Evidence for Manuka Honey in Treating Respiratory Tract Infections in Children
There is insufficient evidence to recommend manuka honey for treating respiratory tract infections in children, as clinical studies specifically evaluating manuka honey for this indication are lacking and current guidelines do not support its routine use.
Current Evidence and Guidelines
The European Respiratory Society (ERS) guidelines for managing children with bronchiectasis and other respiratory conditions do not mention honey as a recommended treatment for respiratory tract infections 1.
The Society for Integrative Oncology-ASCO guidelines state there is "inconclusive evidence to recommend for or against the clinical use of honey for oral mucositis" in cancer patients, highlighting inconsistent results across trials and heterogeneity of honey preparations used 1.
No pediatric respiratory guidelines currently recommend honey as a standard treatment for respiratory tract infections in children 1.
Evidence for Honey in Respiratory Symptoms
Cough Relief
A systematic review and meta-analysis found that honey was superior to usual care for improving symptoms of upper respiratory tract infections, including cough frequency (SMD -0.36,95% CI -0.50 to -0.21) and cough severity (SMD -0.44,95% CI -0.64 to -0.25) 2.
A Cochrane review concluded that honey probably relieves cough symptoms better than no treatment or placebo, but most studies only evaluated treatment for one night, limiting the strength of evidence 3.
A study comparing honey, dextromethorphan, and no treatment found honey was rated most favorably by parents for symptomatic relief of nocturnal cough and sleep difficulty due to upper respiratory tract infections 4.
However, a recent 2022 multicentre, randomized, double-blind, placebo-controlled study in children aged 1-5 years found that honey was no more effective than syrup placebo for treating nocturnal coughs and improving sleep quality 5.
Antimicrobial Properties
Laboratory research has shown potential synergistic effects between manuka honey and antibiotics against certain pathogens, including Mycobacterium abscessus, suggesting possible utility in respiratory infections 6.
However, these in vitro findings have not been validated in clinical trials with children with respiratory tract infections 6.
Limitations and Considerations
Most studies on honey for respiratory symptoms focus on cough as a symptom rather than treating the underlying respiratory tract infection 2, 5, 4, 3.
There is significant heterogeneity in honey preparations used across studies, with most not specifically using manuka honey 1, 3.
The American Academy of Pediatrics and American Academy of Allergy, Asthma, and Immunology guidelines for managing respiratory conditions in children focus on evidence-based treatments like inhaled corticosteroids for viral-induced wheeze rather than complementary therapies like honey 7, 8.
Safety concerns exist, particularly for infants under 12 months due to risk of botulism 3.
Clinical Implications
While honey may provide symptomatic relief for cough in children over 1 year of age, there is insufficient evidence to recommend manuka honey specifically for treating respiratory tract infections 2, 3.
Current pediatric respiratory guidelines prioritize established treatments with stronger evidence bases, such as antibiotics for bacterial infections and inhaled corticosteroids for inflammatory conditions 1, 7, 8.
When considering honey for symptomatic relief, it should be used only in children over 1 year of age and not as a replacement for evidence-based treatments for the underlying respiratory infection 3.
Reported adverse events with honey include gastrointestinal symptoms (RR 1.91,95% CI 1.12 to 3.24) compared to placebo 3.
Conclusion
While honey may offer some symptomatic relief for cough associated with upper respiratory tract infections in children over 1 year of age, there is insufficient evidence specifically supporting manuka honey for treating respiratory tract infections in children. Current pediatric respiratory guidelines do not include honey as a recommended treatment for respiratory infections.