Song, J.J., Twumasi-Ankrah, P., & Salcido, R. (2012). Systematic review and meta-analysis on the use of honey to protect from the effects of radiation-induced oral mucositis. Advances in Skin & Wound Care, 25, 23–28.

To investigate whether the use of honey provides protection from the effects of radiation-induced mucositis

Databases searched were PubMed, MEDLINE via OVID, EMBASE, CINAHAL via EBSCO, and Cochrane.

Keywords searched were honey and mucositis or stomatitis.

Studies were included in the review if they

• Were randomized controlled trials that investigated protective effects of honey in patients with head and neck cancer undergoing radiation therapy.
• Used Radiation Therapy Oncology Group (RTOG) or World Health Organization (WHO) criteria to evaluate the severity of radiation mucositis.

Studies were excluded if they

• Were nonhuman clinical trials.
• Were nonrandomized controlled trials.
• Involved patients without diagnoses of head and neck cancer.
• Were trials in which the protective effects of honey were not studied.

A total of 15 references were retrieved. Four trials reported on the protective effects of honey. One of these was nonblinded. The remaining three were randomized examiner-blinded, and these three trials were assessed for overall risk of bias using the Cochrane method. Three of the four studies met the inclusion and exclusion criteria for the meta-analysis.

• The final number of studies included was four human trials, but one trial was excluded because it reported only on pain relief, not the protective effects of honey.   
• The total sample across all studies was 120 patients with 40 in each study.
• Studies involved adults with head and neck cancer receiving radiation therapy. In one study, patients were receiving concurrent chemotherapy and radiation. I all studies, patients with systemic illness or prior chemotherapy were excluded.

All patients were undergoing the active treatment phase of care.

Meta-analysis of the of the three trials reported that honey appeared to have protective effects against radiation-induced mucositis by 80% compared to the control group. Overall relative risk of developing mucositis was almost 80% lower (risk ratio, 0.19; 95% confidence interval, 0.098–0.371) in the honey treatment group than in the control group.

Trials were fairly homogeneous (I² = 0%, p = 0.39), so meta-analysis used a fixed-effects model (Mantel-Haenszel method) to calculate a pooled risk ratio.

• A limited number of trials met the criteria for meta-analysis. Individual studies were weak.
• Two of the studies included had a high risk of bias because of plausible bias in several criteria.
• Patients were not blinded because of the taste of honey. 
• Grade 3 or 4 on the RTOG scale was used as the outcome measure of interest.

Further research is needed to strengthen the current evidence prior to any clinical recommendations for practice. They suggested blinding the assessor in future studies.