Single-blind study of manuka honey in allergic fungal rhinosinusitis.

BACKGROUND Some patients continue to suffer from symptoms of sinusitis after maximal topical medical and surgical treatment for allergic fungal rhinosinusitis (AFRS). Manuka honey has well-documented antimicrobial and antifungal properties and is currently being used by physicians across the world for a wide variety of medical problems. OBJECTIVE This study aimed to determine the effectiveness of Medihoney Antibacterial Medical Honey in patients who continue to suffer from AFRS resistant to conventional medical treatment after bilateral functional endoscopic sinus surgery and maximal postoperative medical management. METHODS A randomized, single-blind, prospective study was conducted at a tertiary centre. Thirty-four patients with AFRS sprayed one nostril with 2 mL of a 50/50 mixture of honey-saline solution once a day at night for 30 days. Otherwise, patients continued with their regular nasal regimen in both nostrils. A 5-point improvement in our clinic's endoscopic grading system was considered significant. During their pre- and postassessment, patients' sinus cavities were cultured, and the patients filled out a Sino-Nasal Outcome Test (SNOT-22) questionnaire to assess subjective nasal symptoms. RESULTS As a group, the 34 patients who completed the study showed no significant improvement in the treated nostrils versus control nostrils (p  =  1.000). However, the nine patients who did respond to the honey treatment relative to their control side responded very well. A number of these patients had high IgE levels in their blood. The manuka honey did not appear to modify the culture results in the ethmoid cavities after 30 days of treatment, but patients who completed the SNOT-22 questionnaire indicated global improvement in their symptoms while receiving the honey spray (p  =  .0220). CONCLUSION Overall, topical manuka honey application in AFRS, despite showing symptomatic benefits, did not demonstrate a global improvement in endoscopically staged disease, but specific patients did show significant positive responses. Further research is needed to determine the factors of the patients who responded well to the honey spray, which may correlate to high IgE levels.