Is Manuka honey effective for treating respiratory issues?

Manuka Honey for Respiratory Conditions: Limited Evidence of Benefit

Based on current evidence, Manuka honey cannot be recommended as an effective treatment for respiratory conditions due to insufficient high-quality evidence demonstrating clear benefits for respiratory health. 1

Evidence Assessment

Upper Respiratory Tract Infections

• A 2021 systematic review and meta-analysis showed honey (not specifically Manuka) improved symptom scores for upper respiratory tract infections compared to usual care 2
• Honey demonstrated improvements in:
  • Combined symptom scores
  • Cough frequency
  • Cough severity
• However, when compared to placebo (rather than usual care), the evidence was less convincing 2

Chronic Rhinosinusitis and Allergic Fungal Rhinosinusitis

• The European Position Paper on Rhinosinusitis and Nasal Polyps (2020) specifically evaluated Manuka honey for allergic fungal rhinosinusitis (AFRS) 1
• A randomized, single-blind prospective study of AFRS patients who failed surgery and maximal postoperative medical management found that Manuka honey applied to one nostril failed to demonstrate overall improvement 1, 3
• The study concluded: "Manuka honey topically does not improve outcomes" with level 1b(-) evidence 1
• While some patients reported subjective symptomatic benefits, there was no significant endoscopic improvement in disease 3

Safety Profile

• A 2010 animal study found no histological evidence of inflammation or epithelial injury when Manuka honey was applied to rabbit nasal respiratory mucosa 4
• This suggests Manuka honey may be safe for topical application to respiratory mucosa, though human studies are limited

Potential in Cystic Fibrosis

• A pilot study protocol was published in 2022 investigating Manuka honey sinus rinses in cystic fibrosis patients, but results are not yet available 5
• Laboratory studies show that clinical isolates from cystic fibrosis patients (Pseudomonas and Burkholderia) are susceptible to Manuka honey in vitro 6
• Combinations of Manuka honey with antibiotics showed synergistic or additive effects against these pathogens in laboratory settings 6

Clinical Application Considerations

When to Consider Manuka Honey

• For upper respiratory infections, honey (not specifically Manuka) may provide symptomatic relief of cough and other symptoms 2
• However, for chronic conditions like chronic rhinosinusitis or allergic fungal rhinosinusitis, evidence does not support its use 1

Limitations and Caveats

• Most studies on Manuka honey for respiratory conditions are small, with moderate to high risk of bias 1
• The Society for Integrative Oncology-ASCO guideline (2022) found inconclusive evidence for honey in treating oral mucositis, noting inconsistent results across trials 1
• Different honey preparations, doses, and delivery methods make standardization difficult 1
• The largest and most rigorously designed trial testing Manuka honey for radiation esophagitis found it was not superior to standard supportive care 1

Conclusion

For respiratory conditions, conventional evidence-based treatments should be prioritized over Manuka honey. While honey may provide some symptomatic relief for upper respiratory infections, specific evidence for Manuka honey in respiratory conditions is limited and does not currently support its routine use. For chronic conditions like rhinosinusitis, the evidence suggests Manuka honey does not provide significant clinical benefit beyond standard treatments.