The quality of evidence is downgraded by imprecise results (few patients and outcome events).
A Cochrane review [Abstract] 1 included 6 studies with a total of 899 children (age range 1 to 16 years) with acute upper respiratory tract infections. Honey was compared with dextromethorphan, diphenhydramine, salbutamol, bromelin (an enzyme from the Bromeliaceae (pineapple) family), no treatment, and placebo. Honey was given for 1 night only in 4 studies, one study gave honey 3 times on one day, and one study 3 times daily for 5 days. In all studies, low symptom score indicated better cough symptom relief.
Honey was better than no treatment (MD -1.05, 95% CI -1.48 to -0.62; 2 studies, n=154) or placebo (MD -1.62, 95% Cl -3.02 to -0.22; 2 studies, n=402) for reducing frequency of cough. Honey did not differ significantly from dextromethorphan (MD -0.07, 95% CI -1.07 to 0.94; 2 studies, n=149; statistical heterogeneity I² = 87%), and was slightly better than diphenhydramine (MD -0.57, 95% CI -0.90 to -0.24; 1 study, n=80) in reducing cough frequency.
Honey for up to 3 days was more effective in relieving cough symptoms compared to placebo or salbutamol. However, salbutamol was more effective in relieving the impact of cough on the quality of sleep of children and their parents. The administration of honey beyond 3 days had no advantage over salbutamol or placebo in the reduction of cough severity and bothersome cough.
Reported adverse events included mild reactions (nervousness, insomnia and hyperactivity); gastrointestinal symptoms (stomach ache, nausea and vomiting); drowsiness and somnolence. The difference between honey versus dextromethorphan, and honey versus diphenhydramine were not statistically significant. Gastrointestinal symptoms were reported more often in the honey group compared to placebo (RR 1.91, 95% CI 1.12 to 3.24; 2 studies, n=402) or to salbutamol (RR 1.74, 95% CI 1.04 to 2.92; 1 study, n=100).
Note: Using honey is not advised in infantsaged under 12 months because of babies' poor immunity against Clostridium botulinum, a possible contaminant in honey.
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