Royal jelly is a milk-like secretion of honey bees that is used to feed larvae for 3 days for the worker bees and drones and until full development for the queen. Royal jelly has been used widely as a dietary supplement for its purported health prompting properties. Royal jelly is generally well tolerated and has not been linked to serum aminotransferase elevations during therapy or to instances of clinically apparent liver injury.


Royal jelly is a milk-like secretion of honey bees (Apis mellifera) that is used to feed larvae in the honeycomb. Larvae that are to develop into drones (males) or worker bees (infertile females) are fed directly and for 3 days only. Larvae that are to become queens (fertile females) are fed the royal jelly secretions in large amounts and until they are fully developed. Royal jelly is harvested from the individual queen bee cells in honey bee hives and used as an emollient in topical creams as well as a dietary supplement for purported medicinal properties. Royal jelly consists of water, proteins, amino acids, fatty acids, simple carbohydrates, vitamins and minerals. The active component that stimulates and modulates larval development is believed to be a series of “major royal jelly proteins” (MRJP). These MRJP alter DNA methylation resulting in an epigenic, nutritionally-driven change in expression of genes responsible for larva development. Royal jelly is used topically in creams and orally in dietary supplements purported to be beneficial for general health and well being. The bases of these claims have not been substantiated, but in vitro and animal studies suggest that components of royal jelly have antiinflammatory and antioxidant properties. Royal jelly is generally well tolerated without adverse events except for rare allergic reactions particularly in patients with a history of asthma or atopic disease. The hypersensitivity reactions can include urticaria, pruritus, erythema, laryngeal edema, wheezing, chest tightness, hypotension, cardiovascular collapse, and in rare instances death. The reactions arise within minutes of ingestion are most likely due to allergy to one of the major royal jelly proteins.

Other names: Jalea Real, Bee Saliva, Honey Bee Milk


Liver injury attributable to royal jelly has not been reported. In clinical trials of royal jelly as therapy of various conditions, side effects were rarely mentioned and ALT elevations and hepatotoxicity were not reported. Despite availability and widespread use as an alternative therapy, there have been no published reports of royal jelly induced liver injury.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Mechanism of Injury

Royal jelly has many components, but none of them has been shown to be particularly hepatotoxic.

Outcome and Management

Hepatotoxicity from royal jelly has not been reported.

Drug Class: Herbal and Dietary Supplements, Bee Products



Royal Jelly – Generic


Herbal and Dietary Supplements



References updated: May 1, 2022

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    (Review of hepatotoxicity of herbal and dietary supplements [HDS] published in 2007; no mention of royal jelly).
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    (Among 7 patients [6 women, 1 man, ages 19 to 66 years] with hypersensitivity reactions to oral royal jelly [in liquid and capsule forms] usually with acute severe attacks of asthma or anaphylaxis within minutes of ingestion, all had positive skin prick tests as well as IgE antibody that reacted with royal jelly protein extracts).
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    (28 year old man with long-standing asthma developed dyspnea, wheezing, cough and chest tightness shortly after ingesting royal jelly on two occasions was found to have a positive skin test to royal jelly).
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    (26 year old Japanese woman with a history of asthma, atopic dermatitis and food allergies developed anaphylaxis, generalized erythema and swelling of lips 5 minutes after ingesting a beverage of crude royal jelly with progressive respiratory distress requiring temporary intubation).
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    (In 20 healthy volunteers undergoing 2 glucose tolerance tests one week apart, the second after a single 20 gm dose of royal jelly, glucose levels were slightly lower after the royal jelly but insulin and C-peptide levels were similar).
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    (A 7 year old healthy child developed oral allergy symptoms on 2 occasions 10 minutes after ingestion of royal jelly with lip and tongue edema and palate itching).
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    (Among 110 female medical studies students with premenstrual syndrome treated with royal jelly capsules [1000 mg] or placebo once daily] for two menstrual cycles, symptoms decreased with royal jelly but not placebo; no mention of adverse events).
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    (Among 36 postmenopausal women treated with oral royal jelly [150 mg] daily for 3 months, serum HDL cholesterol levels increased [60 to 65 mg/dL] while LDL cholesterol decreased slightly [144 to 136 mg/dL]; no mention of adverse events or changes in serum ALT levels).
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    (Among 72 postmenopausal women treated with royal jelly [3000 mg daily] or placebo for 6 months, bone mineral density did not change in those receiving royal jelly but decreased to some extent in those on placebo; no mention of adverse events).
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  • Li JD, Cui L, Xu YY, Guan K. A case of anaphylaxis caused by major royal jelly protein 3 of royal jelly and its cross-reactivity with honeycomb. J Asthma Allergy. 2021;14:1555–1557. [PMC free article: PMC8866983] [PubMed: 35221696]
    (56 year old Chinese woman developed two episodes of anaphylaxis with urticaria, pruritus, laryngeal edema, hypotension and collapse within 1 hour of consuming royal jelly and was found to have a positive skin prick test to crude extracts of royal jelly; immunoblotting with her serum identified evidence of antibodies to purified royal jelly protein 3).
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    (Extensive review of the preclinical and clinical studies of honey bee products including royal jelly, beeswax and bee pollen; no mention of adverse event rates or hepatotoxicity).