A recent review and meta-analysis asks whether honey is an effective treatment for a cough and other symptoms of upper respiratory tract infections. Overall, the authors conclude, honey is “superior to usual care for the improvement of symptoms.” However, because data are sparse, questions remain.

Upper respiratory tract infections (URTIs), including the common cold, are highly prevalent.

According to the scientists behind the recent review, which appears in the journal BMJ Evidence-Based Medicine, URTIs are “the most frequent reason for antibiotic prescription.”

However, the majority of URTIs are viral, and antibiotics, therefore, cannot help. The rhinovirus alone accounts for an estimated 80% of all respiratory infections during peak seasons.

In the era of antibiotic resistance, a lack of effective treatments for URTIs is a pressing concern. The World Health Organization (WHO) consider antibiotic resistance to be “one of the biggest threats to global health, food security, and development today.” For this reason, there is an urgent need for alternative approaches to these and other infections.

The common cold is far from life-threatening, but treating it successfully could hinder the “slow-motion pandemic” of antibiotic resistance.

Could honey be the answer?

While enduring a cough or cold, many people seek solace in honey. Although this treatment is popular, scientific evidence of its effectiveness is largely lacking.

The recent systematic review and meta-analysis attempts to fill this gap in research.

To put honey through its paces, the team delved into existing findings. They selected relevant studies that involved humans of any age and in any setting. All of the included studies compared honey with at least one other intervention: no treatment, usual care, or a placebo.

In their analysis, the authors defined URTIs as “acute infections of the respiratory tract, including acute cough, colds, and influenza-like illness, but excluding bronchitis or other infections of the lower respiratory tract.”

Does honey work?

In all, the search for papers yielded only 14 relevant studies; of the 14, data from just 12 studies could be combined in a meta-analysis. Alongside the scientists’ data analysis, they also assessed each study’s risk of bias.

The results of the meta-analysis were generally positive but by no means conclusive. When attempting to assess the effects of honey versus a placebo, the authors write:

“Two of the three studies comparing honey with placebo indicated a beneficial effect of honey, but overall, we do not have a strong evidence base from comparisons of honey against matched placebo.”

However, when honey was compared with usual care, the results were slightly clearer. According to the authors, “Honey was associated with a significantly greater reduction in combined symptom score, cough frequency, and cough severity.”

The authors also conclude that, although the methods of usual care varied widely among the studies, they were all “similarly ineffective.”

A number of limitations

A range of factors hindered this study’s ability to draw firm conclusions. Overall, the problems did not concern the methods of this research, but the quality of the studies available for the team to analyze.

For instance, when they investigated the included studies’ risk of bias, nine of the 14 were at risk of at least one type of bias; and seven of those were at risk of more than one type of bias.

Aside from this, nine of the studies had only recruited children as participants, so the results might not apply to adults.

Also, a significant number of the included studies did not use pure honey: One used Honitus syrup, which has a honey base but includes herbs; two used Grintuss syrup, which is a cough suppressant that includes honey; two combined honey with coffee; and one combined honey, coffee, and milk.

Designing a placebo intervention also caused some difficulties. Researchers need to ensure that participants cannot tell whether they are receiving a placebo or the experimental intervention, which in this case was honey.

If the physical properties of honey help reduce symptoms, such as a cough, any similar compound might also soothe symptoms, making it a poor placebo.

Overall, the clearest point that this analysis makes is that we need to see more research before we can reach conclusions about honey and URTIs. Although URTIs are, in the global scheme of things, relatively mild, their relationship with antibiotic overprescribing makes honey worthy of further scrutiny.

And because honey is widely available, natural, and safe for most adults and children older than 1, if using it reduces the number of antibiotic prescriptions, it would be an all-around win.

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