Many clinical observations have been reported of reduced symptoms of inflammation when honey is applied to wounds (Burlando, 1978; Dumronglert, 1983; Efem, 1993; Hejase et al, 1996; Subrahmanyam, 1996; Subrahmanyam, 1998), and of it having a soothing effect when applied to wounds (Burlando, 1978; Keast-Butler, 1980; Subrahmanyam, 1993) and burns (Burlando, 1978; Subrahmanyam, 1993). The (reported) reduction of exudate in wounds dressed with honey is a great help when managing inflamed wounds (Burlando, 1978; Efem, 1993; Hejase et al, 1996; Al-Waili and Saloom, 1999; Betts and Molan, 2001; Alcaraz and Kelly, 2002; Ahmed et al, 2003). The anti-inflammatory action of honey is also seen in the reports of reducing scarring (Subrahmanyam, 1991; Efem, 1993; Subrahmanyam, 1994; Al-Waili and Saloom, 1999; Dunford et al, 2000a, b) and contractures (Subrahmanyam et al, 2001). As well as these clinical observations, it has been demonstrated in animal models that honey gives reduced inflammation compared with various controls; histological studies finding reduced numbers of inflammatory cells present in deep (Postmes et al, 1997) and superficial (Burlando, 1978) burns and in full-thickness wounds (Gupta et al, 1992; Kumar et al, 1993; Oryan and Zaker, 1998). These effects are due to components other than the sugar in honey (Burlando, 1978; Postmes et al, 1997). Similar evidence has also come from a study of biopsy samples from burn wound tissue of hospital patients (Subrahmanyam, 1998). The anti-inflammatory action of honey is not just a consequence of removing the stimulus for inflammation by clearing infection and debriding the wound, as has been observed in experimental wounds in which there were few or no bacteria present (Burlando, 1978; Kandil et al, 1987; El- Banby et al, 1989; Gupta et al, 1992; Kumar et al, 1993; Postmes et al, 1997; Oryan and Zaker, 1998). There has also been a direct demonstration of the anti-inflammatory properties of honey in a standard test for antiinflammatory agents, where it decreased the stiffness of inflamed wrist joints of guinea pigs (Church, 1954). It has also been reported that, when given orally, honey lowers plasma prostaglandin concentrations in normal individuals (Al-Waili and Boni, 2003)
The component of honey responsible for its anti-inflammatory activity has not been identified, but it may be due to the antioxidant activity of honey. There are significant levels of antioxidants in honey (Frankel et al, 1998; Gheldof and Engeseth, 2002; Gheldof et al, 2002; Gheldof et al, 2003; Schramm et al, 2003), including some which complex with iron to stop it catalysing the Fenton reaction2. This reaction forms free radicals from hydrogen peroxide (Buntting, 2001); these free radicals serve to recruit more leukocytes into areas of inflammation, as a self-amplification of the inflammatory response (Flohé et al, 1985). The mechanism of this self-amplification of the inflammatory response is oxidative activation of the nuclear transcription factor NF-?B, which then promotes the production of pro-inflammatory cytokines by leukocytes (Grimble, 1994) and stimulate the activity of the fibroblasts, thus giving hypergranulation and fibrosis (Murrell et al, 1990). It is the free radicals formed from hydrogen peroxide, rather than hydrogen peroxide itself, that are responsible for the activation of the transcription factor NF-?B (Schreck et al, 1991), and this activation can be prevented by antioxidants (Grimble, 1994). A study carried out on burn wounds has shown that application of antioxidants to mop up free radicals reduces inflammation (Tanaka et al, 1995). In a clinical trial it was found that honey dressings prevented partial-thickness burns from converting to full-thickness burns which would have needed plastic surgery (Subrahmanyam, 1998).
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