Effect of Honey Supplementation on Gastrointestinal Complications in Children with Acute Lymphoblastic Leukemia
Mohsen Saleh El Alfy1,Iman Ahmed Ragab1, Yasmin Gamal1 , Sally Mohamed Saber 1,ZahiaShahat El Sayed1
1Faculty of Medicine, Ain Shams University, Cairo, Egypt

KEY WORDS: ALL, Honey, Mucositis, diarrhea

CONTEXT: The treatment of cancer is associated with gastrointestinal complications and weight loss. Honey can fight microbial infection by its immuno-activating, anti-inflammatory and prebiotic activity. 
OBJECTIVE: the aim of this study is to evaluate the effect of honey supplementation on frequency of gastrointestinal complications in pediatric patients with ALL undergoing chemotherapy.
DESIGN and SETTING: this is a follow up  study included 40 children with ALL followed from December 2015 to December 2016 in Children's Hospital, Ain Shams University, oncology unit.

PATIENTSOR OTHER PARTICIPANTS: Study included children with ALL on chemotherapy. All the studied patients were subjected to medical history and clinical examination, with special emphasis on oral mucositis and different gastrointestinal complications. Follow up was done for weight, height z score, gastrointestinal complications and any adverse events. Stool analysis, culture, Clostridium difficle toxin A, B by ELISA was done to all patients at baseline and repeated to patients receiving honey at week 4 of supplementation
INTERVENTIONS: Patients were randomized into two groups; group I (25 patients) who received honey(dose 2gm/kg 3 times daily  for 1month) while group II (15 patients) who did not receive honey.

MAIN OUTCOMES MEASURES: Gastrointestinal side effects of chemotherapy markedly improved in the supplemented group.
RESULTS: 10 patients (40%) had oral mucositis in group 1(WHO grade1 in 1(28% and grade 2(12%)) and 9 patients (60%) in group 2 had oral ulcers (grade 1(40%) and grade 2 (20%)) at initial evaluation. After honey supplementation a significant improvement in degree of oral mucositis in group 1(0.0%) as compared with group 2(26.70%) at weekly evaluation visit. There was significant decrease and improvement in consistency and frequency of diarrhea and abdominal colics in group 1(0.0%) compared with group 2(20.0%) p =. 02.  A slight increase in weight among the supplemented group after 1 month (z-score was-0.208 initially, -0.03 after 1 month) compared to unsupplemented group (z-score was-0.526 initially, -0.89 after 1 month).

CONCLUSIONS: Honey improves chemotherapy induced gastrointestinal complications. C.difficile infection was present in 8% of studied patients

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