Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies

Geographical Origin Authentication-A Mandatory Step in the Efficient Involvement of Honey in Medical Treatment

Nowadays, in people's perceptions, the return to roots in all aspects of life is an increasing temptation. This tendency has also been observed in the medical field, despite the availability of high-level medical services with many years of research, expertise, and trials. Equilibrium is found in the combination of the two tendencies through the inclusion of the scientific experience with the advantages and benefits provided by nature. It is well accepted that the nutritional and medicinal properties of honey are closely related to the botanical origin of the plants at the base of honey production. Despite this, people perceive honey as a natural and subsequently a simple product from a chemical point of view. In reality, honey is a very complex matrix containing more than 200 compounds having a high degree of compositional variability as function of its origin. Therefore, when discussing the nutritional and medicinal properties of honey, the importance of the geographical origin and its link to the honey's composition, due to potential emerging contaminants such as Rare Earth Elements (REEs), should also be considered. This work offers a critical view on the use of honey as a natural superfood, in a direct relationship with its botanical and geographical origin.

The anti-allergic potential of stingless bee honey from different botanical sources via modulation of mast cell degranulation

BACKGROUND

Allergy is an inflammatory disorder affecting around 20% of the global population. The adverse effects of current conventional treatments give rise to the increased popularity of using natural food products as complementary and alternative medicine against allergic diseases. Stingless bee honey, commonly known as Kelulut honey (KH) in Malaysia, has been used locally as a traditional remedy to relieve cough and asthma. This study evaluated the anti-allergic potential of KH collected from four different botanical sources on phorbol ester 12-myristate-3-acetate and calcium ionophore-activated human mast cells.

METHODS

The present study examined the inhibitory effects of all collected honey on the release of selected inflammatory mediators, such as tumor necrosis factor-α (TNF-α), interleukin (IL)-4, IL-6, IL-8, histamine, and β-hexosaminidase in an activated HMC. Besides that, all honey's total phenolic content (TPC) was also examined, followed by using liquid chromatography with tandem mass spectrometry (LC-MS/MS) to identify the phytochemicals in the honey. Further examination of the identified phytochemicals on their potential interaction with selected signaling molecules in an activated mast cell was conducted using computational methods.

RESULTS

The results indicated that there were significant inhibitory effects on all selected inflammatory mediators' release by KH sourced from bamboo (BH) and rubber tree (RH) at 0.5% and 1%, but not KH sourced from mango (AH) and noni (EH). BH and RH were found to have higher TPC values and were rich in their phytochemical profiles based on the LC-MS/MS results. Computational studies were employed to determine the possible molecular target of KH through molecular docking using HADDOCK and PRODIGY web servers.

CONCLUSIONS

In short, the results indicated that KH possesses anti-allergic effects towards an activated HMC, possibly by targeting downstream MAPKs. However, their anti-allergic effects may vary according to their botanical sources. Nevertheless, the present study has provided insight into the potential application of stingless bee honey as a complementary and alternative medicine to treat various allergic diseases.

Manuka honey activates the aryl hydrocarbon receptor: Implications for skin inflammation

Manuka honey (MH) is a complex nutritional material with antimicrobial, antioxidant and anti-inflammatory activity. We have previously shown that MH down regulates IL-4-induced CCL26 expression in immortalized keratinocytes. As MH contains potential ligands of the Aryl Hydrocarbon Receptor (AHR), a key regulator of skin homeostasis, we hypothesize that this effect is mediated via AHR activation. Here, we treated HaCaT cell lines, either stable transfected with an empty vector (EV-HaCaT) or in which AHR had been stable silenced (AHR-silenced HaCaT); or primary normal human epithelial keratinocytes (NHEK) with 2% MH for 24 h. This induced a 15.4-fold upregulation of CYP1A1 in EV-HaCaTs, which was significantly reduced in AHR-silenced cells. Pre-treatment with the AHR antagonist CH223191 completely abrogated this effect. Similar findings were observed in NHEK. In vivo treatment of the Cyp1a1Cre x R26ReYFP reporter mice strain's skin with pure MH significantly induced CYP1A1 expression compared with Vaseline. Treatment of HaCaT with 2% MH significantly decreased baseline CYP1 enzymatic activity at 3 and 6 h but increased it after 12 h, suggesting that MH may activate the AHR both through direct and indirect means. Importantly, MH downregulation of IL-4-induced CCL26 mRNA and protein was abrogated in AHR-silenced HaCaTs and by pre-treatment with CH223191. Finally, MH significantly upregulated FLG expression in NHEK in an AHR-dependent manner. In conclusion, MH activates AHR, both in vitro and in vivo, thereby providing a mechanism of its IL4-induced CCL26 downregulation and upregulation of FLG expression. These results have potential clinical implications for atopic diseases and beyond.

Allergies and Natural Alternatives

Complementary and integrative medicine therapies in the treatment of allergy and allergic rhinitis (AR) are divided broadly into the categories of nutritional supplements, herbal supplements, Ayurvedic, and Chinese traditional medicine. Some therapies are likely completely safe, such as Manuka honey, with no known side effects. Others have significant risks, such as ephedra, which was ultimately banned for use by the Food and Drug Administration. The efficacy of these therapies is varied and under-researched. The therapies with the strongest evidence in the treatment of allergy and AR are Manuka honey, butterbur, and Sinupret.

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

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.

Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis

Background

Complementary and alternative medicine (CAM) treatments are growing in popularity as alternative treatments for common skin conditions.

Objectives

To perform a systematic review and meta-analysis to determine the tolerability and treatment response to CAM treatments in acne, atopic dermatitis (AD), and psoriasis.

Methods

PubMed/Medline and Embase databases were searched to identify eligible studies measuring the effects of CAM in acne, AD, and psoriasis. Effect size with 95% confidence interval (CI) was estimated using the random-effect model.

Results

The search yielded 417 articles; 40 studies met the inclusion criteria. The quantitative results of CAM treatment showed a standard mean difference (SMD) of 3.78 (95% CI [−0.01, 7.57]) and 0.58 (95% CI [−6.99, 8.15]) in the acne total lesion count, a SMD of −0.70 (95% CI [−1.19, −0.21]) in the eczema area and severity index score and a SMD of 0.94 (95% CI [−0.83, 2.71]) in the scoring of atopic dermatitis score for AD, and a SMD of 3.04 (95% CI [−0.35, 6.43]) and 5.16 (95% CI [−0.52, 10.85]) in the Psoriasis Area Severity Index score for psoriasis.

Limitations

Differences between the study designs, sample sizes, outcome measures, and treatment durations limit the generalizability of data.

Conclusions

Based on our quantitative findings we conclude that there is insufficient evidence to support the efficacy and the recommendation of CAM for acne, AD, and psoriasis.

The Rediscovery of Honey for Skin Repair: Recent Advances in Mechanisms for Honey-Mediated Wound Healing and Scaffolded Application Techniques

Honey is a honey-bee product obtained mainly by the enzymatic processing of nectar from a variety of plants, which leads to the wide range of colours and flavours available on the market. These organoleptic and nutritional features are influenced by the chemical composition, which in turn depends on the botanical origin. Bioactive compounds account for honey beneficial activity in medical applications, which explains the extensive use of honey in ethno-pharmacology since antiquity, from cough remedies to dermatological treatments. Wound healing is one of the main therapeutic uses of honey, and various design options in pharmaceutical technology such as smart delivery systems and advanced dressings are currently being developed to potentiate honey’s valuable properties for better performance and improved final outcome. In this review, we will focus on the latest research that discloses crucial factors in determining what properties are most beneficial when considering honey as a medicinal product. We will present the most recent updates on the possible mechanisms responsible for the exceptional effects of this ageless therapeutical remedy on skin repair. Furthermore, the state-of-the-art in application techniques (incorporation into scaffolds as an alternative to direct administration) used to enhance honey-mediated wound-healing properties are explored.

The Potential use of Honey as a Remedy for Allergic Diseases: A Mini Review

Honey has been conventionally consumed as food. However, its therapeutic properties have also gained much attention due to its application as a traditional medicine. Therapeutic properties of honey such as anti-microbial, anti-inflammatory, anti-cancer and wound healing have been widely reported. A number of interesting studies have reported the potential use of honey in the management of allergic diseases. Allergic diseases including anaphylaxis, asthma and atopic dermatitis (AD) are threatening around 20% of the world population. Although allergic reactions are somehow controllable with different drugs such as antihistamines, corticosteroids and mast cell stabilizers, modern dietary changes linked with allergic diseases have prompted studies to assess the preventive and therapeutic merits of dietary nutrients including honey. Many scientific evidences have shown that honey is able to relieve the pathological status and regulate the recruitment of inflammatory cells in cellular and animal models of allergic diseases. Clinically, a few studies demonstrated alleviation of allergic symptoms in patients after application or consumption of honey. Therefore, the objective of this mini review is to discuss the effectiveness of honey as a treatment or preventive approach for various allergic diseases. This mini review will provide insights into the potential use of honey in the management of allergic diseases in clinical settings.

Interventions to reduce Staphylococcus aureus in the management of eczema

BACKGROUND

Staphylococcus aureus (S. aureus) can cause secondary infection in eczema, and may promote inflammation in eczema that does not look infected. There is no standard intervention to reduce S. aureus burden in eczema. It is unclear whether antimicrobial treatments help eczema or promote bacterial resistance. This is an update of a 2008 Cochrane Review.

OBJECTIVES

To assess the effects of interventions to reduce S. aureus for treating eczema.

SEARCH METHODS

We updated our searches of the following databases to October 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase and LILACS. We searched five trials registers and three sets of conference proceedings. We checked references of trials and reviews for further relevant studies. We contacted pharmaceutical companies regarding ongoing and unpublished trials.

SELECTION CRITERIA

Randomised controlled trials of products intended to reduce S. aureus on the skin in people diagnosed with atopic eczema by a medical practitioner. Eligible comparators were a similar treatment regimen without the anti-staphylococcal agent.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. Our key outcomes were participant- or assessor-rated global improvement in symptoms/signs, quality of life (QOL), severe adverse events requiring withdrawal, minor adverse events, and emergence of antibiotic-resistant micro-organisms.

MAIN RESULTS

We included 41 studies (1753 analysed participants) covering 10 treatment categories. Studies were conducted mainly in secondary care in Western Europe; North America; the Far East; and elsewhere. Twelve studies recruited children; four, adults; 19, both; and six, unclear. Fifty-nine per cent of the studies reported the mean age of participants (range: 1.1 to 34.6 years). Eczema severity ranged from mild to severe. Many studies did not report our primary outcomes. Treatment durations ranged from 10 minutes to 3 months; total study durations ranged from 15 weeks to 27 months. We considered 33 studies at high risk of bias in at least one domain. We present results for three key comparisons. All time point measurements were taken from baseline. We classed outcomes as short-term when treatment duration was less than four weeks, and long-term when treatment was given for more than four weeks. Fourteen studies evaluated topical steroid/antibiotic combinations compared to topical steroids alone (infective status: infected (two studies), not infected (four studies), unspecified (eight studies)). Topical steroid/antibiotic combinations may lead to slightly greater global improvement in good or excellent signs/symptoms than topical steroid alone at 6 to 28 days follow-up (risk ratio (RR) 1.10, 95% confidence interval (CI) 1.00 to 1.21; 224 participants; 3 studies, low-quality evidence). There is probably little or no difference between groups for QOL in children, at 14 days follow-up (mean difference (MD) -0.18, 95% CI -0.40 to 0.04; 42 participants; 1 study, moderate-quality evidence). The subsequent results for this comparison were based on very low-quality evidence, meaning we are uncertain of their validity: severe adverse events were rare (follow-up: between 6 to 28 days): both groups reported flare of dermatitis, worsening of the condition, and folliculitis (325 participants; 4 studies). There were fewer minor adverse events (e.g. flare, stinging, itch, folliculitis) in the combination group at 14 days follow-up (218 participants; 2 studies). One study reported antibiotic resistance in children at three months follow-up, with similar results between the groups (65 participants; 1 study). Four studies evaluated oral antibiotics compared to placebo (infective status: infected eczema (two studies), uninfected (one study), one study's participants had colonisation but no clinical infection). Oral antibiotics may make no difference in terms of good or excellent global improvement in infants and children at 14 to 28 days follow-up compared to placebo (RR 0.80; 95% CI 0.18 to 3.50; 75 participants; 2 studies, low-quality evidence). There is probably little or no difference between groups for QOL (in infants and children) at 14 days follow-up (MD 0.11, 95% CI -0.10 to 0.32, 45 participants, 1 study, moderate-quality evidence). The subsequent results for this comparison were based on very low-quality evidence, meaning we are uncertain of their validity: adverse events requiring treatment withdrawal between 14 to 28 days follow-up were very rare, but included eczema worsening (both groups), loose stools (antibiotic group), and Henoch-Schönlein purpura (placebo group) (4 studies, 199 participants). Minor adverse events, including nausea, vomiting, diarrhoea, and stomach and joint pains, at 28 days follow-up were also rare and generally low in both groups (1 study, 68 infants and children). Antibiotic resistance at 14 days was reported as similar in both groups (2 studies, 98 infants and children). Of five studies evaluating bleach baths compared to placebo (water) or bath emollient (infective status: uninfected (two studies), unspecified (three studies)), one reported global improvement and showed that bleach baths may make no difference when compared with placebo at one month follow-up (RR 0.78, 95% CI 0.37 to 1.63; 36 participants; low-quality evidence). One study showed there is probably little or no difference in QOL at 28 days follow-up when comparing bleach baths to placebo (MD 0.90, 95% CI -1.32 to 3.12) (80 infants and children; moderate-quality evidence). We are uncertain if the groups differ in the likelihood of treatment withdrawals due to adverse events at two months follow-up (only one dropout reported due to worsening itch (placebo group)) as the quality of evidence was very low (1 study, 42 participants). One study reported that five participants in each group experienced burning/stinging or dry skin at two months follow-up, so there may be no difference in minor adverse events between groups (RR 1.00, 95% CI 0.35 to 2.87, 36 participants, low-quality evidence). Very low-quality evidence means we are also uncertain if antibiotic resistance at four weeks follow-up is different between groups (1 study, 80 participants ≤ 18 years).

AUTHORS' CONCLUSIONS

We found insufficient evidence on the effects of anti-staphylococcal treatments for treating people with infected or uninfected eczema. Low-quality evidence, due to risk of bias, imprecise effect estimates and heterogeneity, made pooling of results difficult. Topical steroid/antibiotic combinations may be associated with possible small improvements in good or excellent signs/symptoms compared with topical steroid alone. High-quality trials evaluating efficacy, QOL, and antibiotic resistance are required.

Antibacterial activity of varying UMF-graded Manuka honeys

Honey has been used as a traditional remedy for skin and soft tissue infections due to its ability to promote wound healing. Manuka honey is recognized for its unusually abundant content of the antibacterial compound, methylglyoxal (MGO). The Unique Manuka Factor (UMF) grading system reflects the MGO concentration in Manuka honey sold commercially. Our objective was to observe if UMF values correlated with the antibacterial activity of Manuka honey against a variety of pathogens purchased over the counter. The antibacterial effect of Manuka honey with UMF values of 5+, 10+, and 15+ from the same manufacturer was assessed by the broth microdilution method. Minimum inhibitory concentration (MIC) values were determined against 128 isolates from wound cultures representing gram-positive, gram-negative, drug-susceptible, and multi-drug resistant (MDR) organisms. Lower MICs were observed with UMF 5+ honey for staphylococci (n = 73, including 25 methicillin-resistant S. aureus) and Pseudomonas aeruginosa (n = 22, including 10 MDR) compared to UMF 10+ honey (p<0.05) and with UMF 10+ compared to UMF 15+ (p = 0.01). For Enterobacteriaceae (n = 33, including 14 MDR), MIC values were significantly lower for UMF 5+ or UMF 10+ compared to UMF 15+ honey (p<0.01). MIC₅₀ for UMF 5+, UMF 10+, and UMF 15+ honey against staphylococci was 6%, 7%, and 15%, and for Enterobacteriaceae was 21%, 21%, and 27%, respectively. For Pseudomonas aeruginosa MIC₅₀ was 21% and MIC₉₀ was 21–27% for all UMFs. Manuka honey exhibited antimicrobial activity against a spectrum of organisms including those with multi-drug resistance, with more potent activity overall against gram-positive than gram-negative bacteria. Manuka honey with lower UMF values, in our limited sampling, paradoxically demonstrated increased antimicrobial activity among the limited samples tested, presumably due to changes in MGO content of honey over time. The UMF value by itself may not be a reliable indicator of antibacterial effect.

Alternative Treatments for Atopic Dermatitis: An Update

Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease in which management with topical anti-inflammatory agents during exacerbations remains the mainstay of treatment. With no cure in sight, a significant proportion of patients elect to incorporate complementary and alternative medicine (CAM) as an adjunct to conventional treatment. Many clinicians find it difficult to provide recommendations as the field covers an extensive number of very disparate therapies, with limited quality evidence to indicate efficacy. Since publication of the last review on this topic in the Journal that compiled and analyzed randomized controlled trials (RCTs) on CAMs in 2015, several new studies have surfaced. This update aims to aggregate and review these new data. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Global Resource for EczemA Trials (GREAT) databases for RCTs on complementary and alternative therapies in AD from March 2015 through May 2018, resulting in 15 studies being included in this review. The preliminary results for many treatments such as vitamin E, East Indian Sandalwood Oil (EISO), melatonin, L-histidine, and Manuka honey show positive clinical effects, but there is currently not enough evidence to recommend their use in AD therapy. Future investigative efforts should focus on reproducing some of these studies with a larger sample size whose clinical characteristics and demographics are more reflective of the general AD population, and standardizing the process to produce reliable data.

Manuka Honey: A Case Study of Severe Atopic Eczematous Dermatitis Reaction to Henna Tattoo

Many mainstream medications were derived from plants and originally utilized in patient management well prior to the extensive research and testing processes of current pharmaceutical standards. The evolution of therapeutic management within the pharmaceutical and skin care industry often uses synthetic processing of products with less of a focus on the natural ingredients from which they were originally derived. However, more recently there has been a shift in pharmacological management to include the therapeutic use of more holistic medicines and practices and thus a broadening of the uses of nontraditional medical treatment options. This has been seen in the use of treatments, such as Manuka honey, for skin conditions and dermal injuries. It is often with off-label uses, or conditions resistant to other treatments, that then prompt the use of holistic products and the true value of the product is validated. As with the following case study, the example of the use of Manuka honey on a severe atopic contact dermatitis eczematous reaction provides further documentation and supportive evidence of the potential efficacy of the properties of this particular natural product.