Harnessing Nature's Remedy: Local Raw Honey as Immunotherapy for Allergic Rhinitis and Seasonal Allergies

Allergic rhinitis (AR) affects nearly one in six Americans and is responsible for as much as $2 to $4 billion in annual lost productivity.¹ For those suffering from allergic rhinitis and seasonal allergies, local raw honey may offer a promising complementary therapy. This article explores the potential benefits of using local raw honey as an immunotherapy approach, backed by recent studies, while also pointing out concerns regarding conventional treatments.

The Power of Local Raw Honey

Honey is widely recognized for its anti-microbial, anticancer, anti-inflammatory and wound healing properties.² The concept of using local raw honey for allergy relief is rooted in the principles of immunotherapy. This approach suggests that regular consumption of small amounts of local pollen present in raw honey may help desensitize the immune system to these allergens over time, offering a safer alternative to subcutaneous injection treatments, which carry a risk of anaphylaxis. 

Supporting Evidence

While research is still limited, some studies have shown promising results:

A randomized placebo-controlled trial by Zamzil Amin Asha'ari, MD, et al. investigated the effects of Tualang honey on AR. The study found that patients who consumed honey (one gram (g) per kilogram (kg) body weight per day) showed significant improvement in mean total symptom scores compared to the placebo group. Notably, the honey group continued to show improvement even after discontinuing antihistamine use. ³

A 2011 randomized controlled pilot study found that pre-seasonal use of birch pollen honey resulted in a 60 percent lower total symptom score, twice as many asymptomatic days, and 70 percent fewer days with severe symptoms compared to the control group.⁴

These studies suggest that honey consumption may offer a natural approach to managing allergy symptoms, potentially reducing reliance on conventional medications, however not all studies had positive outcomes.  In a 2002 study on the effect of raw honey on rhinoconjunctivitis, 36 people were randomly assigned to three groups.  One received raw local honey, one pasteurized honey, and a third consumed corn syrup with synthetic honey flavoring (placebo).  Neither honey group had symptom reduction in comparison with the placebo group.⁵

Mechanism of Action

The proposed mechanism behind honey's effectiveness involves gradual exposure to local allergens. Raw, unprocessed honey contains small amounts of pollen from nearby plants. Regular consumption of this honey may help the immune system build tolerance to these specific allergens over time, potentially reducing the severity of allergic reactions.⁶ Honey has been found to modulate the activity of immune cells, including mast cells that release histamines during an allergic response.⁷

Implementing Honey Therapy in Practice

When recommending honey therapy to patients, consider the following guidelines:

• Source: Emphasize the importance of using local, raw, unprocessed honey to ensure the presence of relevant pollen.
• Dosage: Based on the Dr. Asha'ari study, a dose of 1g per kg of body weight per day may be effective,³ however, common dosages are one to two teaspoons per day.
• Timing: Encourage patients to start honey consumption well before the allergy season begins for potential pre-seasonal benefits, on the order of two or more months.
• Duration: Advise patients that consistent, long-term use may be necessary to see results.
• Combination Therapy: Consider honey therapy as a complementary approach alongside other treatments, including acupuncture, quercetin and bromelain.⁸

Cautions and Considerations

While honey therapy shows promise, it's essential to note some important considerations:

• Variability: The amount of pollen in honey can vary, making standardization challenging.⁹
• Allergic Reactions: Patients with severe pollen allergies may risk an allergic reaction to honey itself. ⁹
• Protection against allergens: Since bees only pollenate flowers, if patients are allergic to grasses, honey won’t have a positive effect.⁹
• Infant Safety: Raw honey should never be given to infants under one year old due to the risk of botulism.⁹
• Limited Evidence: More robust clinical trials are needed to definitively establish honey's effectiveness for allergy treatment.⁹

The Downside of Conventional Antihistamines

While discussing natural alternatives, it's crucial to address concerns about conventional antihistamine treatments, particularly their anticholinergic properties and potential long-term effects.

Recent studies have raised alarms about the prolonged use of anticholinergic medications, including many common antihistamines:

A 2019 study published in JAMA Internal Medicine found a significant association between anticholinergic drug exposure and increased risk of dementia. The study specifically highlighted anticholinergic antidepressants, antipsychotic drugs, and antiparkinsonian drugs as having the strongest associations.¹⁰

A systematic review and meta-analysis published in 2020 concluded that the use of anticholinergic agents for three months or longer appeared to increase the risk of dementia by an estimated 46 percent on average compared to non-use.¹¹

A 2023 study, while not finding a conclusive link to dementia, did identify a significant association between anticholinergic use and a higher risk of developing mild cognitive impairment.¹²

An excellent tool for clinicians to evaluate the potential risk of dementia is an anticholinergic burden calculator (www.acbcalc.com).¹³

Extended use of antihistamines may also lead to urinary retention, tinnitus and balance issues leading to falls in seniors.¹⁴

These findings underscore the importance of recommending alternative approaches to managing allergic symptoms, especially for patients who may require long-term treatment.

Integrating Honey Therapy into Practice

• Education: Inform patients about the potential benefits of local raw honey and guide them on proper usage and expectations.
• Monitoring: Regularly assess patients' progress and adjust treatment plans as needed.
• Collaboration: Work with allergists and other healthcare providers to ensure comprehensive care, especially for patients with severe allergies.

While more research is needed, the potential of local raw honey as a natural immunotherapy for allergic rhinitis and seasonal allergies is worth further investigation. As integrative health professionals, we can offer this as a complementary approach, potentially reducing our patients' reliance on conventional antihistamines and their associated risks.

References

1. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC; Guideline Otolaryngology Development Group. AAO-HNSF. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. doi: 10.1177/0194599814561600. PMID: 25644617.
2. Aw Yong PY, Islam F, Harith HH, Israf DA, Tan JW, Tham CL. The Potential use of Honey as a Remedy for Allergic Diseases: A Mini Review. Front Pharmacol. 2021 Jan 26;11:599080. doi: 10.3389/fphar.2020.599080. PMID: 33574752; PMCID: PMC7870997.
3. Asha'ari ZA, Ahmad MZ, Jihan WS, Che CM, Leman I. Ingestion of honey improves the symptoms of allergic rhinitis: evidence from a randomized placebo-controlled trial in the East coast of Peninsular Malaysia. Ann Saudi Med. 2013 Sep-Oct;33(5):469-75. doi: 10.5144/0256-4947.2013.469. PMID: 24188941; PMCID: PMC6074882.
4. Saarinen K, Jantunen J, Haahtela T. Birch pollen honey for birch pollen allergy-a randomized controlled pilot study. Int Arch Allergy Immunol. 2011;155:160–6.
5. Rajan T. V., Tennen H., Lindquist R. L., Cohen L., Clive J. (2002). Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Ann. Allergy Asthma Immunol. 88, 198–203. 10.1016/s1081-1206(10)61996-5 [DOI] 
6. Aw Yong PY, Islam F, Harith HH, Israf DA, Tan JW, Tham CL. The Potential use of Honey as a Remedy for Allergic Diseases: A Mini Review. Front Pharmacol. 2021 Jan 26;11:599080. doi: 10.3389/fphar.2020.599080. PMID: 33574752; PMCID: PMC7870997.
7. Ishikawa Y, Tokura T, Nakano N, et al. Inhibitory effect of honeybee-collected pollen on mast cell degranulation in vivo and in vitro. J Med Food. 2008;11:14–20. 
8. Asher BF, Seidman MD, Reddy WD, Omole FS. Integrative medical approaches to allergic rhinitis. Curr Opin Otolaryngol Head Neck Surg. 2015 Jun;23(3):221-5. doi: 10.1097/MOO.0000000000000152. PMID: 25943958.
9. “Does Local Honey help Allergies?” https://www.medicalnewstoday.com/articles/does-local-honey-help-allergies#theory accessed 1/19/25.
10. Coupland CAC, Hill T, Dening T, Morriss R, Moore M, Hippisley-Cox J. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019;179(8):1084–1093. doi:10.1001/jamainternmed.2019.0677
11. Aw Yong PY, Islam F, Harith HH, Israf DA, Tan JW, Tham CL. The Potential use of Honey as a Remedy for Allergic Diseases: A Mini Review. Front Pharmacol. 2021 Jan 26;11:599080. doi: 10.3389/fphar.2020.599080. PMID: 33574752; PMCID: PMC7870997.
12. Poonawalla, I.B., Xu, Y., Gaddy, R. et al. Anticholinergic exposure and its association with dementia/Alzheimer's disease and mortality in older adults. BMC Geriatr 23, 401 (2023). https://doi.org/10.1186/s12877-023-04095-7
13. Reddy, B. Understanding the risks of Anticholinergic Drugs: Safeguard Patients Against Dementia with the Anticholinergic Burden Calculator. Acupuncture Today, 2024 Jun
14. Drowsiness, Dry Mouth, and More: 7 Antihistamine Side Effects to Know About. https://www.goodrx.com/classes/antihistamines/common-side-effects accessed 1/21/25