Is honey a good anti-allergy?
That may be depend on what's in your honey.
Following yesterday’s post on antihistamines reader TunaFortuna asked about my thoughts on honey as a possible antihistamine agent.
I haven’t looked deeply into natural or non-pharmaceutical alternatives when writing my article yesterday. Otherwise, I’d just fall down even more rabbit holes and get caught up in the weeds of research.
That being said, I have heard several arguments favoring honey in dealing with allergies. Some of these comments revolved around local honey being best for allergies. I think I’ve even parroted these comments before without understand why local honey would be beneficial, if beneficial at all.
Honey has been known for centuries, possibly millennia, as carrying many beneficial health properties. Bees are consuming the fruits of their labor after all, and they seem to be doing pretty well all of these years. Well, that’s if we disregard the hornet infestations and the problems with insecticides killing off bee populations…
Anyways, honey is argued to contain many anti-inflammatory, antioxidant, and antimicrobial properties which make them a near super food.
But does that mean that honey can help with seasonal allergies?
The answer to that question is rather complex.
The argument that honey may help with allergies is based on two hypotheses.
One hypothesis suggests that allergen exposure through honey consumption can provide tolerance to these allergens, thus reducing allergy symptoms. This process is similar to providing small amounts of a food allergen such as a peanut until a person gains tolerance and doesn’t produce a detrimental immune response towards the allergen.
The second hypothesis suggests that natural, likely plant-derived flavonoids and polyphenols contained within honey may be the culprit in reducing allergy symptoms.
In any case, both hypotheses operate under the idea that what is in your honey is what’s important.
With that said, there’s a major issue in the allergen tolerance hypothesis. This comes from the fact that many cases of allergic rhinitis are not due to flowering plants, but rather grass, tree pollen, and as evident from yesterday’s post, ragweed.
Most bees, if not all bees, are sourcing pollen from flowers, and so it’s very unlikely that honey, even if local, will contain some of these common aeroallergens. This also comes with the fact that the pollen collected by bees will likely not stay intact, as it would likely be digested in the making of honey. Therefore, the quantity of intact pollen, even if properly sourced, would either be minimal or highly varied and inconsistent. This may not be the case with raw honey, although again it’s not likely that raw honey would carry the pertinent allergens anyways.
In a blog post from the Asthma and Allergy Foundation of America (AAFA) the following comments are made about honey:
Unfortunately, honey does not help with allergies. Bees eat nectar and gather pollen produced by brightly colored flowers. These are not the same pollens responsible for most allergies (trees, grasses, and weeds). Very little of these common pollen allergens would make it into honey.
Also, the bees mix their food with enzymes to start digesting it to turn it into honey. This changes the pollen protein. And then processing, pasteurization, and even digestion by your own stomach’s enzymes would remove or break down pollen. You would not ingest enough intact pollen for your immune system to start becoming desensitized to it.
David Stukus, MD, and a member of AAFA's Medical Scientific Council, gives a simple explanation:
The old 'honey cures pollen allergies' gambit. Unfortunately, it does not. Easy explanation:
-Bees collect pollen from flowers
-This is different pollen than what causes allergy symptoms
-If honey contained pollen that causes allergies, it would create, not treat, symptoms https://t.co/rO9heC99Bi— Dr. Dave Stukus (@AllergyKidsDoc) December 30, 2019
The last bullet isn’t quite accurate, as tolerance to allergens requires a dose-dependent, time-dependent response. We should assume that the initial consumption of honey would, hypothetically, induce some of the symptoms of allergic rhinitis that would then attenuate through long-term consumption of honey if the allergen tolerance hypothesis is accurate.
That being said, we should still see reports of people noting allergy-like symptoms following honey consumption if this hypothesis was correct, and as far as I can tell I can’t recall people stating that they have runny/stuffy noses from consuming honey.
So does this mean that honey may not help? Again, the answer is complex. Relative to the two hypotheses proposed, it doesn’t appear that allergen tolerance is a likely model for honey being an anti-allergy food.
That leaves us with the other hypothesis of compounds in honey bearing antihistaminic, anti-inflammatory properties, and in reality there is some merit to this hypothesis.
Honey is comprised of many beneficial flavonoids and polyphenols, all dependent upon the plants from which the bees derive their pollen. This may also explain the antioxidant properties of honey as phenolic compounds are readily known for their antioxidant capacity.
A review from Jibril, et al.1 which looked at characterized polyphenols sourced from honey noted the following:
Natural honey is composed of nutritive polyphenols (Manyi-Loh et al. 2011). Polyphenols are primary identifying markers for the botanical origin of honey (Wang and Li 2011), and they display high therapeutic and dietary value (Uthurry et al. 2011). Bioactive polyphenol compounds are responsible for the colors, aromas, and tastes of all plant-based products, including fruits, cereals, and vegetables (Chaturvedula and Prakash 2011). The different polyphenol-derived ranges of honey color, aroma, and taste are directly dependent on the pollen source (Gil et al. 1995). More importantly, polyphenols integrate the physiological functions of a plant and are composed of secondary metabolites of various groups or classes (Di Ferdinando et al. 2014). Specific examples of such metabolites include tocopherol, flavonoids, phenolic acids, alkaloids, chlorophyll substances, amino acids (peptides), amines, carotenoid derivatives, and ascorbic acid (Cavalcanti et al. 2013). The phenolic groups of polyphenols derived from citrus fruits are vital for reducing proinflammatory cytokines in humans (Morand et al. 2011; Bernabé et al. 2013).
This isn’t too surprising given that many of the polyphenols and flavonoids produced by flowers in order to attract pollinators also carry many health benefits themselves.
Some examples of these bioactive compounds are shown in the following table, noting the geographical origin of the honey, the compounds in question, as well as the bees the honey was derived from:
Bear in mind that these compounds were more than likely characterized from raw honey. It’s possible that processing of honey and pasteurization may reduce the polyphenol content of the honey as some of these compounds are likely to be volatile compounds.
One compound that appears readily in honey polyphenol characterization is the now-famous compound Quercetin.
Studies, both in vitro and in vivo, have noted quercetin as playing a role in attenuating allergic diseases.
The effects here are rather widespread. Some evidence suggests that Quercetin may reduce the release of IgE antibodies. Quercetin may also attenuate degranulation of granulocytes, thus inhibiting the release of histamine. Quercetin may also ameliorate cytokine release (among other pathways) and reduce inflammation.
A summary of some studies and the reported effects of Quercetin on allergies in in vivo studies is noted in a table from Jafarinia, et al.2
An additional article worth considering is the following as well, although the evidence from these review articles are likely taken from the same sources:
Mlcek, et al.3: Quercetin and Its Anti-Allergic Immune Response
Note that these anti-allergy effects of Quercetin are upstream of the effects produced by OTC antihistamines. That is, many of the effects of Quercetin appear to either dampen the antibody response or dampen the release of histamine whereas OTC antihistamines block histamine from binding to H1 receptors and turning them “on”. Although histamine is blocked it is likely being readily released within the context of OTC antihistamines.
And so, relative to the two hypotheses proposed, it’s quite possible that polyphenols in honey may help to reduce symptoms of allergic responses. This effect, however, is likely to vary depending on whether the honey was treated/pasteurized, and from what flowers the bees sourced their honey from.
Interestingly, if many of these benefits stem from the polyphenol content of honey, then it’s quite possible that other plant-based foods may provide similar, if not better, sources of allergy-reducing compounds.
Consider that one of the best sources of Quercetin is apples. Given that it is apple season, we may argue that routine consumption of apples may be related to reduced allergy symptoms. It doesn’t quite appear that such studies have been conducted, although it doesn’t seem difficult to find articles making similar remarks as this.
In general, this is an important reminder that we should take into consideration why certain foods may be beneficial to us. In particular, what compounds in these foods may serve as the source of these health benefits.
With that said, here are some of my opinions based on the limited information I have found:
There seems to be two working hypotheses for why honey may help with allergies.
The first one, allergen tolerance, argues that routine exposure to seasonal allergens in honey may help lead to tolerance towards these allergens.
The second suggests that antihistaminic, anti-inflammatory compounds, mostly polyphenols and flavonoids found in honey may ameliorate some symptoms of allergies.
There isn’t much evidence for the first hypothesis, and in fact is contradicted by the fact that bees are not sourcing their pollen from the same plants that are common culprits in seasonal allergies.
The evidence appears to support the second hypothesis the most, although this comes with the caveat that if polyphenols are responsible for reduced allergy symptoms then it is worth considering other food sources which may be rich in polyphenols. Keep in mind that polyphenol content of honey will vary substantially depending on whether the honey was processed and from what plants the pollen was collected.
To that, consider doing your own research into other food sources. Consider local, seasonal fruits and vegetables that may provide possible benefits. For instance, apples are high in quercetin, and something worth consuming given the time of year.
If you’re interested in some studies…
There were two studies that I was going to include in this article which looked at honey consumption and allergy symptoms, with one being a commonly cited study from Rajan, et al.4 that has been used to suggest that honey doesn’t help with allergy symptoms.
Note that the sample size in this study was very small (23 people split into 3 groups). Participants were stratified into a placebo (sugar syrup) group, a national honey group, and a local, raw honey group. There are some interesting aspects to the study design here, including the fact that seasonality and the type of allergen were considered in the study design (4 separate time periods were included). However, the study required participants to consume one tablespoon of honey/placebo daily, either as one full tablespoon or broken into 3 teaspoon doses.
There didn’t appear to be a strong difference in reported symptoms (self-reported in diaries), and in fact higher reports of allergy symptoms were noted in the honey groups. The rather low dose, among other issues, are likely the reason for this outcome.
In contrast, a study from Asha'ari, et al.5 noted reduced allergy symptoms in those provided Tualang honey relative to those provided honey-flavored syrup. This study design was interesting, as the study looked at a 4-week initial period in which both placebo and honey groups were provided a daily course of the second generation antihistamine Loratadine. Although this would seem like a confounding variable, those within the honey group reported fewer symptoms relative to untreated allergy symptoms as compared to the group provided Loratadine and placebo syrup. The effect seemed to extend after Loratadine was stopped in the 4-8 week study portion, with some allergy symptoms increasing within the placebo group.
This may suggest further evidence towards the second hypothesis in allergy reduction due to the consumption of honey. Tualang honey is an unfiltered, raw, multifloral honey sourced from bee hives found in Malaysian rainforests. This honey appears to contain many polyphenols including Quercetin.6 It’s possible that the continued reduction in allergy symptoms even after halting Loratadine may be contributed to the compounds in Tualang honey. Note that the dosage in this study was far higher than Rajan, et al. Participants were told to consume 1g/kg body weight of honey throughout the day. To put that into perspective, one tablespoon is equivalent to 20 g, and so it’s very likely that the participants in this study consumed at least 2 tablespoons a day of Tualang honey (the authors don’t provide a mean bodyweight measure, but I’m using the cutoff of 100 lb for my “at least” measure).
Together, this raises the important issue of understanding differences in study design before looking at the conclusions.
Both of these studies were cited in a CNBC article on local honey and allergies, with only the following information provided:
The pool of studies that examine the effects of local honey on allergy symptoms is extremely small, he adds, which makes it difficult to come to a clear conclusion. Still, researchers have conducted small studies to test this hypothesis.
A 2002 study of 36 participants who had seasonal allergies found that eating locally collected and unfiltered honey had no significant effect on the allergy symptoms of those who ate it versus those who did not.
On the flip side, a 2013 study with 40 participants concluded that eating honey daily, in addition to taking allergy medication as needed, was associated with less allergy symptoms at the eight-week mark, compared to taking the allergy medication alone.
Note that the Rajan, et al. study had only 23 participants (13 dropped due to several reasons, with one main one being due to how sweet the honey/placebo syrups were). Participants in the Asha'ari, et al. also didn’t take Loratadine “as needed”, but were instructed to take 10 mg/day for the first 4 weeks irrespective of which group they were in.
All this to say that I don’t find much promise in some of the studies cited by mainstream outlets. It’s a bit of an oversimplification to not consider differences in dosage as possibly being the reason for the conflicting results.
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Jibril, F.I., Hilmi, A.B.M. & Manivannan, L. Isolation and characterization of polyphenols in natural honey for the treatment of human diseases. Bull Natl Res Cent 43, 4 (2019). https://doi.org/10.1186/s42269-019-0044-7
Jafarinia, M., Sadat Hosseini, M., kasiri, N. et al. Quercetin with the potential effect on allergic diseases. Allergy Asthma Clin Immunol 16, 36 (2020). https://doi.org/10.1186/s13223-020-00434-0
Mlcek, J., Jurikova, T., Skrovankova, S., & Sochor, J. (2016). Quercetin and Its Anti-Allergic Immune Response. Molecules (Basel, Switzerland), 21(5), 623. https://doi.org/10.3390/molecules21050623
Rajan, T. V., Tennen, H., Lindquist, R. L., Cohen, L., & Clive, J. (2002). Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 88(2), 198–203. https://doi.org/10.1016/S1081-1206(10)61996-5
Asha'ari, Z. A., Ahmad, M. Z., Jihan, W. S., Che, C. M., & Leman, I. (2013). Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East coast of Peninsular Malaysia. Annals of Saudi medicine, 33(5), 469–475. https://doi.org/10.5144/0256-4947.2013.469
Ahmed, S., & Othman, N. H. (2013). Review of the medicinal effects of tualang honey and a comparison with manuka honey. The Malaysian journal of medical sciences : MJMS, 20(3), 6–13.
we keep bees and have looked at pollen gathered by them under the microscope. we have found cases where the bees were actively foraging on grasses and sedges (actually i have also been sent a photo of someone's bees foraging on timothy). so the claim that honey bees only forage on flowers is incorrect and this is not widely known. we also found that there were traces of wind borne pollens in the flower pollen samples - ie. wind distributed pollens are deposited on flowers that the bees are foraging on and are picked up that way. honey bees do forage on some 'wind pollinated' plants - ie. in spring willow is a favourite source of pollen. all that being said - there isn't enough solid evidence to make the claim that honey helps with seasonal allergies and i wince when i hear beekeepers make this claim. but placebo is very real! and honey is delicious.
Honey should be harvested within a 25 mile radius of the Allergic person to be most beneficial