Instead of antibiotic creams, some physicians will now be reaching for a much sweeter substitute for the treatment of wounds. The US Food and Drug Administration (FDA) has recently given marketing clearance to both Medihoney Ltd. and Comvita New Zealand Ltd. to produce honey-based wound-care products in the US. This comes at a time when wound care is gaining importance because of an aging population as well as the increase in diabetes cases.
Apitherapy, which is the use of bee honey or its products for prevention or management of diseases or other medical conditions, is currently receiving renewed attention as a venerated medical treatment for a variety of conditions. Products used include honey, pollen, royal jelly, and bee venom.
According to the American Apitherapy Society (AAS), there is evidence that apitherapy may be partially useful for the treatment of several conditions. This ranges from cardiovascular and gastrointestinal to pulmonary and even autoimmune and infectious conditions. AAS is also suggesting apitherapy for neuropathic pain, ring worm, athlete's foot, arthritis, eczema, and other forms of dermatitis.
Wound care by the application of honey is by no means a new concept; in fact, it was used 4,000 ago by the ancient Egyptians. It was also used extensively in World Wars I and II. However, with the discovery of antibiotics and their introduction into mainstream medicine, the use of honey as a poultice started to fade away (Chang et al).
Sudden Comeback
Dr. Peter Molan, director of the honey research unit and professor of biological sciences at the University of Waikato, New Zealand, said that the increasing incidences of antibiotic-resistant bacteria is behind the re-evaluation of honey in wound care. Some species of bacteria have become resistant to many of the available antibiotics due to their overuse as well as the lack of new antibacterial agents. He explained that, more recently, honey has been considered "because of the reports of clinical outcomes that are superior to those achieved with pharmaceutical products, now that selected honey and appropriate dressing procedures are being used."
Honey has been found to have both anti-microbial as well as anti-fungal properties. It inhibits more than 60 different species of bacteria. Honeys "selected for their high level of antibacterial activity have a full spectrum of activity (aerobes, anaerobes, Gram positive, Gram negative, fungi, protozoa) and are fully effective on antibiotic-resistant strains of bacteria," said Molan.
Clarity Henderson, the customer service manager of Comvita New Zealand Ltd. and Medihoney Honey Ltd., said, "Medical honey has been shown to be effective in many different types of wounds, from burns, grazes, cuts, surgical incisions, fissures, sinus wounds, and ulcers." Honey is, therefore, currently being used for the treatment of such wounds, especially when other more conventional modern treatments have failed. The application of honey on wounds has many beneficial effects.
Henderson points out that "research has discovered that the use of honey in wounds helps to provide a moist healing environment, reduce inflammation, reduce odour, and promote the growth of new healthy tissue." It also rapidly clears the infection and reduces pain and swelling. Since it enhances the removal of dead tissue, it promotes the healing process with minimal scarring (DermNet NZ).
Promoting Healing
Honey has a number of anti-microbial properties that act together to inhibit microbes. One of these properties is its high osmolality. Honey is a concentrated sugar solution that draws water away from the microorganisms. This causes them to shrink and dry up, thus inhibiting their growth.
However, it was found that when honey is used for wound therapy, it becomes diluted by the wound exudates. This reduces the osmolality that then becomes insufficient to control the infection. This dilution, however, does not interfere with its anti-microbial properties. On the contrary, it increases it.
This can be explained by the fact that, when diluted by the wound exudates, honey gradually releases low levels of hydrogen peroxide by means of an enzyme reaction. While a three-percent concentration of hydrogen peroxide can damage human tissues besides killing germs, this is not the case with honey. The very low levels of hydrogen peroxide released by honey kill the microbes without causing any harm to the adjacent tissues.
In studies on honey where the hydrogen peroxide component was removed, honey was still found to have antibacterial properties. This has been associated with an unidentified phytochemical component. Phytochemicals are compounds in plant-derived foods that have biological activity in the body. This phytochemical has been found in Manuka honey, which comes from bees that feed on the Manuka bushes (Leptospermum scoparium) of New Zealand.
Honey does more than just inhibit the microbes in the wound. It has also been found to increase and stimulate the activity of immune cells that fight invading germs, enhancing the body's defences and immunity. In addition, the acidity of honey and its glucose content aid certain bacteria-killing cells called macrophages in doing their job, explained Molan.
Types of Honey
Unfortunately, not all honey is made equal. The antibacterial properties of honey depend on its plant source and on the way it is processed after collection. Regular honeys are not suitable for wound therapy – even though they have some level of antibacterial activity. This is because they may contain viable spores such as those of clostridia (the bacteria that cause botulism) as well as pollen and small particles of wax, as they are not adequately filtered. Honey must be sterilized using gamma irradiation and laboratory tested to determine its antibacterial activity before use, explained Molan.
The New Zealand Manuka honey is known to have high antibacterial activity because of its high content of the previously mentioned phytochemical. The phytochemical antibacterial component of the Manuka honey is rated according to its potency using the Unique Manuka Factor (UMF). This scaling system was devised by Molan to gauge the potency of a particular honey's antibacterial activity. "It has been discovered that, while most honeys contain hydrogen peroxide, which in itself assists in cleaning wounds, the Leptospermum (Manuka) honey has added properties in that it contains the Unique Manuka Factor, which is antibacterial in nature," explained Henderson.
If the UMF is high, this indicates a high antibacterial activity. Usually a rating of UMF 10 or higher is used by the healthcare community. This is the type of honey that can kill the antibiotic resistant MRSA bacteria, a group of bacteria that have become resistant to an antibiotic called methicillin. It is also a more stable honey that remains active under conditions such as exposure to light and heat that cause other less stable types to lose their effectiveness (Buonanotte).
"We have tried honey on a very wide range of types of wound, including deep sinuses, and on infections beneath intact skin with manuka honey. We have found that it works extremely well in all cases, even with diabetics, where healing would not normally be expected," explained Molan.
"The only exception has been where there is blockage of the arteries supplying the area of the wound (the tissue is non-viable so healing cannot occur). But honey is still a very suitable dressing on these wounds as it keeps them clean and stops deterioration."
Bee Venom Therapy
In addition to honey-based wound therapy, another form of apitherapy that has been gaining much attention from the media is bee venom therapy (BVT). BVT is the application of honeybee venom therapeutically, using live bee stings to help in the relief and treatment of various conditions. It has been used traditionally in Chinese medicine to bring relief for painful conditions and to treat chronic inflammatory diseases such as rheumatoid arthritis.
The mechanism of action of bee venom is not fully known although it has been investigated for nearly 100 years. Bee venom is made up of a number of active components such as enzymes and proteins that have anti-inflammatory and anti-arthritic properties — possibly by modifying how the immune system functions.
There is also evidence suggesting that bee venom may have analgesic properties. It may assist in the healing of nerve disorders, as it has been found to facilitate the repair of nerve damage and helps restore mobility. In this regard, BVT has been tried for the relief of muscular pain, sciatic pain, and nerve pain.
An additional property of bee venom is its ability to kill cancer cells and inhibit tumor growth. This has lead to extensive research by pharmaceutical companies into the possibility of using bee venom as a potential chemotherapeutic agent against malignancy.
Action
BVT uses bee venom to relieve the symptoms associated with multiple sclerosis (MS). According to Pat Wagner, an MS patient who has been receiving BVT since 1992, there is some evidence supporting the idea that the venom may decrease pain and improve coordination, vision, mobility, as well as the sensitivity to touch in MS patients. The venom is injected by allowing a bee to sting the person's skin, releasing its venom into the recipient. In other cases, it may also be used in a cream, liniment, or ointment.
The principal active component of bee venom is mellitin, a powerful anti-inflammatory substance, said to be 100 times more potent than hydrocortisone. Mellitin can stimulate the adrenal gland to produce cortisol, which aids in the natural healing processes of the body.
There are some precautions that should be applied before deciding to use BVT. Some people may be allergic to bee venom. This may cause severe allergic reactions leading to anaphylactic shock and death. Therefore, it must be first determined if the individual is allergic to the venom. This is done by the administration of small amounts of venom into the skin to see if an allergic reaction develops within a certain period of time. If not, then the number of stings administered is gradually increased for a period determined by the nature and severity of the condition.
Although some cases have reported the effectiveness of BVT, the small number of studies as well as the varying results regarding its efficacy make this form of therapy in need of further studies before it can become an established medical treatment.
Sources:
- "FDA Approves Comvita's Honey Wound Dressing." NZ Food Daily.
- "What Is Apitherapy." Apitherapy.
- Chang, Y. Cho and S. Lo. Jacob. "Dressing the Part." Dermatologic Clinics.
- Molan, P.C. "Honey as a Topical Antibacterial Agent for Treatment of Infected Wounds." World Wide Wounds.
- Ngan, V. "Honey." DermNet NZ.
- Buonanotte, F. "Destroying the MRSA Super-Bug With Manuka Honey." PR-Inside.
- Dong, J. S, Jae, W. L., Young, H. L, Ho, S. S, Chong, K. L and Jin, T. H. "Therapeutic Application of Anti-Arthritis, Pain-Releasing, and Anti-Cancer Effects of Bee Venom and Its Constituent Compounds." Pharmacology & Therapeutics.
- Mirshafiey, A. "Venom Therapy in Multiple Sclerosis." Neuropharmacology.
- Wagner, P. "Bee Sting Therapy: Healing from the Hive." Discovery Health.
- Simics, M. "Bee Venom Therapy." Apitronic Services: Bee Venom Therapy Supplies and Books.
