venom’s anti-nociceptive effects were found to be mediated though alpha-2 adrenoceptors [6]. At the same time, it is also well known that bee venom can inflict severe compli- cations such as anaphylaxis [7]. We cannot be entirely sure of the role of bee venom in our patient because rechallenge experiments could not be done. Also, the possibility of having an underlying infection as a precipitating factor cannot be totally refuted. However, considering the temporal sequence of the patient’s clinical history, it is likely that a mild subclinical level of lupus activity must have been ongoing, and it seems very likely that the venom triggered the borderline disease into a full-blown onset of overt lupus. As there was no microbial evidence except oral candidiasis and no response to antimicrobial therapy, the influence of infection (if any) seems to be small. There are very few reports of lupus triggered by bee stings, with only one report of subacute cutaneous lupus that was triggered by a wasp sting [8]. Our case is noteworthy for this as well. It should be noted that the patient’s IgE levels were high. As mentioned above, lupus is traditionally thought to be related to Th2 immunity, which is also associated with allergic diseases. There is evidence that the IgE levels correlate with lupus activity [9], so it may be postulated that the bee venom induced an immune response that most likely involved Th2, and this tipped the balance to the full development of lupus. Since no venom-specific antibodies were detected, the precise mechanism could not be clearly defined. In conclusion, although bee venom therapy may be effective, taking a careful pre-treatment history and clinical evaluation must be done before starting treatment. It also should be noted that bee venom therapy may cause a flare-up of lupus, and this can happen in previously diagnosed patients, so prudence is needed before treating such patients. Rho YH, et al. Bee Venom and SLE 285 REFERENCES 1. Arend WP, Gabay C. Cytokines in the rheumatic diseases. Rheum Dis Clin North Am 2004;30:41-67, v-vi. 2. Lee JD, Park HJ, Chae Y, Lim S. An Overview of Bee Venom Acupuncture in the Treatment of Arthritis. Evid Based Complement Alternat Med 2005;2:79-84. 3. Panush RS. Honeybees and arthritis: sharpening perspective on a sticky issue. J Rheumatol 1988;15:1461-1462. 4. Kwon YB, Lee JD, Lee HJ, et al. Bee venom injection into an acupuncture point reduces arthritis associated edema and nociceptive responses. Pain 2001;90:271-280. 5. Park HJ, Lee SH, Son DJ, et al. Antiarthritic effect of bee venom: inhibition of inflammation mediator generation by suppression of NF-kappaB through interaction with the p50 subunit. Arthritis Rheum 2004;50:3504-3515. 6. Baek YH, Huh JE, Lee JD, Choi do Y, Park DS. Antinociceptive effect and the mechanism of bee venom acupuncture (Apipuncture) on inflammatory pain in the rat model of collagen-induced arthritis: Mediation by alpha2-Adrenoceptors. Brain Res 2006;1073- 1074:305-310. 7. Song HJ, Suh YJ, Yang YM, et al. Two cases of anaphylaxis due to bee venom acupuncture. J Asthma Allergy Clin Immunol 2002; 22:481-486. 8. Boehm I, Bieber T. Wasp-sting-triggered LE. Allergy 2001;56:87- 88. 9. Sekigawa I, Yoshiike T, Iida N, Hashimoto H, Ogawa H. Allergic diseases in systemic lupus erythematosus: prevalence and immunological considerations. Clin Exp Rheumatol 2003;21:117- 121.