Safety in use

Honey is extremely safe to use. In the 500-plus cases reported in publications on using honey on wounds, and the 140-plus cases reported of using honey in ophthalmology, there has been no mention of any adverse effects. A large number of other cases that have not been published are known to the author and, again, there have been no adverse effects observed in any of these, with the exception of one case where there appeared to be an allergic reaction on the skin around the wound. With honey, there are no reported cytotoxic effects that would slow the healing process, whereas all antiseptics in common use can be harmful to body tissues (Tatnall et al, 1991), including silver as released from nanocrystalline silver dressings (Poon and Burd, 2004).

There have been reports of honey causing a stinging pain when applied to wounds (Dunford et al, 2000b; Robson et al, 2001; Ahmed et al, 2003). This appears to be due to the acidity of honey, as pain is not experienced when neutralised honey is used (Dunford et al, 2000b; Betts and Molan, 2001). The pain experienced does not seem to be indicative of damage being done to the wound, as wounds have healed rapidly in cases where patients have endured the pain to benefit from the stimulation of healing that they see, and in cases where analgesia has been used (personal communications from numerous clinicians). There is evidence that honey stimulates nocioceptors (Al-Swayeh and Ali, 1998), nerve endings that create a pain sensation in response to heat, acidity and some organic chemicals such as those in ginger and chilli. It is of interest that patients have been reported to experience a ‘peppery’ sensation from application of honey to their ulcers (Oluwatosin et al, 2000). It may be that it is not a direct effect of the acidity of honey, as neutralising honey could affect the ionisation of some of its components and make them unable to fit in the nocioceptors. It is possible that in some patients these nerve endings are sensitised and are more responsive to the acidity and/or the component organic chemicals of honey.

However, there are many reports of honey relieving pain (Al- Waili and Saloom, 1999; Dunford et al, 2000a, b; Cooper et al, 2001; Subrahmanyam et al, 2001; Richards, 2002; Stewart, 2002; Misirlioglu et al, 2003). In a trial in which pain was measured on a visual analogue scale, the pain experienced with a honey-soaked gauze dressing was found to be one-third less than with saline-soaked gauze and paraffin gauze, but slightly more than with a hydrocolloid dressing (Misirlioglu et al, 2003). In another trial, where the comfort of honey dressings on chronic venous leg ulcers was investigated, six patients experienced a transient stinging pain, and eight experienced a lasting pain, but only some of the times the dressing was applied (Dunford and Hanano, 2004). However, in this trial, the overall result was that pain was significantly reduced by the honey dressings, and the patient satisfaction with the honey dressings was high.

Other cases where honey is reported to cause pain are few. In one of these, there was pain experienced by the patient for the first twenty to thirty minutes (Dunford et al, 2000b). In another case, a patient experienced moderate pain for fifteen to thirty minutes after honey was applied (Robson et al, 2001). In a clinical trial of honey dressings, one of the sixty patients treated with honey withdrew because the dressings caused pain (Ahmed et al, 2003). In a pilot trial in which the author participated (Betts and Molan, 2002), six of the twenty patients recruited withdrew because of the pain caused by honey on the wound. This probably reflects the recruitment criterion of infected or heavily colonised wounds for the trial, as it was observed that pain was experienced only in inflamed wounds. Patients who found honey very painful when their wounds were inflamed experienced no problem with pain once the inflammation had subsided. Similarly, in the trial where the comfort of honey dressings on chronic venous leg ulcers was investigated, the six patients who withdrew from the trial because of the honey being painful (out of a total of forty participants), had a higher than average pain level before the start of the honey dressings (Dunford and Hanano, 2004).

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