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 Table of Contents  
Year : 2022  |  Volume : 13  |  Issue : 4  |  Page : 271-275  

The effectiveness of forest honey toward symptoms of atrophy patients: Study of ear nose and throat-head neck and dermatology venereology

1 Department of Dermatology and Venereology, Universitas Tadulako, Kota Palu, Sulawesi Tengah, Indonesia
2 Department of Ear Nose and Throat- Head Neck, Universitas Tadulako, Kota Palu, Sulawesi Tengah, Indonesia
3 Department of Microbiology, Faculty of Medicine, Universitas Tadulako, Kota Palu, Sulawesi Tengah, Indonesia

Date of Submission18-Apr-2022
Date of Decision01-Jul-2022
Date of Acceptance02-Jul-2022
Date of Web Publication10-Oct-2022

Correspondence Address:
Dr. Asrawati Sofyan
Soekarno-Hatta Km. 9, City of Palu, Sulawesi Tengah
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/japtr.japtr_359_22

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The effectiveness of forest honey in Total Nasal Symptom Score (TNSS) improvement in allergic rhinitis patients and index Scoring Atopic Dermatitis (SCORAD) in Atopic Dermatitis (AD) patients were discovered. It was an experimental study with a pretest–posttest design. A total of 20 people with atopy (15 people with allergic rhinitis and five people with AD) were given forest honey in the morning (1 ml × 10 ml dose) for 8 weeks and 20 atopy patients without forest honey. TNSS and SCORAD index were evaluated before the intervention, week 2, week 4, and after the intervention (week 8). The mean TNSS before treatment was higher in the honey group, namely 7.73, and a significant decrease after 8 weeks of intervention, namely 2.73 with P = 0.000. The nonhoney group showed that there was no significant difference after 8 weeks with P = 0.888. The SCORAD values of the honey and nonhoney groups had significantly different values from week 0 to week 4 (P = 0.003) and week 0 to week 8 (P = 0.003). Forest honey can give as an additional therapy for patients with allergic rhinitis and AD.

Keywords: Allergic rhinitis, atopic dermatitis, forest honey

How to cite this article:
Sofyan A, Nayoan CR, Asrinawaty AN. The effectiveness of forest honey toward symptoms of atrophy patients: Study of ear nose and throat-head neck and dermatology venereology. J Adv Pharm Technol Res 2022;13:271-5

How to cite this URL:
Sofyan A, Nayoan CR, Asrinawaty AN. The effectiveness of forest honey toward symptoms of atrophy patients: Study of ear nose and throat-head neck and dermatology venereology. J Adv Pharm Technol Res [serial online] 2022 [cited 2022 Nov 28];13:271-5. Available from: https://www.japtr.org/text.asp?2022/13/4/271/358212

  Introduction Top

Atopy is the tendency for a person and/or family to be sensitized and produce immunoglobulin E (IgE) in response to allergens, usually in the form of protein.[1],[2] Atopy affects a large proportion of the population, an estimated 10%–30% in developed countries. About 80% of atopy individuals have a family history of allergies.[3] Atopy is a mild disease common in children, but it can affect the degree of health, quality of life, and mortality in its course. Atopy refers to the development of allergy-related diseases such as asthma, dermatitis, and rhinitis, which are chronic and have a high recurrence rate.

Allergic Rhinitis (RA) is inflammation of the nasal mucosa mediated by IgE-mediated hypersensitivity reactions to allergens with symptoms of nasal itching, pruritus, rhinorrhea, sneezing, and nasal congestion.[4],[5],[6] The prevalence of RA in children is 10%–40% of the world population and increases yearly.[7] RA cases in Indonesia variety as happened in Semarang City, it was found 11.5% in children aged 6-7 years, 17.3% at 13-14 years old,[8],[9] and in Surabaya City was about 23.05% among school-aged children.[10]

Atopic dermatitis (AD) is an itchy chronic skin disease characterized by ill-defined erythema, edema, vesicles, and madidans in the acute stage and skin thickening (lichenification) at the chronic stage.[11] The International Study of Asthma and Allergies in Childhood stated that AD in children varies in different countries. Based on the data in the URJ skin disease for children, Dr. Soetomo Hospital, AD patients have increased every year. The number of new cases in 2006 was 116 patients (8.14%); in 2007, there were 148 patients (11.05%); and in 2008, there were 230 patients (17.65%).[12]

Prevention of atopy can be done by avoiding contact with allergens and using chemical drugs. However, this only reduces the symptoms that are added to traditional medicine.[13] One companion treatment for allergies is honey,[14] a nutritional–conventional medicine product for various clinical conditions. It provides antioxidant, anti-inflammatory, antimicrobial, anticancer, antimetastatic, and antiproliferative effects.[15]

Several studies have shown that honey use affects atopy associated with allergic rhinitis and AD. One of the mechanisms of honey against atopy is suppressing IgE-mediated hypersensitivity.[16] However, using honey is still a matter of debate in reducing allergies. Based on this, it is necessary to test honey's potential for symptom improvement in atopy sufferers, especially forest honey of Central Sulawesi.

  Materials and Methods Top

The research subjects were patients with allergic rhinitis and AD at UNDATA Hospital. This research was quasi-experimental with a pretest–posttest design. The research subjects were 40 people divided into two groups randomly: the control group without giving forest honey and the treatment group with providing honey. A total of 20 people with atopy (15 allergic rhinitis and 5 AD) were given forest honey orally in the morning (dose: 1 × 10 ml/day) for 8 weeks and 20 people with atopy without given forest honey. The variables observed were clinical symptoms examined at the beginning of the study/pretest (0 weeks), 2 weeks, 4 weeks, and the end of the study/posttest (8 weeks).

Assessment of changes in clinical symptoms used the Total Nasal Symptom Score (TNSS) for allergic rhinitis and the scoring of atopic dermatitis (SCORAD) for AD, analyzed with a t-test to identify the significance of differences between control and treatment groups.

  Results Top

[Table 1] shows the subject's characteristics, including gender, age, and occupation. A total of 24 female subjects (60%) were more than a total of men (40%). Most of the study subjects were over 18 years old (by the older age of 45 years), and the youngest was 8 years old. Most research subjects (35%) were civil servants/police/military.
Table 1: Characteristics of respondents with atopy (n=40)

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[Table 2] shows that the mean TNSS before treatment was higher in the honey group, namely 7.73, and a significant decrease after 8 weeks of intervention, namely 2.73 with P = 0.000. The nonhoney group showed that there was no significant difference after 8 weeks with P = 0.888.
Table 2: Mean Total Nasal Symptom Score for honey and nonhoney groups at week 0 and week 8

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Research on patients with AD was conducted using and without giving honey. We performed four times of data collections, namely weeks 0, 4, and 8 [Table 3]. Patients were measured using the SCORAD index, which consists of the area affected by the rule of nine, the intensity consisting of erythema, edema, crusting, excoriation, lichenification, and dryness, which is scored with points 0–3, as well as itching disorders and sleep disorders measured subjectively by the patient with a value of 0–10. The AD score was adjusted according to the SCORAD formula which was then categorized into 3, namely values > 50 mean heavy AD, 25-50 AD moderate, and < 25 AD light.
Table 3: Mean index score of atopic dermatitis for honey and nonhoney groups at week 0, week 4, and week 8

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The number of samples is very limited, consisting of 5 people with atopy by consuming honey and 5 people with atopy without honey. Patients were followed-up on the 1st day and then on weeks 2, 4, and 8.

The comparison test results between the two treatment groups showed P = 0.00 or significantly different, where the TNSS score was lower than the nonhoney group [Table 4]. It showed that honey effectively reduced the TNSS score in patients with allergic rhinitis.
Table 4: The results of the Total Nasal Symptom Score comparison test for the honey and nonhoney groups at week 8

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[Table 4] shows that at weeks 0, 4, and 8 in AD patients who used honey and non-honey gave insignificant results on their SCORAD with P < 0.05. However, the honey and nonhoney group treatment obtained significant results from week 0 to week 4 and week 0 to week 8 [Table 5]. This result indicates that forest honey's daily consumption can be used as an additional treatment for AD.
Table 5: The comparison test results from the atopic dermatitis index score in the honey and nonhoney groups from week 0 to week 4 and week 0 to week 8

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Giving forest honey to patients with AD did not significantly improve the patient's SCORAD index. However, based on [Figure 1] and [Figure 2], shows an improvement in atopic dermatitis from week 0 to week 8.
Figure 1: A 21-year-old male patient with moderate-grade atopic dermatitis at week 0 (a); week 4 (b); week 8 (c)

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Figure 2: A 15-year-old female patient with moderate atopic dermatitis at week 0 (a); week 4 (b); week 8 (c)

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  Discussion Top

Evaluated signs used TNSS and SCORAD index. This research obtained the mean TNSS score at week 0 or pretest was 6.5 in the honey group and 6.5 in the nonhoney group. TNSS is a way of assessing the quality of allergic rhinitis symptoms in sufferers. TNSS was calculated by adding up the scores for 4 signs of allergic rhinitis in the form of nasal congestion, itchy nose, sneezing, and runny nose. Each symptom is given a 4-rating scale from 0 to 3. A score of 0 indicates no signs; a score of 1 indicates tolerable mild symptoms; a score of 2 disturbing symptoms/moderate but bearable; and a score of 3 if the symptoms are severe and interfere with daily activities. TNSS will have the highest and lowest scores of 12 and the lowest score of 0.[17]

The consumption of honey in allergic rhinitis sufferers will accelerate the improvement of allergic rhinitis symptoms.[18] The progress of allergic rhinitis symptoms in patients who consume honey is thought to pass through several mechanisms. First, honey can suppress IgE-mediated hypersensitivity reactions. Several animal studies have shown the effect of honey on immune reactions. Mast cells are known to form a lot when an allergic reaction occurs and release many mediators, one of which is histamine, which is involved in many symptoms of allergic rhinitis. The second mechanism, honey, will induce the body's ability to tolerate aeroallergens to reduce the formation of hypersensitivity reactions. The third mechanism is the disruption of the allergy cascade due to honey's anti-inflammatory effect. Besides having an anti-inflammatory effect, honey is also proven to have antibacterial effects, especially Staphylococcus aureus and Pseudomonas aeruginosa bacteria, which can produce biofilms that can be used as additional therapy in rhinosinusitis sufferers.[19]

In AD, the consumption of honey has no significant effect. It can make up for inadequate sample sizes and the available honey used topically for AD. However, regular consumption of honey showed decreased SCORAD index at week 4 and until week 8, although it was not normal in this study. The decrease in SCORAD value in patients with AD is influenced by several factors based on AD's risk factors. The forest honey mechanism in reducing the score resembles the previously described allergic rhinitis mechanism.

Honey can influence immune reactions in dermatitis by stopping cell activation, which is mediated by IgE. Alangari et al.'s study showed that degradation of mast cells was significantly inhibited after giving honey.[20] In preclinical studies, bee products improve the immune response through the modulation of B- and T-lymphocytes function and chemotaxis.[21] The antibacterial properties of honey are generally related to the following two main mechanisms: (i) inhibition of the microbial growth by hydrogen peroxide (H2O2), which is formed by enzymatic activity (for example, glucose oxidase) and (ii) inhibition of microbial growth through nonperoxide activities.[22],[23]

Besides that it can also cause low tolerance to allergens or desensitization, which can also function as an anti-inflammatory. Honey also provides antioxidant, antimicrobial, antiproliferative, anticancer, and antimetastatic effects.[24] However, the impact of the consumption of forest honey still needs further research. This study used forest honey, which type of content is different from livestock honey. Forest honey has a darker color, and the types of flora consumed by forest honey can be more diverse. Flavonoids and phenols in darker honey and polyfloral were higher than in light honey and monofloral, so they are effective antioxidants.[15],[25],[26] Further research is needed to assess forest honey content in the Central Sulawesi region.

  Conclusions Top

The decrease in the value of TNSS in allergic rhinitis patients and SCORAD in AD patients in subjects using honey suggests that consuming forest honey regularly can be an additional therapy in managing allergic rhinitis and AD. Further research on forest honey in Central Sulawesi and its use as an atopic treatment, including allergic rhinitis and AD, still needs to be done.


This study was funded by the Faculty of Medicine, Tadulako University, through the Superior Research Grant from Tadulako University.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol 2004;113:832-6.  Back to cited text no. 1
Čelakovská J, Čermákova E, Vaňková R, Andrýs C, Krejsek J. Sensitisation to molecular components of fungi in atopic dermatitis patients, the relation to the occurrence of food hypersensitivity reactions. Food Agric Immunol 2022;33:328-45.  Back to cited text no. 2
Vaillant AA, Modi P, Jan A. Atopy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.  Back to cited text no. 3
Verschoor D, von Gunten S. Allergy and atopic diseases: An update on experimental evidence. Int Arch Allergy Immunol 2019;180:235-43.  Back to cited text no. 4
Wheatley LM, Togias A. Allergic rhinitis. N Engl J Med 2015;372:456-63.  Back to cited text no. 5
Madanipour MR, Fatehi-Zardalou M, Rahimi N, Hemmati S, Alaeddini M, Etemad-Moghadam S, et al. The anti-inflammatory effect of dapsone on ovalbumin-induced allergic rhinitis in balb/c mice. Life Sci 2022;297:120449.  Back to cited text no. 6
Turner P, Kemp AS. Allergic rhinitis in children. J Paediatr Child Health 2012;48:302-10.  Back to cited text no. 7
Widodo P. The Relationship Between Allergic Rhinitis and Affecting Factors in Semarang City Junior High School Students Age 13-14 Years Using the International Study of Asthma and Allergies in Childhood Questionnaire. Semarang: Universitas Diponegoro; 2003.  Back to cited text no. 8
Nancy YM. Prevalence and risk factors for allergies in children 6-7 years old in Semarang. Semarang: Universitas Diponegoro; 2005.  Back to cited text no. 9
Soegiarto G, Abdullah MS, Damayanti LA, Suseno A, Effendi C. The prevalence of allergic diseases in school children of metropolitan city in Indonesia shows a similar pattern to that of developed countries. Asia Pac Allergy 2019;9:e17.  Back to cited text no. 10
Price SA, Wilson LM. Konsep Klinis Proses-Proses Penyakit. 6th ed. Jakarta: EGC; 2005.  Back to cited text no. 11
Sihaloho K, Indramaya M. Penelitian Retrospektif: Dermatitis Atopik pada Anak (Retrospective Study: Atopic Dermatitis in Childhood). Portal Garuda 2015;27:177-9.  Back to cited text no. 12
Lin PY, Chu CH, Chang FY, Huang YW, Tsai HJ, Yao TC. Trends and prescription patterns of traditional Chinese medicine use among subjects with allergic diseases: A nationwide population-based study. World Allergy Organ J 2019;12:100001.  Back to cited text no. 13
Islam R, Mizuguchi H, Shaha A, Nishida K, Yabumoto M, Ikeda H, et al. Effect of wild grape on the signaling of histamine H1 receptor gene expression responsible for the pathogenesis of allergic rhinitis. J Med Invest 2018;65:242-50.  Back to cited text no. 14
Samarghandian S, Farkhondeh T, Samini F. Honey and health: A review of recent clinical research. Pharmacognosy Res 2017;9:121-7.  Back to cited text no. 15
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 2020;11:599080.  Back to cited text no. 16
Ellis AK, Soliman M, Steacy L, Boulay MÈ, Boulet LP, Keith PK, et al. The Allergic Rhinitis-Clinical Investigator Collaborative (AR-CIC): Nasal allergen challenge protocol optimization for studying AR pathophysiology and evaluating novel therapies. Allergy Asthma Clin Immunol 2015;11:16.  Back to cited text no. 17
Shaha A, Mizuguchi H, Kitamura Y, Fujino H, Yabumoto M, Takeda N, et al. Effect of royal jelly and brazilian green propolis on the signaling for histamine H1 receptor and interleukin-9 gene expressions responsible for the pathogenesis of the allergic rhinitis. Biol Pharm Bull 2018;41:1440-7.  Back to cited text no. 18
Alandejani T, Marsan J, Ferris W, Slinger R, Chan F. Effectiveness of honey on Staphylococcus aureus and Pseudomonas aeruginosa biofilms. Otolaryngol Head Neck Surg 2009;141:114-8.  Back to cited text no. 19
Alangari AA, Morris K, Lwaleed BA, Lau L, Jones K, Cooper R, et al. Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies. Immun Inflamm Dis 2017;5:190-9.  Back to cited text no. 20
El-Seedi HR, Eid N, Abd El-Wahed AA, Rateb ME, Afifi HS, Algethami AF, et al. Honey bee products: Preclinical and clinical studies of their anti-inflammatory and immunomodulatory properties. Front Nutr 2021;8:761267.  Back to cited text no. 21
Dumitru CD, Neacsu IA, Grumezescu AM, Andronescu E. Bee-derived products: Chemical composition and applications in skin tissue engineering. Pharmaceutics 2022;14:750.  Back to cited text no. 22
Almasaudi S. The antibacterial activities of honey. Saudi J Biol Sci 2021;28:2188-96.  Back to cited text no. 23
Sakač M, Jovanov P, Marić A, Četojević-Simin D, Novaković A, Plavšić D, et al. Antioxidative, antibacterial and antiproliferative properties of honey types from the Western Balkans. Antioxidants (Basel) 2022;11:1120.  Back to cited text no. 24
Engin G, Songül C, İhsan GS. An overview of honey: Its composition, nutritional and functional properties. J Food Sci Eng 2019;9:10-4.  Back to cited text no. 25
Pena Júnior DS, Almeida CA, Santos MC, Fonseca PH, Menezes EV, de Melo Junior AF, et al. Antioxidant activities of some monofloral honey types produced across Minas Gerais (Brazil). PLoS One 2022;17:e0262038.  Back to cited text no. 26


  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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