Research Article: Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents

Date Published: January 19, 2017

Publisher: Public Library of Science

Author(s): Parviz Ayazi, Abolfazl Mahyar, Mahdieh Yousef-Zanjani, Abbas Allami, Neda Esmailzadehha, Taraneh Beyhaghi, Thomas Penzel.


Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents.

Partial Text

A cough is a normal protective mechanism of the respiratory system to eliminate excessive secretions and foreign bodies. The causes of cough can be bacterial or viral infections and/or the presence of an irritant or allergen in the respiratory tract [1]. Upper respiratory tract infections (URTIs) are prevalent among the pediatric age group and usually occur 6–8 times per year. URTIs are one of the most common causes of coughing among children [2]. Viruses are generally the cause of URTIs, with bacteria the causative agent in less than 10% of cases [3]. Rhinorrhea, malaise, a low-grade fever, sneezing, and coughing are the typical signs and symptoms of viral disease. Most of these symptoms appear during the first 3 days and disappear within a week. However, the cough may persist for weeks [2,4].

This was a clinical trial study, which began in September 2013 and ended in October 2014. The participants were 1–12 years old children who attended the pediatrics outpatient clinic of the children’s hospital affiliated to Qazvin University of Medical Sciences in Qazvin, Iran. The ethics committee of Qazvin University of Medical Sciences approved the study protocol (No.: 28.20.7932, 15 October 2013), and it was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The parents were given an information sheet about the study protocol before they entered the trial and informed that they could withdraw from the study at any point. All the parents provided written informed consent on behalf of their children.

In total, 92 children were enrolled in the study and the mean age was 3.5±1.6 years. Of these 92 patients, 87 (94.6%) completed the two-night study and the final questionnaire, and none of these patients were excluded from the analysis. The other five (5.4%) patients (two in Group 1, two in Group 2, and one in Group 3) were excluded from the analysis due to inappropriate usage of the treatment (Fig 1). The number of patients lost to follow up was not significantly different between the groups (P>0.050).

Despite the common occurrence of URTIs and coughs, there are no accepted therapies for the latter [10], and most nonantibiotic treatments are probably not effective for coughs [17]. Studies have shown that dextromethorphan and DPH do not relieve the nighttime symptoms of URTIs [18]. Furthermore, these OTC medications have side effects, including somnolence, restlessness, overdoses, and unexpected deaths [5,19–23]. All the aforementioned data have led to the use of other non-OTC drugs or substances, including honey, for the treatment of URTI-related coughs.