By Martin S. Lipsky, MD

Chancellor, South Jordan Campus, Roseman University of Health Sciences, South Jordan, UT

Dr. Lipsky reports no financial relationships relevant to this field of study.

SYNOPSIS: In a meta-analysis, researchers found honey alleviates cough for patients with upper respiratory infections.

SOURCE: Abuelgasim H, Albury C, Lee J. Effectiveness of honey for symptomatic relief in upper respiratory tract infections: A systematic review and meta-analysis. BMJ Evid Based Med 2020; Aug 18;bmjebm-2020-111336. doi: 10.1136/bmjebm-2020-111336. [Online ahead of print].

Upper respiratory infections (URIs) are among the most common reasons for patients to visit their primary care providers. Despite evidence indicating antibiotics are ineffective, URIs also are the most common reason for physicians to prescribe an antibiotic.1 Unnecessary antibiotics expose patients to side effects and drive up both costs and antimicrobial resistance.2 A lack of effective alternatives may be one driving force behind these unnecessary prescriptions.

One possible alternative is honey. Long considered a “home remedy,” Abuelgasim et al systematically reviewed the literature for evidence related to the use of honey and its effectiveness for URI symptoms. They identified 14 randomized, clinical trials or in-vivo observational studies that compared honey of any type or administered in any way (either alone or in conjunction with other treatments) to at least one other group (either no treatment, placebo, or usual therapy) for treating URI symptoms. They found that compared with usual care, honey improved combined symptom scores (three studies, mean difference, -3.96; 95% CI, -5.42 to -2.51; I2 = 0%), cough frequency (eight studies, standardized mean difference [SMD], -0.36; 95% CI, -0.50 to -0.21; I2 = 0%), and cough severity (five studies, SMD, -0.44; 95% CI, -0.64 to -0.25; I2 = 20%).

They concluded honey was superior to usual care for the improvement of symptoms of URIs, but recommended further high-quality, placebo-controlled trials to confirm and assess the level of benefit.

COMMENTARY

Although personal anecdote and testimony is at the bottom of the evidence-based food chain, hot tea with honey is my personal go-to remedy when I have the “sniffles.” This study adds credibility to my belief in honey. Known for its antibacterial properties, the lay media touts several health benefits related to honey.3,4 This meta-analysis provides modest evidence supporting the use of honey to reduce the incidence of URI symptoms, especially for cough. One head-to-head study also revealed honey proved superior to dextromethorphan and diphenhydramine.5

How honey might work remains uncertain. In addition to its antimicrobial activity, it also seems to produce some antioxidant and antiviral activity.6,7 Eccles proposed honey’s natural sweetness causes reflex salivation and an increase in airway mucus, which might sooth the pharynx and larynx mucosa, thereby alleviating cough.8 He also suggested that closely related sensory nerve fibers that initiate cough and the gustatory nerve fibers that taste sweetness may produce the antitussive effects of sweet substances via a central nervous system mechanism.

Since there is little to offer those with URIs, honey represents a low-risk, inexpensive, and easily accessible alternative that seems reasonable to suggest to patients. Adding that honey is a natural remedy also may appeal to many patients. Not only may honey offer some benefit, it might reduce the use of unnecessary antibiotics. Two caveats: First, avoid giving honey to those younger than age 1 year because of the risk of infant botulism.9 Second, remember that honey largely is sugar, and that each teaspoon of honey contains about 15 calories.

REFERENCES

  1. Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: A cross-national database study. Lancet 2005;365:579-587.
  2. Ventola CL. The antibiotic resistance crisis: Part 1: Causes and threats. P T 2015;40:277-283.
  3. Berry J. What are the health benefits of raw honey? Medical News Today. April 17, 2019.
  4. Cleveland Clinic. The benefits of honey + how to incorporate it into your diet. Oct. 12, 2020.
  5. Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med 2010;16:787-793.
  6. Allen KL, Molan PC, Reid GM. A survey of the antibacterial activity of some New Zealand honeys. J Pharm Pharmacol 1991;43:817-822.
  7. Gheldof N, Wang XH, Engeseth NJ. Identification and quantification of antioxidant components of honeys from various floral sources. J Agric Food Chem 2002;50:5870-5877.
  8. Eccles R. Mechanisms of the placebo effect of sweet cough syrups. Respir Physiol Neurobiol 2006;152:340-348.
  9. Centers for Disease Control and Prevention. Infant botulism. Page last reviewed June 7, 2019.