A bedtime dose of buckwheat honey was more effective than was dextromethorphan or no treatment at all for quieting cough and facilitating sleep in children aged 2–17 who had upper respiratory infection, reported Dr. Ian M. Paul and his associates at Pennsylvania State University, Hershey.
Honey decreased the frequency, severity, and “bothersome” nature of children's coughs associated with upper respiratory tract infections, thus improving both their sleep and their parents' sleep. Dextromethorphan wasn't any better than no treatment at all in a study comparing the three strategies.
The findings, combined with those of a previous study by the same researchers that found that neither dextromethorphan nor diphenhydramine was superior to placebo for cold symptoms, “now provide a generally safe and well-tolerated alternative for practitioners to recommend,” they wrote.
Dextromethorphan is the most commonly used over-the-counter antitussive for childhood cough, even though its use is not supported by the American Academy of Pediatrics or the American College of Chest Physicians.
The agent has been linked to serious adverse events including dystonia, anaphylaxis, and bullous mastocytosis at standard doses, as well as psychosis, mania, hallucinations, ataxia, dependence, and death at higher doses.
In contrast, honey, an alternative remedy used by many cultures and endorsed by the World Health Organization, is generally considered safe—with the exception of a risk of infantile botulism in children aged under 1 year.
Honey is thought to soothe the throat and to have antioxidant and antimicrobial effects, although there is “no scientific evidence to support” its use, Dr. Paul and his associates noted (Arch. Pediatr. Adolesc. Med. 2007;161:1140–6).
The researchers assessed the two cough remedies against no treatment in 105 patients at a single university-affiliated pediatric practice. The patients were randomly assigned to receive no treatment (37 children), buckwheat honey (35 children), or a honey-flavored dextromethorphan liquid (33 children) packaged in identical 10-mL syringes. They were treated for a single night and assessed via parent interviews before and after the intervention. The children had a median age of 5 years and had cough or rhinorrhea for 7 days or fewer before receiving treatment.
Buckwheat honey provided the greatest relief from cough and was significantly superior to both dextromethorphan and no treatment, the researchers wrote.
There was no difference in illness duration among the three groups. Parents reported mild adverse events such as hyperactivity, nervousness, or insomnia in five children who received honey and two who received dextromethorphan, compared with none of the children in the no-treatment group. This could influence physicians' recommendations in some cases, Dr. Paul and his associates said.
Among the limitations of this study noted by the researchers was that much of the improvement in all groups “can also be attributed to the natural history of [upper respiratory tract infections], which generally improve with time and supportive care.
“While additional studies to confirm our findings should be encouraged, each clinician should consider the findings for honey, the absence of such published findings for dextromethorphan, and the potential for adverse effects and cumulative costs associated with dextromethorphan when recommending treatments for families,” they added. The researchers explained that compared with other types, darker honeys, such as buckwheat, tend to have more phenolic compounds. These compounds have been associated with the antioxidant properties of honey that may have contributed to its relieving effect.
Further, they wrote, honey's “topical demulcent effect may contribute to its benefits for cough as postulated by the World Health Organization review.”
Antioxidant properties of darker honey are believed to help relieve coughing. Elsevier Global Medical News