Ovarian Carcinomas - Characterisation of Two Rare Tumor Entities.

Objective: Small cell ovarian carcinomas (SCOC) are differentiated into two types: hypercalcaemic (SCOCHT) and pulmonary (SCOCPT). Unfortunately, little is known about pulmonary-type small cell ovarian carcinoma. Study Design: We carried out a systematic analysis of all available reports in the literature on individual cases of SCOCHT and SCOCPT. Results: We found that patients with SCOCPT were significantly older than those with SCOCHT. Vimentin and chromogranin detection by immunohistochemistry allow good differentiation between the two types. Interestingly, SCOCPT but not SCOCHT was found to be associated with other benign and malignant ovarian tumours in about 44 % of cases. Although the percentage of R0/R1 resections was high (~ 74 %), survival was poor; even in patients with disease limited to the ovaries (stage Ia and Ib) the recurrence rate was 40 %. Chemotherapy with etoposide or anthracyclines could be useful. Conclusion: Taking the limitations of our study such as its retrospective nature into account and based on the results from studies of small cell carcinomas originating from other tumour sites, we conclude that treatment of SCOCPT should be based on the therapies used to treat other small cell carcinomas. Surgery is appropriate, especially in very early stages of disease, but chemotherapy should not be omitted. Newer concepts such as treatment with somatostatin analogues could help to control symptoms and stabilise some slow-growing tumours.

How are Interactions Taken into Account in Studies on Conventional and Complementary Therapies for Breast Cancer Patients with Menopausal Complaints?

Introduction: Postmenopausal symptoms in breast cancer patients undergoing antihormone treatment lead to high drop-out rates from the therapy. From the therapeutic point of view, methods of both conventional and complementary medicine are concerned. Interactions are being discussed in cases of natural substances. However, they are also relevant for conventional medical substances. The aim of this analysis is to answer the question as to what extent potential interactions are taken into account in clinical studies and reviews on supportive therapies. Materials and Methods: Clinical studies and reviews were identified by means of a systematic search and analysed with regard to the consideration of potential interactions. Results: Altogether 46 clinical studies and one Cochrane review were found. Among the 35 studies on conventional drug therapies, 5 (14 %) took possible interactions into account. Among the 17 studies on complementary medicine, there were 2 (11.7 %) such publications. The Cochrane review did not mention interactions. Discussion: For future studies in which interactions cannot be excluded, a strategy to control for their clinically relevant consequences should be developed. The present authors suggest that the use of survival and recurrence data as secondary endpoints, also for studies on purely supportive therapies, is a reasonable approach. The resulting considerations for study routines are listed thematically.

Consumption of rapeseed honey leads to higher serum fructose levels compared with analogue glucose/fructose solutions.

BACKGROUND: Studies suggest that honey has less influence on serum glucose concentrations than monosaccharides and disaccharides. Previous studies, however, have only analysed glucose metabolism. METHODS: This study investigated the influence of two types of honey (rapeseed and acacia) on the serum levels of glucose, fructose, insulin and C-peptide values in healthy subjects. The results were compared with honey-comparable glucose-fructose solutions. All solutions contained 75 g of glucose and/or fructose. RESULTS: We found significantly higher fructose serum levels with rapeseed honey after 2 h but no such differences for acacia honey. C-peptide levels were significantly higher after administration of both honeys after 1 and 2 h. CONCLUSIONS: For the first time it has been found out that honey ingestion leads to a rise of blood fructose concentration: in one case, this rise was lower than that achieved after fructose/glucose controls, in the other cases it was same as after the controls. Fructose metabolism may be inhibited by unidentified substances present in the rapeseed honey. Further study to elucidate underlying mechanisms may be worthwhile, as usually there is no differentiation between the different types of honey.

Transvaginal NOTES with semi-rigid and rigid endoscopes that allow adjustable viewing angles.

PURPOSE: To evaluate semi-rigid and rigid endoscopes for transvaginal NOTES surgery. METHODS: One rigid endoscope (EndoCAMeleon, KARL STORZ GmbH & Co. KG, Tuttlingen Germany) and one semi-rigid endoscope (EndoEYE LTF-VH, Olympus Deutschland GmbH, Hamburg, Germany) that allow adjustable viewing angles have been used during four transvaginal gynecological NOTES procedures for chronic pelvic pain and infertility. RESULTS: Feasibility of transvaginal access to enter the abdominal cavity was shown. Posterior peritoneum, ovaries and tubal patency were evaluated. The evaluated endoscopes did not overcome the inability to explore the anterior pelvic structures. CONCLUSIONS: Rigid and semi-rigid endoscopes that allow adjustable viewing angles during transvaginal NOTES approaches cannot explore the whole pelvic anatomical structures.

Establishing transvaginal NOTES for gynecological and surgical indications: benefits, limits, and patient experience.

Gynecologists have been performing transvaginal surgery for over a century and consequently the transvaginal approach was advocated for establishing natural orifice transluminal endoscopic surgery (NOTES) in gynecological and surgical practice. From 2008 the NOTES alternative has been offered to selected patients. Transvaginal cholecystectomies were intended in 13 patients and completed in 12. Various additional procedures were performed. All surgical procedures and postoperative courses were uneventful. The mean operating time for transvaginal cholecystectomy only was 88.4 minutes (standard deviation [SD] 17.3). A questionnaire was posted to the patients after a mean follow-up of 8.5 months. Patients primarily chose transvaginal NOTES because of the lack of scarring. Vaginal sensation was not affected. Patients perceived transgastric, transvesical, and transrectal surgery to be less acceptable approaches. The feasibility of transvaginal NOTES was proven for different indications. Patients' experiences and perceptions concerning transvaginal NOTES were excellent.

Prognostic role of platinum sensitivity in patients with brain metastases from ovarian cancer: results of a German multicenter study.

BACKGROUND: Ovarian cancer is the leading cause of death in women with gynecological malignancies. Brain metastases are considered an uncommon metastatic site. Only few data exist on prognostic factors for this patient collective. PATIENTS AND METHODS: A multicenter retrospective chart review was carried out including all patients with histologically confirmed ovarian cancer from six different German hospitals from 1981 to 2008. Overall, 4277 cases of patients with ovarian cancer were screened and patients with brain metastasis were identified and analyzed regarding various clinical variables and survival. RESULTS: A total of 74 women with brain metastases were identified, resulting in an incidence of 1.73%. In multivariate analysis, the following clinical parameters had a significant impact on overall survival: multiple lesions [hazard ratio (HR) 4.4, 95% confidence interval (CI) 2.0-9.7] and low grading (HR 3.1, 95% CI 1.7-5.8) were associated with a negative impact. Platinum sensitivity (HR 0.23, 95% CI 0.12-0.48) was significantly associated with a favorable outcome. Good performance status (60%-80% HR 0.48, 95% CI 0.23-0.99 and 90%-100% HR 0.21, 95% CI 0.08-0.53) also had a positive impact on overall survival. CONCLUSIONS: Platinum sensitivity is the most important prognostic factor in patients with ovarian cancer metastatic to the brain. This novel finding should be considered in the strategy of multimodal therapy for brain metastases in ovarian cancer.

Efficacy of venom immunotherapy in beekeepers.

INTRODUCTION: We previously found that some beekeepers continue beekeeping even after experiencing systemic allergic reactions. The present study was performed to collect data on the experience of beekeepers who underwent desensitization and continued beekeeping. The results are important for future counseling in this group of patients, and they show the effectiveness of desensitization under real conditions. METHODS: With the help of German and American beekeeping journals, we asked beekeepers who had undergone desensitization to participate. Data were obtained using a newly developed questionnaire and supplemented by reports obtained from the physicians who treated the allergy. RESULTS: We sent a questionnaire to each of the 73 beekeepers who responded to our call, and 63 (86.3%) questionnaires were returned. The vast majority of participants were hobby beekeepers who developed signs of allergy after a median of 2 years' beekeeping (mean, 4.27 years) and a median of 15 stings (mean, 51 stings). Additional allergies were reported by 35 beekeepers. Forty-three beekeepers were evaluated to determine the effectiveness of desensitization. The average number of bee stings after desensitization was 107 (median 18). All but one reported no longer having allergic responses; however, in the case of those that did, the severity of the allergic symptoms improved significantly. CONCLUSION: To our knowledge, this study is the first to provide data on the experience of beekeepers who continue their activity after desensitization. Our results show that desensitization can result in a complete absence of symptoms after re-exposure to bee stings.

Contact allergy to propolis in beekeepers

Background: Allergy to propolis seems to be rare and little is known about it. Objective: The aim of the study was to survey a subset of affected beekeepers to determine aspects such as time of onset of disease, comorbidity, and possible methods of prevention. Methods: With the help of two German journals for beekeepers we contacted 41 beekeepers with propolis allergy. They were sent a questionnaire which assessed several aspects of the disease and was based on the current literature. Results: 70.7% returned our questionnaire and had clear signs of propolis allergy with positive testing by their local allergologists. They reported that allergy had developed after an average of 9.5 years beekeeping. We also found a high prevalence of other allergies (72.4%). Interestingly, there were also systemic reactions to propolis in some beekeepers but not necessarily when using propolis as a medication against other diseases. Beekeepers believed that solvents used to clean the hands could play a role in the development of the disease. Conclusion: This study provides new insights into allergy to propolis. The hypothesis that solvents used to clean the hands could play a role in the development of the disease should be addressed in future studies (AU)

Contact allergy to propolis in beekeepers.

BACKGROUND: Allergy to propolis seems to be rare and little is known about it. OBJECTIVE: The aim of the study was to survey a subset of affected beekeepers to determine aspects such as time of onset of disease, comorbidity, and possible methods of prevention. METHODS: With the help of two German journals for beekeepers we contacted 41 beekeepers with propolis allergy. They were sent a questionnaire which assessed several aspects of the disease and was based on the current literature. RESULTS: 70.7% returned our questionnaire and had clear signs of propolis allergy with positive testing by their local allergologists. They reported that allergy had developed after an average of 9.5 years beekeeping. We also found a high prevalence of other allergies (72.4%). Interestingly, there were also systemic reactions to propolis in some beekeepers but not necessarily when using propolis as a medication against other diseases. Beekeepers believed that solvents used to clean the hands could play a role in the development of the disease. CONCLUSION: This study provides new insights into allergy to propolis. The hypothesis that solvents used to clean the hands could play a role in the development of the disease should be addressed in future studies.

Allergy to bee venom in beekeepers in Germany.

OBJECTIVE: The aim of this study was to determine the incidence of bee venom allergy in German beekeepers, to explore risk factors for bee venom allergy in this group, and to determine which factors best predicted severe reactions. METHODS: A questionnaire incorporating 2 instruments on beekeepers' physical and mental health and working practice was included in 3 German beekeeping journals. A reference group also completed the questionnaire. Simple descriptive methods, bivariate correlation, cross-tabulation, 1-way analysis of variance, and stepwise discriminant analysis were used to analyze data. RESULTS: Altogether, 1053 questionnaires were returned. No significant differences were seen between the 2 groups. The mean number of bee stings annually was 57.8 (median, 30; range, 0-1000). Overall, 46 (4.4%) beekeepers reported systemic reactions to bee stings, 797 (75.6%) had mild local reactions, and 196 (18.6%) had no reactions. The study confirmed several risk factors. These were, in descending order of importance, symptoms of upper respiratory allergy while working on the hive, presence of other allergies, time spent as a beekeeper, and more severe nonallergic reactions to bee stings in springtime. These factors identified beekeepers at risk of allergic reactions to bee venom in 85.2% of cases. Our results also showed an association between allergy and emotional instability. Risk management in allergic beekeepers was not good. CONCLUSION: The results of this study will help to identify beekeepers at risk of systemic reactions to bee stings and to inform them about the dangers of bee venom allergy.

Contact allergy to propolis in beekeepers.

BACKGROUND: Some toothpastes, cosmetics and ointments contain propolis, a bee product, and it is increasingly popular as a dietary supplement. Although propolis is known to cause contact allergy, there have been no studies of the prevalence of this. OBJECTIVES: This study aimed to determine the prevalence of contact allergy to propolis in beekeepers and any relationship between propolis allergy and environmental and physical and mental health characteristics in this group. SUBJECTS AND METHODS: A specially developed instrument which included a validated questionnaire on emotional stability was included in the issues of three German beekeeping journals sent to subscribers in a number of regions (potential readership 35,000). A reference group also completed questionnaire. RESULTS: 1051 questionnaires were returned and 37 cases of allergic reactions to propolis were reported (3.6%). Only 10 of the 37 (27%) beekeepers had recognised the allergy before participating in this study. Propolis contact allergy was significantly associated with lung diseases and other allergic reactions. Only some affected beekeepers protected their hands more while working with bees and showed significantly greater emotional instability than those not sensitised to propolis. CONCLUSIONS: Contact allergy to propolis is common among beekeepers, but they do not seem to recognise the problem or protect themselves properly.

Contact allergy to propolis in beekeepers / Alergia de contacto al propolis en apicultores

Background: Some toothpastes, cosmetics and ointments contain propolis, a bee product, and it is increasingly popular as a dietary supplement. Although propolis is known to cause contact allergy, there have been no studies of the prevalence of this. Objectives: This study aimed to determine the prevalence of contact allergy to propolis in beekeepers and any relationship between propolis allergy and environmental and physical and mental health characteristics in this group. Subjects and methods: A specially developed instrument which included a validated questionnaire on emotional stability was included in the issues of three German beekeeping journals sent to subscribers in a number of regions (potential readership 35,000). A reference group also completed questionnaire. Results: 1051 questionnaires were returned and 37 cases of allergic reactions to propolis were reported (3.6 %). Only 10 of the 37 (27 %) beekeepers had recognised the allergy before participating in this study. Propolis contact allergy was significantly associated with lung diseases and other allergic reactions. Only some affected beekeepers protected their hands more while working with bees and showed significantly greater emotional instability than those not sensitised to propolis. Conclusions: Contact allergy to propolis is common among beekeepers, but they do not seem to recognise the problem or protect themselves properly

Antecedentes. Algunas pastas de dientes, cosméticos y pomadas contienen propolis, un producto de las abejas, que esta teniendo un popular incremento como suplemento alimenticio. Aunque el propolis es conocido como causante de alergia de contacto, no hay estudios sobre la prevalencia de esto. Objetivos. Este estudio está dirigido para determinar la prevalencia de la alergia de contacto al propolis en apicultores y la relación entre alergia al propolis y ambiente, y las características físicas y mentales de este grupo. Controles y métodos. Un instrumento especialmente desarrollado que incluía un cuestionario validado sobre estabilidad emocional, se incluyó en la edición de tres revistas Alemanas de apicultores, enviado a los suscriptores de un número de regiones (35.000 potenciales lectores). El cuestionario también lo completó un grupo de referencia. Resultados. Retornaron 1.050 cuestionarios que reportaron 37 casos de reacciones alérgicas a propolis (3,6%). Sólo 10 de los 37 (27%) apicultores habían reconocido la alergia antes de participar en este estudio. La alergia de contacto al propolis estuvo asociada significativamente con enfermedad pulmonar y otras reacciones alérgicas. Solamente algunos apicultores protegían sus manos cuando trabajaban con las abejas y mostraron una mayor significativa inestabilidad emocional que los no sensibilizados al propolis. Conclusiones. La alergia por contacto al propolis es común entre apicultores, pero ellos no parece que reconozcan el problema y se protejan adecuadamente