1 Department of Otolaryngology, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Natural Medicines Office in Deputy of Food and Drug, Ministry of Health and Medical Educations, Tehran, Iran
4 Department of Dermatology, Baqiyatallah University of Medical Sciences, Tehran, Iran
5 Department of Hematology and Oncology, Baqiyatallah University of Medical Sciences, Tehran, Iran
6 Department of Epidemiology and Biostatics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
7 Research Branch, Islamic Azad University of Pharmaceutical Science, Tehran, Iran
8 Research Center of Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Natural Medicines Office in Deputy of Food and Drug, Ministry of Health and Medical Educations, Tehran, Iran
4 Department of Dermatology, Baqiyatallah University of Medical Sciences, Tehran, Iran
5 Department of Hematology and Oncology, Baqiyatallah University of Medical Sciences, Tehran, Iran
6 Department of Epidemiology and Biostatics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
7 Research Branch, Islamic Azad University of Pharmaceutical Science, Tehran, Iran
8 Research Center of Baqiyatallah University of Medical Sciences, Tehran, Iran
BMC Complementary and Alternative Medicine 2014, 14:293
doi:10.1186/1472-6882-14-293
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/293
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/293
| Received: | 2 April 2014 |
| Accepted: | 17 July 2014 |
| Published: | 8 August 2014 |
© 2014 Raeessi et al.; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
Background
Oral mucositis is one of the common complications of cancer chemotherapy and about
40% of the patients who take chemotherapy protocols, experience this irritating problem.
The purpose of this study was to draw comparison between the therapeutic effects of
our treatment modalities (topical steroid, honey, honey plus coffee) in patients suffering
from oral mucositis.
Methods
This was a double blinded randomised clinical trial of a total of 75 eligible adult
participants which they randomly fell into three treatment groups. For all the participants
a syrup-like solution was prepared. Each 600 grams of the product consisted of “20
eight-mg Betamethasone solution ampoules” in the Steroid (S) group, “300 grams of
honey plus 20 grams of instant coffee” in the Honey plus Coffee (HC) group, and “300
grams of honey” for the Honey (H) group. The participants were told to sip 10 ml of
the prescribed product, and then swallow it every three hours for one week. Severity
of lesions was clinically evaluated before the treatment and also one week after the
initiation of the intervention. This study adhered to the principles of the Declaration
of Helsinki and guidelines of Good Clinical Practice.
Results
This study showed that all three treatment regimens reduce the severity of lesions.
The best reduction in severity was achieved in HC group. H group and S group took
the second and third places. In other words, honey plus coffee regimen was the most
effective modality for the treatment of oral mucositis.
Conclusion
Oral mucositis can be successfully treated by a combination of honey and coffee as
an alternative medicine in a short time. Further investigations are warranted in this
field.
Trial registration
Iranian Registry of Clinical Trials IRCT: 201104074737N3, (9 May 2011).
Keywords:
Oral mucositis; Cancer chemotherapy; Honey; Coffee; Topical steroidBackground
Approximately 57 million deaths occur every year in the world which cancers are responsible
for 27% of them [1,2]. Increased life expectancy, environmental alterations, the changes in lifestyle,
potential precise diagnosis, longer life spans and smoking are some of the mentioned
causes for increased cancer rates [3,4].
Cancers are mostly treated with one or more cytotoxic anti-neoplastic agents (chemotherapeutic
drugs) as part of a standardised regimen [5]. Anti-neoplastic or cytotoxic drugs trigger all cells with rapid replication cycle.
Thereby not only they kill cancer cells, but also hair follicles, bone marrow cells
and basal epithelial cells of digestive tract are implicated. Therefore the patients
who receive chemotherapy drugs may suffer from mucositis in oral cavity, oropharynx
and digestive system [6]. Oral mucositis is one of the common irritating complications of cancer treatment
[7,8]. At least 30-40% of the patients who take chemotherapy drugs, experience some degrees
of this oral problem which starts five to ten days after the initiation of the treatment
regimen [6].
Oral mucositis is characterised by inflammation, erythema and ulcerations of the mucous
membrane of the oral cavity. This mucositis cusses a lot of pain which interferes
with normal feeding and may lead to secondary complications such as dehydration, parageusia
and malnutrition. In myelosuppressed cancer patients, the infected mucous of the oral
cavity can also be a source of systemic infection and septicemia [9]. Undoubtedly, its effective therapy can substantially reduce the oral complications
and the risk of oral and systemic infections. One of the common treatments for oral
mucositis is topical steroids which is expensive and may have side effects [10-14]. Our suggested treatment is the combination of coffee and honey.
Honey is one of the oldest known natural drugs and since ancient times has been regarded
as a health giving substance [15]. Its medical use is recorded from around 3000 B.C. onward and is addressed as a curative
substance in the holy Bible. Honey has been highly valued in the Middle East region
and it was mentioned as a curative material for human illnesses more than 1400 years
ago in the Holy Quran. In traditional medicine, honey has been used for treatment
of the signs and symptoms of Upper Respiratory Tract Infections (URTIs), especially
coughing [16-20]. The World Health Organization (WHO) has cited that honey demulcents may soothe the
throat and therefore it can be a potential treatment for cough and other URTI symptoms
[17].
Honey bees produce honey from flower nectar [21,22].Since honey is not a generic product and its ingredients and their relative amounts
depend on the flora of the area from which honey bees collect pollen, it is difficult
to determine the composition of honey [23]. It has been reported that honey contains more than 200 substances such as sugars,
proteins, minerals, some vitamins, organic acids and antioxidants (phenolic compounds,
enzymes, flavonoids, amino acids, carotenoid-like substances and other phytochemicals)
[22,24-26]. According to some studies, honey by its antioxidants can increase cytokine release
and has antimicrobial effects [27-29]. Moreover it can prevent cellular oxidative damage which leads to aging, diseases
and death [22].
In recent decades, honey has been rediscovered for the maintenance of health in several
diseases, burns, injuries, and wounds [17,30]. It has many medicinal properties including its wound healing capacity [31]. Moreover, honey reduces inflammation and edema, stimulates epithelialisation and
tissue regeneration and thus improves granulation and debridement [16,32,33] which in turn accelerates tissue repair and leads to wound healing [16,20,32-36]. Owing to its therapeutic properties in the treatment of gingivitis and periodontal
disorders, honey is also recommended for dental hygiene [37,38]. Honey by its sweet substances stimulates saliva secretion and also the secretion
of mucus in the airways [16,32,39]. Previously, some studies have proved promising effects of honey on the cancer treatment-induced
oral mucositis [9,40-42].
On the other hand, Caffeine is a natural alkaloid in coffee, tea, cola drinks, and
cocoa [43]. Bronchodilators such as methylxanthines (theophylline and caffeine) stimulate breathing
and have been used to prevent apnea [43,44]. Caffeine is also hypoalgesic and has anti-oxidant and anti-inflammatory effects
[43-45]. It is the world’s most commonly used psychoactive substance which stimulates the
central nervous system [46]. Caffeine improves psychomotor performance and increases self-reported alertness
and decreases self-reported weariness and sleepiness. Coffee per se or its specific
compounds contain antioxidant properties and have protective effects against oxidative
DNA damage, liver lesions (hepatotoxicant induced fibrosis) and tissue damage [47]. Coffee consumption also attenuates liver induced insulin resistance [48].
To the best of our knowledge, there have been no previous reports about the combination
of honey and coffee as a treatment for oral mucositis. While assessing the effect
of “honey plus coffee” on the persistence post-infectious cough in our three previous
studies [49-51], we noticed the rapid healing impact of this treatment modality on the lesions in
hypopharynx mucosal membrane. Thus we decided to design a new trial to evaluate the
effect of this regimen on oral mucositis after cancer chemotherapy. Considering the
great number of people around the world suffering from oral mucositis, the aim of
this study was to evaluate the therapeutic effects of coffee plus honey and compare
them with those of topical steroids in the treatment of patients with oral mucositis
after cancer chemotherapy.
