Honey and Infant Botulism

My daughter is now 7 months old. I have been adding locally produced honey to my daughter’s food to help with her allergies. In my opinion, this has decreased her allergy like symptoms. My wife and I have had great success decreasing our allergies with this practice. I was told that honey can hurt an infant. Is this true?
Mark Torrans – Pineville, Louisiana

Honey and Infant Botulism

Dr. Greene’s Answer:

Mark, your care for your daughter comes through clearly in your question. Taking the initiative with preventive measures to insure her health and comfort is a very loving act. Getting information regarding the safety and efficacy of these preventive measures is very wise indeed, and may save your daughter’s life.

Like you, I have heard claims that wild honey might reduce allergy symptoms. In fact, today in a local supermarket I saw a jar labeled “100% Natural Raw Honey, Unfiltered Unblended.” This product went on to promise great health benefits.

And indeed, careful scientific study has recognized great medicinal value in honey. Honey has significant, known antibiotic properties (Journal of Pharmacology, Nov 1996). Honey is also a traditional remedy for upset stomach. It has now been proven to prevent the growth of Helicobacter pylori in the stomach — the organism responsible for many ulcers and much abdominal discomfort (J R Soc Med, Jan 1994). Honey also reduces the gastritis caused by drinking too much alcohol (Scandinavian Journal of Gastoenterology, Mar 1991).

Honey has been proven to decrease the cancer-producing effects of many carcinogens, and to be effective in eradicating yeast (Cytologic Genetics, Nov-Dec 1996). Topical honey is known to be useful in treating gangrene, preventing both death and amputation (Surgery, Feb 1993). Burns heal faster when treated with honey than when treated with OpSite burn dressings (British Journal of Plastic Surgery, Jun 1993). There is also less pain, less scarring, and fewer contractures when burns are treated with honey rather than with Silvadene dressings (British Journal of Surgery, Apr 1991). In Russia, honey was even proven to effectively preserve vision when cataracts begin to form in the elderly (Vestn Oftalmol, Nov-Dec 1990). Honey is an amazing substance — but …

As it turns out, NOT giving your daughter honey while she is an infant is an important preventive health measure. It may save her life.

The concern is with infant botulism.

Botulinum spores are found widely in soil, dust, and honey. Adults who swallow botulinum spores are almost never affected. When infants swallow the spores, however, the spores can germinate in their immature gastrointestinal tracts and begin producing botulinum toxin. This has occurred even when the honey was only used to sweeten a pacifier (European Journal of Epidemiology, Nov 1993).

Botulinum toxin is the most poisonous natural substance known to man. The lethal dose is only 0.0000001 mg per kg of body weight — an amount that would be invisible to the naked eye. This tiny amount in the blood stream can cause death within minutes through paralysis of the muscles used in breathing.

Infant botulism has been found on every continent except Africa (Journal of Perinatology (2007) 27, 175–180). In the United States it is most common in the states of California, Utah, and Pennsylvania. While infant botulism can occur from taking in soil or dust (especially vacuum cleaner-bag dust), eating honey is a more easily preventable cause. Corn syrups are not sterilized and may also be a source of contamination (The AAP Red Book, 2000).

Infant botulism can occur any time in the first year of life, but like SIDS it is most common in the first six months. In fact it has been suggested that it might be the cause of death in up to 10% of SIDS cases (Nelson Textbook of Pediatrics; Saunders 1992).

Thankfully, in most instances of infant botulism, the amount of toxin is so incredibly minuscule that the case remains mild. For this reason it is often misdiagnosed.

The first symptom of infant botulism is constipation (which is also a common benign finding in many infants). This can appear 3 to 30 days following ingesting spore-containing honey (The AAP Red Book, 2000). Typically, the parents then observe increasing listlessness, decreased appetite, and weakened cry over the next several days. Nursing mothers often report new engorgement. Sometimes this is the full extent of the disease. If the disease progresses, however, the child moves less and less and might begin to drool from the mouth. Gagging and sucking reflexes diminish. Loss of previous head control is also an important sign. Complete respiratory arrest can occur either suddenly or gradually.

If an otherwise healthy baby develops constipation, followed by weakness and difficulty in sucking, crying, or breathing, then infant botulism should be considered the most likely diagnosis until proven otherwise.

When infant botulism is diagnosed, the average Intensive Care Unit stay for the baby is about one month, typically including mechanical ventilation and continuous tube feedings. This is followed by another 2 weeks on the hospital ward, with a total hospital cost often exceeding $100,000 (Pediatrics; Feb 1991). Thankfully if the botulism is correctly diagnosed and the baby receives appropriate supportive care, almost all will recover fully and completely. The fatality rate for babies who have been hospitalized with botulism is less than 1%. Recently, an antitoxin for infant botulism has been developed and shown to reduce hospital days, mechanical ventilation, and tube feedings (The AAP Red Book, 2000).

The single most effective way to prevent infant botulism is for infants to avoid honey. Breast feeding also appears to lessen the severity of botulism cases.

Therefore, despite other health benefits, honey is an unsafe food for any infant. HONEY SHOULD NOT BE GIVEN TO CHILDREN YOUNGER THAN 12 MONTHS.

Breast feeding, though, is a great way to prevent or decrease allergy symptoms. Breast feeding and minimizing your daughter’s being exposed to potential allergens (such as cigarette smoke, cat hair, house dust, etc.) are the best ways to serve your goals of reducing her allergies and her allergy symptoms. These measures will benefit your daughter now, and the benefit will last for years to come.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. krystal

    My baby is now 2 weeks old and I gave her honey on pacifier and now I read this article im freaking out I see no.signs so far….what should I do doctor doesn’t open until Monday and its Friday evening…. shoukd I take her to er to get checked?

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  2. Steve Bowman

    For anyone asking if it is safe to give their child, who is under 12 months old, honey, the answer is a simple NO. If you read the article it is made clear that Botulism is a serious risk up to 12 months old. If you have been in the habit of giving your infant honey until just recently and are wondering if you should take him/her to your pediatrician, I would definitely say yes. It is better to be safe than sorry, and the life of your child is worth being very safe. It is common sense; DO NOT give your infant honey or products mixed with honey, or products meant for children much older than your infant unless specifically directed by your pediatrician.

    On a side note, if you are a breastfeeding mother wondering if it is safe for you to ingest honey, I believe the answer is yes. You will digest the honey safely and nothing dangerous can be passed on to your infant. If anyone has contrary information, however, feel free to correct.

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  3. Mark

    My wife and I have a newborn baby girl, now 1.5 months old. We never knew that giving our baby girl a finger tip coated in honey to relieve hiccups could cause constipation. Within the last 3 days she has not had a bowel movement yet is breast fed 75-80 percent of the time. How do I know when to see a doctor or when I’m just overreacting?

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    • John

      It’s the botulin toxin, not the honey, that causes the constipation. Dun dun dun. I would ask my pediatrician.

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  4. shella

    Is it safe to my baby to take honey? My baby is 6 months old?

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    • Steve Bowman

      NO! Not at all! Did you even read the article?

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  5. Esperansa

    My son’s tongue was cleaned with honey and sometimes he was given to consume by the lady who came to give him bath. This was done almost alternate days from the first month itself until he completed two months. He used to cry a lot during that period but now he is okay. After reading the article on honey I’m disturbed, tense and worried. What am I supposed to do? Do I have to take him for a test or a check up?

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  6. ruby

    My daughter is 9 weeks old and I dabbed a tiny amount of yoghurt that was mixed with honey on her mouth. I wasn’t aware that infant botulism existed and now I’m really starting to worry. Please, please can someone give me some advice? I’m starting to panic. Thank you.

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    • Steve Bowman

      Take your baby to a pediatrician and take their advice. If there have been no symptoms thus far you should be okay, but please be safe and check with a doctor.

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  7. Carmen van der Hoef

    Hi Dr. Greene. I have a 7 month old baby who I am still breastfeeding and was wondering if it is safe for my baby if I myself eat raw honey (we have our own beehive in our back yard which we harvest honey from). Is it possible for my baby to contract Botulism in this way?

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    • Jen

      Did you ever find anything out on honey and nursing?

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  8. arathi

    My baby is 7months old. I gave her one drop of honey 5 to 6 times during this 7months. After reading this article I have stopped giving honey. Is there any change of getting any problem with what I have done previously. My concern is I have the habit of having warm water with honey in the morning. since am feeding my baby can I continue using honey in my dite or should I avoid using it.

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  9. Sean VDM

    Hi there. My 11 week old child has started going to day-care and it was suggested that he takes Bio-Strath for tots and toddlers to help prevent him picking up illness. I have noticed that it contains honey. Should this product then be avoided or has the honey been treated?

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    • Katherine Parrick

      You absolutely SHOULD NOT give your child Bio-Strath at 11 weeks-old. And I would seriously [re]consider the intelligence-level (ahem, or utter lack thereof) of whoever recommended this to you!

      If you’re looking for a preventative, call YOUR pediatrician and ask if there’s anything formulated especially for babies and newborns. In the meanwhile, bottle up your breastmilk and send it along with your child to day care…breast milk has more protective qualities than anything you can BUY.

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    • Katherine Parrick

      Um, just felt the need to add: something made for TOTS and TODDLERS means something for kids ages two and up. It says right there in the name that it ISNT meant for your 11 WEEK old baby.

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  10. L.Johnson

    My 11 month old daughter has a cold, I took her to the pediatrician and he suggested that I get a cough syrup called Little Remedies. Its has 100% Honey, but the label says not give to children younger than 12 months, because of the risk of BOTULISM. Is it safe for her to continue this medicine?

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    • Stephanie

      Hylands baby makes a cough syrup that has no honey in it and it is all natural. You could try that one instead . I got mine at Babies R Us.

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  11. Aanchal

    My baby girl is seven months old and I am giving her honey continuously to prevent her from teething troubles. is it safe or not?

    Should salt be given to her or not?

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    • Katherine Parrick

      Argh. No, it’s not safe. Did you not READ the article? Stop giving your BABY honey. Period.

      And the salt… Why? What possible reason is there to give it to your kid? Sure, when they’re able to eat adult foods, they can partake in the seasoning and flavor of the foods but salt itself is dangerous in the long term to ones health (especially the heart). And short-term overexposure can cause serious imbalances in a tiny body. I certainly wouldn’t risk it. So why bother?

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  12. Raj

    I gave my 4 and a half month old baby 1 teaspoon of honey 2 days ago because he had a cold and his voice had become hoarse. It seemed like he had a really bad sore throat because he was having trouble swallowing. I did not know about infant botulism and now reading all this I am so worried and nervous. He still has the cold. His voice is still bad. He is wheezing. I can hear him breathe loudly. He still has trouble swallowing but otherwise he is very active, has lots of muscle strength, smiles and laughs, and is not constipated (in fact he has diarrhea).

    I don’t know what to do. I am very worried. Should I go to the doctor right away or wait until he is feeling better from the cold and then see if he develops any symptoms? For how long should I be watching him for botulism symptoms?

    Please help!!

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    • Ryan

      What should you do!? Take him to a doctor if you’re that concerned!

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  13. Trillistar Auriestre

    As with most articles on this you show the information on raw honey and apply it to all honey. Pasteurized honey does not have the same botulism risk. Only raw unprocessed honey is the risk.

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    • Katherine Parrick

      That’s not necessarily true. There have been cases where pasteurization didn’t kill the botulism SPORES. Unlike bacteria which will die at hotter temps provided during pasteurization, fungi and spores can survive this…thus infecting your infant child.

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  14. Audelia Vallejo

    I am currently breastfeeding and I was wondering if eating the raw and unfiltered honey would go into my milk? My baby is going on eight months now and he has allergy symptoms could this still affect him if not ingested directly?

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  15. Hema

    I unknowingly fed my 5 months and 1 week old baby girl with few drops of honey. Would it cause any major problem? I fed her this drops of honey yesterday and she is active till today. Anything alarming? If anyone knows kindly let me know. I am nervous and worried.

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    • Steve Bowman

      Obviously this was a long time ago and I’m sure you have sorted everything out, but for anyone reading through the comments recently and wondering the same thing, here is the answer
      Read the article! Even the tiniest amount of honey can be lethal to an infant! As the article states, “The lethal dose [of Botulinum toxin] is only 0.0000001 mg per kg of body weight — an amount that would be invisible to the naked eye.” It may take a few days for symptoms to occur, so if you have fed your child honey keep vigilant, and the second you believe something to be wrong take them to a doctor. Or if you are just very worried but haven’t observed any symptoms, take them to a pediatrician to ease your mind and be safe.

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  16. Jessica W. Tanner

    I think it’s important to add that if you are avoiding honey for botulism, you need to avoid all honey products as well. Cooking honey does not kill botulism so honey graham crackers, cereals, and honey powder used as a sweetener should all be avoided.

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    • Katherine Parrick

      Most commercial products HAVE been heated to a degree hat does kill the botulism spores. Though I personally agree and avoided all just in case until my child was one.

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  17. Sam

    My son is 11 months old and will be 1 under a month, he became very sick with cold/ flu like symptoms. I was told to give him lemon wArm water and raw honey.. He had about 2 spoons and he is fine but now i am freaking out! do babies over 6 months get botchulism ?

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    • Katherine Parrick

      For future readers, don’t freak out in a case like this (the 11 month-old getting a couple teaspoons of honey).

      Most infant cases of botulism happen under 6 months; and if the child isn’t showing clear symptoms* within a week, then you’re very, very, likely to be in the clear. If concerned, take your kids to the pediatrician or if they ARE showing symptoms, go the ER and push for the antidote (even if it means ordering it in from a special, children’s hospital!

      *symptoms are:
      Weak sucking +/- poor feeding
      Problems swallowing and noticeably increased drooling
      Muscle weakness and a general lethargy
      Constipation
      Neck pain
      Breathing problems occur when it’s nearing it’s lethal stage so if your baby exhibits three or more of these symptoms and exhibits problems breathing, RUN as fast, as you can, to an ER

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  19. Tomaira Billie

    My daughter just turned six months. She’s overall a very happy baby. Friday, my older kids gave her some of their pancakes that was dressed with honey and syrup. Saturday she’s still a happy baby acting normal. Sunday she woke up very fussy. She’s a breastfed baby and today she will only eat if she is falling asleep. I can’t tell if it’s a faint sucking or not. When she’s awake she constantly crying non stop as if she’s in pain. She haven’t had a bowel movement all day but normally, she would have had two by now. I brought the honey at a local Wal-Mart in Oklahoma. I feel as if she’s crying a lot and so irritable because of the constipation. Does botulism cause a lot of fussiness when their awake before shutting down their nerves? Should I take her to the emergency room? That was the first time ever she have been feed honey. She don’t have any fevers or any other symptom besides constipation.

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    • Katherine Parrick

      Just keep an eye on her. At six months, she’ll probably be in the clear–so just watch for the signs–especially the weak suck and neck issues (since she’s already experiencing constipation).

      I wouldn’t take a trip to the ER, but I would warrant one to the pediatrician in the next few days…

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  20. Tomaira Billie

    My daughter just turned six months. She’s overall a very happy baby. Friday, my older kids gave her some of their pancakes that was dressed with honey and syrup. Saturday she’s still a happy baby acting normal. Sunday she woke up very fussy. She’s a breastfed baby and today she will only eat if she is falling asleep. I can’t tell if it’s a faint sucking or not. When she’s awake she constantly crying non stop as if she’s in pain. She haven’t had a bowel movement all day but normally, she would have had two by now. I brought the honey at a local Wal-Mart in Oklahoma. I feel as if she’s crying a lot and so irritable because of the constipation. Does botulism cause a lot of fussiness when their awake before shutting down their nerves? Should I take her to the emergency room? That was the first time ever she have been feed honey. She don’t have any fevers or any other symptom besides constipation.

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  21. Sila Tasolo

    Hi Doc, I have just come across this information after feeding my baby girl who is 5 weeks old honey recommended to help strengthen her immune system. I brought it locally and I live in Brisbane Australia. My daughter is not being breast fed although I would love nothing more than to have her breast fed! Should this be a worry to me as I have just started a morning routine of giving her honey??

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  22. Chelsea

    My husband fed my daughter raw honey as a sweetener for her baby food. She is 4 months old. I called my pediatrician and was told not to worry because the FDA has been on top of this problem. Our honey, however, is from a farmers market!
    Why should I do?

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    • Alex Castillo

      Yes, the FDA is on top of it. The way they are reducing the risk is by NOT feeding it to your infants. Please do not feed honey to infants less than 12 months old.

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  23. Jamie Winterton Sam

    I accidentally fed my 8 month-old baby honey about an hour ago. I had used it to sweeten some warm applesauce, she woke up, I fed her 2 dabs off my finger before remembering that I had used honey (I often feed this to her, but don’t use honey). Since I am using local honey from here in Utah, I’m just a little nervous. Is there anything I can do besides just sit and wait to see if she gets constipated, especially since she’s been having trouble with constipation anyways, so that wouldn’t necessarily be the cause?

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    • Alan Greene

      Jamie, even though the standard recommendation is to avoid honey for the whole first year, that provides a wide margin of error. The average age of infant botulism is only 3 or 4 months old, and by 8 months old this already-rare disease is even more rare. As you suggest, it is more common in Utah, Pennsylvania and California than in other states – but still quite rare.

      The early warning signs are a weak suck (remember, it’s usually younger babies), droopy eyelids, inactivity, and constipation.

      Healthy gut bacteria lessen the odds of developing infant botulism. To this end, getting probiotics and avoiding unnecessary antibiotics may be helpful. Breastfeeding is also known to be somewhat protective, perhaps in part for the same reason.

      You might find beneficial bacteria in yogurt, kefir, or in a probiotic supplement.

      You sound like a great mom! I’m glad you were sharing some of the same food. And the two dabs of honey-sweetened applesauce from your fingers may be a reason to keep your eyes open, but not a reason for alarm.

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  24. Anton Tsjechov

    Sorry, but what you write about Helicobacter pylori seems ill informed, or old-fashioned at least. Even the discoverer of the influence of H. pylori on the stomach ulcer, Martin Blaser, has acknowledged (already in 1996) that the disappearance of H. pylori might be responsible for new disorders that have arisen, and that H. pylori might have benefits as well as costs. Please read Moises Velasquez-Manoff’s ‘An epidemic of absence’, chapter 8.

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    • Alan Greene

      I’ve ordered the book you suggested and look forward to reading it. I strongly agree with supporting the body’s natural rhythms and biology. And that H. pylori, acquired from Mom early in infancy, for instance, can be beneficial. But if acquired later, and in different health contexts, it has been linked to stomach problems including ulcers.

      When I was talking about the medicinal use of honey as a tummy remedy, I was talking, not clearly, about honey for older kids and adults, beyond infancy. It’s a gentle remedy with a long history of use, and valuable in part because it is less disruptive of beneficial bacteria than many medical options.

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      • Anton Tsjechov

        Thanks for your reply. Very curious what you think of Velasquez-Manoff’s book: it’s one of those books that kind of ‘shattered’ my image of the world and of health.

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  25. Christiana Weisel

    My infant loves the vacuum cleaner. Do I need to make sure the vacuum stays locked up so he won’t get any botulism from the dust?

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  26. Karenza Mcleod

    can you tell me how many babies have had botulism from honey?

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    • Alan Greene

      Great question! On average about 79 babies get infant botulism in the US each year (which also means, about 4 million babies don’t). Most cases happen between 2 and 8 months old – and the average age is only 3-4 months.

      It used to be thought that honey was the top cause of infant botulism, because botulism spores are found in honey, and because lots of babies ate honey, including those who got botulism. However…

      When word spread to avoid honey for babies, honey consumption plummeted, especially before solids were introduced. But the botulism rate and typical age didn’t change as people had hoped.

      Botulism spores are widespread, especially in soil, and especially in certain states (e.g. California, Utah, Pennsylvania – where infant botulism rates are highest). It’s now thought that most cases of infant botulism are environmental, not from honey.

      So, you asked how many babies have had botulism from honey, and the answer must be fewer than the total 79 cases of infant botulism a year. Probably it’s far fewer than half that number.

      Honey has probably gotten a bad rap. I’m not recommending that babies eat honey – but I doubt botulism rates would go up appreciably if they did. Especially if parents avoided honey in the first 6 months, when there are many foods they might want to avoid.

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      • Karenza Mcleod

        Thank you Dr Greene. I live in Rotorua New Zealand and we have been using honey for babies for many generations and this is the first I have heard about it. I guess I can contact John Molan who does research about honey in New Zealand. Once again thank you for answering my question.

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        • Alan Greene

          You are most welcome Karenza – please keep me posted on what you learn.

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