Can ingesting local honey reduce symptoms of allergic rhinitis (hay fever) in children and young people?

Correspondence to Dr Ashley Reece, Department of Paediatrics, West Hertfordshire Teaching Hospitals NHS Trust, Watford, WD18 0HB, UK; [email protected]

Clinical scenario

A 14-year-old boy with allergic rhinitis (AR), more commonly known as hay fever, presents with sneezing, runny nose and itchy eyes. He is sensitised to grass, tree and birch pollen on skin prick testing. His symptoms affect him throughout the spring and summer months, affecting his performance at school. Despite medical therapies including oral antihistamine, nasal spray and eye drops, there are some days he remains symptomatic, and his mother is keen to find better treatment. She has heard that if you eat local honey, then this can improve the symptoms of hay fever and asks for your advice. You wonder whether eating local, unpasteurised honey can help reduce the symptoms of AR or even be a cure for the symptoms of hay fever.

Structured clinical question

In children and young people under 16 years of age with AR symptoms and sensitisation to pollens (hay fever) (patient), does ingesting local, unpasteurised honey (intervention) reduce symptoms and/or the need for pharmacological treatments to help improve the symptoms (outcome)?

Search strategy and outcome

A literature search was undertaken in October 2021, and Medline, Embase and CINAHL databases were searched using the following search terms: ((Honey OR Honey* OR local honey OR (ingest* OR consume OR eat) adj3 honey)) AND ((Hayfever OR Hay fever OR Rhinitis OR Allergic rhinitis OR Seasonal rhinitis OR Seasonal allergic rhinitis OR Rhinoconjunctivitis OR Rhino-conjunctivitis OR Allergic rhinoconjunctivitis OR Allergic rhino-conjunctivitis OR Seasonal allerg* OR Sensitive nose)).

Of the 43 articles, there were 3 which were suitable.^1–3 None of these papers focused on the paediatric population in isolation. These are summarised in table 1.

Table 1

Summary of studies featuring children and young people and adults

Citation	Study group	Study type (level of evidence)	Outcome	Key result	Comments
Saarinen et al1	61 patients with AR, aged 8–79 years randomised to BPH or RH or no honey (control). Invited through public announcements/ advertisements.	Single blinded RCT (1b)	Symptom score graded (range 0–3) in April and May. Symptom-free days. Use of additional antihistamine medications for symptoms.	BPH patients reported a 60% lower total symptom score (p<0.01). More symptom-free days in honey groups:...