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Wise et al.

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• Cost: Cost of acupuncture treatment with multiple treatments required. • Benefits-Harm Assessment: Balance of benefit and harm. • Value Judgments: The authors determined that the evidence was inconclusive but that acupuncture could be appropriate for some patients to consider as an adjunct therapy. • Policy Level: Option. • Intervention: In patients who wish to avoid medications, acupuncture may be suggested as possible therapeutic adjunct. IX.B.11.b. Honey.: A long-held belief has been that honey is effective in treating symptoms of AR; however, evidence in support of this is scarce. It is postulated that environmental antigens contained within locally produced honey could, when ingested regularly, lead to the development of tolerance in a manner similar to SLIT. It is important to note that heavy, insect-borne pollens do not meet Thomen’s postulates, as they are not airborne and hence should not be able to induce allergic sensitivity. 818 Studies in animals have demonstrated the ability of honey to suppress IgE antibody responses elicited against different allergens and to inhibit IgE-mediated mast cell activation. 1503-1505 As yet, these same effects have not been tested for in humans; however, studies in humans have demonstrated various anti-inflammatory properties of honey which point to a potential benefit for its use in the treatment of AR. 1506,1507 There have been 2 randomized, double-blind, placebo-controlled trials and 1 RCT evaluating honey in the treatment of AR (Table IX.B.11.b). The studies differed in geographic location, length of honey treatment, dose of honey, and timing regarding specific allergy seasons. One double-blind trial and 1 RCT showed a significant decrease in total symptom scores in the treatment group compared to control. 1508,1509 The RCT additionally reported fewer number of severe symptom days and decreased need for antihistamines in the honey group. 1509 Contradicting these findings, a randomized, double-blind, placebo-controlled trial by Rajan et al. 1510 found no benefit of honey ingestion compared to controls for the relief of AR symptoms. Of note, it has been reported that higher doses (50 to 80 g daily intake) of honey are required to achieve health benefits from honey 1511 and only the study by Asha’ari et al. 1508 dosed patients at that level. • Aggregate Grade of Evidence: B (Level 1b: 2 studies; Level 2b: 1 study; Table IX.B.11.b). • Benefit: Unclear, as studies have shown differing results. Honey may be able to modulate symptoms and decrease need for antihistamines. • Harm: Some patients stopped treatment because they could not tolerate the level of sweetness. Some patients could have an allergic reaction to honey intake, and in rare instances, anaphylaxis. Use of this therapy in prediabetics and diabetics would likely need to be avoided out of concern for elevated blood glucose levels. • Cost: Cost of honey; low.

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Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.