Cohen
A
,
Rozen
J
,
Kristal
H
, et al
.
Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study
.
Pediatrics
.
2012
;
130
(
2
):
465
-
471
; doi:
https://doi.org/10.1542/peds.2011-3075

Investigators from Tel Aviv University conducted a double-blind, randomized, placebo-controlled trial to evaluate the effect of honey on cough frequency in children with upper respiratory tract infections (URI). Children who were 1 to 5 years of age were screened for eligibility using a validated questionnaire in which parents were asked to subjectively assess their child's cough and sleep difficulty. Children whose parents rated their nocturnal cough frequency and/or sleep quality the night prior at a score of 3 or higher on a 7-point severity scale were eligible.

Study participants were randomized to receive one of 3 types of honey (eucalyptus, labiatae, and citrus) or a date extract placebo 30 minutes prior to bedtime. Date extract was chosen as a placebo because it had a consistency and taste similar to honey. Investigators re-administered the cough and sleep questionnaire to parents the day after treatment. Each item on the questionnaire was scored from 0 (not at all severe/frequent/bothersome) to 6 (extremely severe/frequent/bothersome) and added together to get a total symptom score. The primary outcome was the change in cough frequency symptom score. Secondary outcomes included changes in total symptom score as well as changes in cough severity, disruptive nature of the cough, and effect on sleep quality.

The investigators enrolled 300 children, 75 in each of the 4 groups; 89% completed the study. There were no differences in age, baseline cough and sleep symptom scores, or total symptom scores among children in each group. Compared to pre-intervention scores, those who received eucalyptus honey had a mean 1.77-point improvement in cough frequency compared with a 1.95-point change for those receiving citrus honey, 1.82-point change for those receiving labiatae honey, and a 1.00-point change for those who were treated with placebo (P < .05 for comparisons between each honey group and placebo). The change in total symptom scores as well as cough severity and sleep quality symptom scores were all statistically improved for each treatment group as compared to placebo. There was no statistical difference between the honey treatment groups. Reported adverse events (stomachache, nausea or vomiting) were not statistically different between groups.

The authors conclude that honey provided better symptomatic relief for cough associated with URI than a date extract placebo.

The use of over-the-counter (OTC) remedies for the treatment of URI symptoms is common in children. Most, if not all, of these OTC therapies have little to no benefit and can have significant side effects. The US Food and Drug Administration (FDA) now recommends that such cold and cough products not be used in children <2 years of age and with caution in children <6 years of age. This has made it difficult for parents since URIs are common and the burden of symptoms is high....

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