What are the uses and precautions of propolis in medical treatment?

Medical Uses and Precautions of Propolis

Propolis has limited evidence-based medical applications, with dental avulsion storage being its most well-established use, though it carries risk of hypersensitivity reactions, particularly in allergic individuals.

Established Medical Uses

Dental Avulsion Storage

• Propolis is recommended as a temporary storage solution for avulsed teeth that cannot be immediately replanted 1
• Concentration: 0.04 mg to 2.5 mg per mL in 0.4% ethanol 1
• Effectiveness ranking: According to the 2020 international consensus on first aid science, propolis is among the preferred storage solutions for avulsed teeth, alongside HBSS (Hank's Balanced Salt Solution), oral rehydration salts, and cling film 1
• Mechanism: Helps maintain periodontal ligament (PDL) viability until dental reimplantation is possible 1

Other Potential Applications (Limited Evidence)

Wound Healing

• Propolis has been investigated for healing potential in various wound types, including diabetic, venous, and surgical wounds 2
• Proposed mechanisms include antimicrobial, anti-inflammatory, analgesic, and angiogenesis-promoting properties 2
• Limitation: Lack of standardization in administration methods and concentrations for specific wound types 2

Oral Mucositis

• Has been studied for prevention/treatment of chemotherapy and radiation-induced oral mucositis 1
• Limitation: Evidence is insufficient to make clinical recommendations due to:
  • Heterogeneity in formulations used across studies
  • Poorly defined endpoints
  • Studies not powered to detect differences 1

Antiviral Properties

• Some research suggests potential immunomodulatory and antiviral activity 3
• Limitation: Clinical trials are lacking to confirm efficacy in viral diseases 3

Important Precautions and Contraindications

Hypersensitivity Reactions

• Propolis is a potent sensitizer that can cause allergic reactions 4, 5, 6
• High-risk populations: Patients with allergic predispositions, particularly those with pollen allergies 5
• Reported reactions include:
  • Dermatological symptoms (skin reactions)
  • Respiratory symptoms
  • Edema
  • Some cases requiring hospitalization or emergency department visits 5
  • Life-threatening events have been reported 5

Other Adverse Effects

• Digestive tract reactions have been reported 5
• Cases of acute renal failure have been linked to propolis use 4

Regulatory and Labeling Issues

• In many countries, propolis products are sold as dietary supplements without adequate warning labels 5
• Products containing bee derivatives often lack warnings about possible allergic reactions 5

Clinical Decision Algorithm

1. For dental avulsion emergencies:

   • Consider propolis as a storage medium if HBSS is unavailable
   • Verify no history of allergies to bee products or pollen
   • Use at concentration of 0.04-2.5 mg/mL in 0.4% ethanol if available

2. For all other potential uses:

   • Screen for allergic predisposition, especially to pollen or bee products
   • Avoid use in patients with history of allergies
   • Consider alternative treatments with stronger evidence base
   • If using propolis, monitor closely for hypersensitivity reactions

3. If hypersensitivity reaction occurs:

   • Discontinue propolis immediately
   • Treat allergic reaction according to severity
   • Document allergy to prevent future exposure

Key Takeaways

• Despite public perception of natural products as safe, propolis carries significant risk of adverse reactions
• The strongest evidence supports propolis use only for temporary storage of avulsed teeth
• For other applications, evidence is insufficient to recommend routine clinical use
• Patients with allergic predispositions should avoid propolis products
• Healthcare providers should be aware of the potential for serious allergic reactions