{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:55:24Z","timestamp":1790934924804,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Allergic fungal rhinosinusitis (AFRS) is a persistent sinus condition caused by fungal allergies. Endoscopic sinus surgery (ESS) and postoperative systematic and local medical therapies are the most common treatment protocols. Although oral antifungals such as itraconazole are frequently utilised postoperatively, there is increasing interest in alternate therapies that exhibit fewer systemic adverse effects. Manuka honey, recognised for its powerful antibacterial, antifungal and anti\u2010inflammatory characteristics, is a promising alternative. The aim of this study was to assess the efficacy of Manuka honey sinus irrigation in comparison with oral itraconazole for the postoperative management of AFRS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty patients diagnosed with AFRS were recruited for the current randomised clinical trial after ESS. Patients in the two groups randomly received either oral itraconazole (Group A) or Manuka honey sinus irrigation (Group B) for 6\u2009weeks postoperatively. Both cohorts were monitored for 6\u2009months postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Lund\u2013Kennedy endoscopic scores, total IgE levels and SNOT\u201022 scores were significantly improved in Group B after Manuka honey sinus irrigation. Both groups had similar Lund\u2013Mackay radiological scores and numbers of postoperative sinus infections during the follow\u2010up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postoperative Manuka honey sinus irrigation is more effective than oral itraconazole for reducing symptoms and preventing the recurrence of AFRS. It is considered a promising therapeutic alternative in the postoperative management of AFRS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/coa.70161","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:11:11Z","timestamp":1787371871000},"page":"960-965","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manuka Honey Sinus Irrigation Versus Systemic Itraconazole in Allergic Fungal Rhinosinusitis: Randomised Clinical Trial for Efficacy and Safety"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5739-5726","authenticated-orcid":false,"given":"Khalaf","family":"Hamead","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine Minia University  Minya Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine Minia University  Minya Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahim A.","family":"Abdelkarim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine Minia University  Minya Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelhakim Atef","family":"Abdelhakim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine Minia University  Minya Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3438-205X","authenticated-orcid":false,"given":"Khaled Mohamed","family":"Abdelzaher","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Faculty of Medicine Minia University  Minya Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/19458924231152983"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-022-03338-0"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13438"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2023.02.018"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iac.2019.12.001"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-4486.2009.01995.x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.5455\/aim.2023.31.53-56"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-33199-2_19"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30841"},{"key":"e_1_2_12_11_1","first-page":"Mc01","article-title":"Comparison of Steroid and Itraconazole for Prevention of Recurrence in Allergic Fungal Rhinosinusitis: A Randomized Controlled Trial","volume":"11","author":"Rojita M.","year":"2017","journal-title":"Journal of Clinical and Diagnostic Research"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.47611\/jsrhs.v12i4.5433"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-024-04605-y"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.2500\/105065801781329428"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12070-024-05130-8"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13637"},{"key":"e_1_2_12_17_1","first-page":"238","article-title":"Single\u2010Blind Study of Manuka Honey in Allergic Fungal Rhinosinusitis","volume":"40","author":"Thamboo A.","year":"2011","journal-title":"Journal of Otolaryngology\u2014Head & Neck Surgery"},{"key":"e_1_2_12_18_1","first-page":"870","article-title":"Effectiveness of Itraconazole in the Management of Refractory Allergic Fungal Rhinosinusitis","volume":"37","author":"Chan K. O.","year":"2008","journal-title":"Journal of Otolaryngology\u2014Head & Neck Surgery"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.14014"},{"key":"e_1_2_12_20_1","first-page":"1598","article-title":"A Study to Assess the Efficacy of Oral Itraconazole as an Add\u2010On to Steroids in Allergic Fungal Rhinosinusitis in a Tertiary Care Hospital","volume":"14","author":"Mamatha K.","year":"2024","journal-title":"National Journal of Physiology, Pharmacy and Pharmacology"},{"key":"e_1_2_12_21_1","first-page":"66","article-title":"The Role of Systemic Itraconazole in Management of Allergic Fungal Rhinosinusitis","volume":"28","author":"Mahfouz El\u2010Ghadafi A. Y.","year":"2022","journal-title":"Zagazig University Medical Journal"}],"container-title":["Clinical Otolaryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70161","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/coa.70161","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/coa.70161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:08:56Z","timestamp":1790932136000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/coa.70161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1111\/coa.70161"],"URL":"https:\/\/doi.org\/10.1111\/coa.70161","archive":["Portico"],"relation":{},"ISSN":["1749-4478","1749-4486"],"issn-type":[{"value":"1749-4478","type":"print"},{"value":"1749-4486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"assertion":[{"value":"2025-11-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}