Propolis

Purported Benefits, Side Effects & More
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Propolis

Common Names

  • Bee propolis
  • Propolis resin
  • Propolis wax
  • Bee glue
  • Bee putty

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


How It Works

Propolis has a number of properties, but evidence that it can treat various conditions is lacking.

Propolis is a mixture of pollen, beeswax, and resin collected by honeybees from buds and sap of certain trees and plants. It has been used in folk medicine, food, and beverages to improve health and prevent disease. Propolis is thought to be effective against a number of chronic conditions, infections, and inflammation, but this has yet to be confirmed in humans. In some instances propolis may actually have toxic effects.

Bee pollen, found in propolis, is a mixture of plant pollens, nectar, and bee secretions that bees form into granules to store as food. It is claimed as a “cure all” by some and thought to have antioxidant, antiaging, and stamina-increasing properties. Bee pollen has also been used to treat chronic inflammation as well as other conditions. Aside from its nutritional value however, clinical data suggest benefits are limited.

Allergic reactions to propolis and bee pollen have been reported. Patients who are allergic to bee stings, honey, ragweed, or chrysanthemum should not take either of these supplements. For this reason, royal jelly should also be avoided.

Purported Uses and Benefits
  • Cancer
    A study on propolis supplementation for colon cancer prevention in high-risk patients found no benefit, and actually indicated potential negative effects on muscle tissues including heart muscle cells.
  • Mouth ulcers from cancer treatment
    A few studies on propolis-containing products have had mixed results.
  • Diabetes
    Evidence is lacking to support this claim.
  • Heart disease
    Evidence is lacking to support this claim.
  • Infections
    A few small studies suggest propolis can be effective in treating ear infections.
  • Inflammation
    Lab studies show that propolis has immunomodulatory effects. Human studies are needed.
Do Not Take If
  • You are allergic to bee stings, honey, ragweed, or chrysanthemum. For this reason, royal jelly should also be avoided.
  • You are taking warfarin: Propolis can increase the time required for blood coagulation.
Side Effects

Increased use of propolis or bee pollen in cosmetics, supplements, food, and other industries has led to a rise in reports of both skin and systemic reactions.

Case Reports

  • Toxic reaction to sunlight: A 32-year-old woman experienced itching and rash with sun exposure after taking a dietary supplement containing ginseng, goldenseal, and bee pollen.
  • Lip swelling, pain, skin redness and inflammation: In an 18-year-old woman who used propolis spray for gum swelling caused by orthodontic bands.
  • Recurring lesion over a 1-year period: In a 55-year-old man related to the ingestion of bee pollen containing propolis.
  • Fungal infection and recurrent itchy eyelid rash: In a 28-year-old woman related to daily application of beeswax-containing lip gloss using her fingers.
  • Recurrent itchy widespread rash over a 3-year period: In a 65-year-old woman with non-Hodgkin B-cell lymphoma related to the hobby of glass beading which involved contact with beeswax.
  • Life-threatening deep neck infection that traveled into the chest cavity: In an otherwise healthy 40-year-old woman who took liquid propolis 3 times daily for 1 week to relieve common cold symptoms, requiring chest surgery.
  • Tumor mimicking lung cancer: In a 36-year-old woman caused by the inhalation of long-term topically applied propolis on nasal passages to treat asthma. Interestingly, this patient tested negative to pollen allergies both before and after this adverse event occurred, even though this effect was confirmed to be related to the product.
  • Acute kidney failure: In a 59-year-old man requiring dialysis after ingesting propolis for 2 weeks.
  • Increase in liver enzymes: In a young man due to chronic ingestion of large amounts of propolis candies (>10 per day) to calm his sensation of sore throat.
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For Healthcare Professionals

Clinical Summary

Propolis is a resinous mixture of pollen and beeswax collected by honeybees from the buds and exudates of certain trees and plants (1). It has been used in folk medicine, food, and beverages to improve health and prevent disease.

Preclinical studies suggest antimicrobial, anti-inflammatory, antioxidant, immunostimulatory, vasomodulatory, cardio- and radioprotective properties (2) (3) (15) (16) (17). It also demonstrated anticancer activities in several human cancer cell lines (19) (20) (21) (22) (23). Other experiments suggest it might enhance temozolomide effects in human glioblastoma cells (18).

Data in humans are limited. Small trials suggest propolis may help treat warts (5), fungal foot infections (29), or diabetic foot ulcers (63). It may also reduce microbial counts and improve symptoms following periodontal treatment (30). A propolis/zinc suspension reduced the number of acute otitis media infections in children (6) and supplementation with cranberry and propolis may help reduce the incidence of urinary tract infections (64). A double-blind RCT did not find benefit with Brazilian propolis for rheumatoid arthritis (67).

In cancer settings, supplemental propolis was not useful for colon cancer prevention, and had negative effects on muscle tissues including myocardial cells (31). Its effects on chemotherapy-induced mucositis are thus far equivocal (32) (33) (34) (65) (66).

Bee pollen, a constituent of propolis, is a mixture of plant pollens, nectar, and bee saliva that bees form into granules to store as food (8). It is claimed as a “cure all” by some and touted as having antioxidant, antiaging, and stamina-increasing properties. Aside from nutritional value, it had limited effects on athletic performance (9) (10).

Propolis or its constituents may also act as pro-oxidants (35), produce cytotoxic effects in normal cells (31) (36) (37) (38), and/or have mutagenic activity (39) (40), indicating that risk versus benefit needs further evaluation.

Purported Uses and Benefits
  • Cancer
  • Mucositis
  • Diabetes
  • Heart disease
  • Infections
  • Inflammation
Mechanism of Action

In vitro studies have identified a number of active propolis constituents and potential mechanisms. Generally, antimicrobial and antioxidant activities are related to total phenolic contents (15). Caffeic acid phenethyl ester (CAPE) and artepillin C are well-known anti-inflammatory components (25). The main active anticancer constituents are CAPE and chrysin (23). However, all of these constituents possess these other characteristics to some degree and vary with geographic origin.

CAPE specifically inhibits NF-kB (41). In human breast cancer cells, it also inhibits MDR gene expression, EGFR, and VEGF (20). CAPE decreased malignancy potential of breast cancer stem cells via inhibition of self-renewal, progenitor formation, and clonal growth, and significantly decreased CD44 expression (42). CAPE-initiated S- and G2/M-phase cell-cycle arrests and apoptosis in human cervical cancer lines was associated with increased E2F-1 expression (43).

The flavonoid chrysin demonstrated photoprotective effects by attenuating UVA- and UVB-induced apoptosis, ROS production, and COX-2 expression (44). Chrysin inhibits aromatase, an enzyme converting testosterone into estrogen (39), as well as histone deacetylase and HDAC8 enzymatic activity (23). Chrysin may overcome TNF-related apoptosis-inducing ligand (TRAIL) resistance through Mcl-1 downregulation via STAT3 phosphorylation inhibition (45).

The phenolic compound artepillin C is the major constituent that stimulates pungent taste by activating TRPA1 channels (47). Immunomodulating effects are attributed to suppression of IL-2, IFN-γ and IL-17 expression in alloreactive CD4 T cells, suggesting potential to treat graft versus host disease (48). Artepillin C also sensitizes prostate cancer cells to TRAIL-induced apoptosis by engaging both extrinsic receptor-mediated and intrinsic mitochondrial apoptotic pathways (21). In different tumor cell lines, artepillin C and baccharin were more cytotoxic than propolis, without additive or synergistic effects when combined (49).

Propolis as a whole modulates key inflammatory mediators of mRNA transcription, inhibiting specific inflammatory cytokines, and blocking NF-kB activation (55). Synergy between propolis and temozolomide in human glioblastoma cell lines is also partly attributed to reduced NF-kB activity (18). Propolis also inhibited proliferation of human leukemia cells via caspase-3 activation (2).

In animal models, propolis promotes wound healing via downregulation of type I allergy and inflammation (25) and modifying fibronectin metabolism (26). Immunomodulatory effects occur through increased toll-like receptor expression and IL-1β and IL-6 production (12). Pretreatment with orally-administered propolis extract reduced doxorubicin-induced oxidative damage to heart mitochondria (3). Diabetic hepatorenal damage was attenuated via antioxidant activity including free-radical scavenging, and was more pronounced in ethanol than water extracts (56).

Contraindications

Patients who are allergic to bee stings, honey, ragweed, or chrysanthemums should avoid products containing bee pollen such as propolis (8). For this reason, royal jelly should also be avoided.

Adverse Reactions

Strong sensitizing properties; contact allergen

Due to increased use in cosmetics, supplement, food, and other industries, there has been a rise in contact allergy and systemic reactions.

Case Reports

  • Photosensitivity: Itching and rash in a 32-year-old woman after taking a dietary supplement containing ginseng, goldenseal and bee pollen (14).
  • Contact cheilitis and perioral dermatitis: Lip edema, perioral skin erythema accompanied by lip burning pain in an 18-year-old woman with self-prescribed topical use of propolis spray as a medication for gingival swelling caused by orthodontic molar bands (57).
  • One-year history of a recurrent lesion: In a 55-year-old man attributed to ingestion of bee pollen containing propolis. The lesion eventually cleared with cessation of the natural product used and erupted again with subsequent substance re-challenge, confirming product reaction (58).
  • Ectopic periorbital dermatitis and mycosis: In a 28-year-old woman with a 4-month history of recurrent itchy rash of the eyelids. Patch testing included positive reactions to propolis. Daily application of beeswax-containing lip gloss using her fingers implicated propolis in beeswax as the relevant allergen (59).
  • Fungoides-like dermatitis: In a 65-year-old woman with non-Hodgkin B-cell lymphoma and 3-year history of a recurrent itchy widespread rash. Patch testing included positive reactions to propolis. Her reaction was related to the hobby of glass beading which involved contact with beeswax (59).
  • Descending necrotizing mediastinitis and aspiration pneumonia: In an otherwise healthy 40-year-old woman who took liquid propolis 3 times daily for 1 week to relieve common cold symptoms. Severe sore throat, difficulty swallowing, easy choking, and fever and chills developed. Thoracoscopic surgery to achieve immediate and adequate drainage was necessary for this life-threatening reaction (60).
  • Propolis aspiration mimicking lung cancer: In a 36-year-old woman who presented with a pulmonary tumor with high carcinoembryonic antigen titer caused by chronic aspiration from propolis topically applied on nasal mucosa as 6 months’ adjuvant therapy for asthma. Interestingly, this patient had negative allergen-specific IgE assay results for all common inhalant allergens, including pollen, before and after this adverse event (61).
  • Acute renal failure requiring hemodialysis: In a 59-year-old man requiring hemodialysis after ingestion of propolis for 2 weeks (62).
  • Elevated liver enzymes: In a young man due to chronic ingestion of large amounts of propolis candies (>10 per day) to calm his sensation of sore throat (68).
Herb-Drug Interactions
  • Warfarin: A published case report described a probable interaction between warfarin and honeybee pollen, which caused an increase in the international normalized ratio (INR) (8).
Dosage (OneMSK Only)
References
  1. Ohta T, Kunimasa K, Kobayashi T, et al. Propolis suppresses tumor angiogenesis by inducing apoptosis in tube-forming cells. Biosci Biotechnol Biochem. 1998;72(9);2436-2440.
  2. Eom HS, Lee EJ, Yoon BS, et al. Propolis inhibits the proliferation of human leukaemia HL-60 cells by inducing apoptosis through the mitochondrial pathway. Nat Prod Res. 2010 Mar;24(4):375-86.
  3. Alyane M, Kebsa LB, Boussenane HN, et al. Cardioprotective effects and mechanism of action of polyphenols extracted from propolis against doxorubicin toxicity. Pak J Pharm Sci. 2008 Jul;21(3):201-9.
  4. Khayyal MT, el-Ghazaly MA, el-Khatib AS, et al. A clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patients. Fundam Clin Pharmacol. 2003 Feb;17(1):93-102.
  5. Zedan H, Hofny ER, Ismail SA. Propolis as an alternative treatment for cutaneous warts. Int J Dermatol. 2009 Nov;48(11):1246-9.
  6. Marchisio P, Esposito S, Bianchini S, et al. Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media. Int J Immunopathol Pharmacol. 2010 Apr-Jun;23(2):567-75.
  7. Li F, Awale S, Tezuka Y, Kadota S. Cytotoxicity of constituents from Mexican propolis against a panel of six different cancer cell lines. Nat Prod Commun. 2010 Oct;5(10):1601-6.
  8. Hurren KM, Lewis CL. Probable interaction between warfarin and bee pollen. Am J Health Syst Pharm. 2010 Dec 1;67(23):2034-7.
  9. Maughan RJ, Evans SP. Effects of pollen extract upon adolescent swimmers. Br J Sports Med. 1982 Sep;16(3):142-5.
  10. Steben RE, Boudreaux P. The effects of pollen and protein extracts on selected blood factors and performance of athletes. J Sports Med Phys Fitness. 1978;18:221-6.
  11. Mirkin G. Can bee pollen benefit health? JAMA 1989;262:1854.
  12. Orsatti CL, Missima F, Pagliarone AC, et al. Propolis immunomodulatory action in vivo on Toll-like receptors 2 and 4 expression and on pro-inflammatory cytokines production in mice. Phytother Res. 2010 Aug;24(8):1141-6.
  13. DerMarderosian A, editor. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.
  14. Palanisamy A, Haller C, Olson KR. Photosensitivity reaction in a woman using an herbal supplement containing ginseng, goldenseal, and bee pollen. J Toxicol Clin Toxicol. 2003;41(6):865-7.
  15. Mavri A, Abramovic H, Polak T, et al. Chemical properties and antioxidant and antimicrobial activities of Slovenian propolis. Chem Biodivers. Aug 2012;9(8):1545-1558.
  16. Massaro FC, Brooks PR, Wallace HM, et al. Effect of Australian propolis from stingless bees (Tetragonula carbonaria) on pre-contracted human and porcine isolated arteries. PLoS One. 2013;8(11):e81297.
  17. Al-Waili N, Al-Ghamdi A, Ansari MJ, et al. Synergistic effects of honey and propolis toward drug multi-resistant Staphylococcus aureus, Escherichia coli and Candida albicans isolates in single and polymicrobial cultures. Int J Med Sci. 2012;9(9):793-800.
  18. Markiewicz-Zukowska R, Borawska MH, Fiedorowicz A, et al. Propolis changes the anticancer activity of temozolomide in U87MG human glioblastoma cell line. BMC Complement Altern Med. 2013;13:50.
  19. Kamiya T, Nishihara H, Hara H, et al. Ethanol extract of Brazilian red propolis induces apoptosis in human breast cancer MCF-7 cells through endoplasmic reticulum stress. J Agric Food Chem. Nov 7 2012;60(44):11065-11070.
  20. Wu J, Omene C, Karkoszka J, et al. Caffeic acid phenethyl ester (CAPE), derived from a honeybee product propolis, exhibits a diversity of anti-tumor effects in pre-clinical models of human breast cancer. Cancer Lett. Sep 1 2011;308(1):43-53.
  21. Szliszka E, Zydowicz G, Mizgala E, et al. Artepillin C (3,5-diprenyl-4-hydroxycinnamic acid) sensitizes LNCaP prostate cancer cells to TRAIL-induced apoptosis. Int J Oncol. Sep 2012;41(3):818-828.
  22. Kumazaki M, Shinohara H, Taniguchi K, et al. Propolis cinnamic acid derivatives induce apoptosis through both extrinsic and intrinsic apoptosis signaling pathways and modulate of miRNA expression. Phytomedicine. Jul-Aug 2014;21(8-9):1070-1077.
  23. Sun LP, Chen AL, Hung HC, et al. Chrysin: a histone deacetylase 8 inhibitor with anticancer activity and a suitable candidate for the standardization of Chinese propolis. J Agric Food Chem. Nov 28 2012;60(47):11748-11758.
  24. Yu Y, Si Y, Song G, et al. Ethanolic extract of propolis promotes reverse cholesterol transport and the expression of ATP-binding cassette transporter A1 and G1 in mice. Lipids. Sep 2011;46(9):805-811.
  25. Chirumbolo S. Flavonoids in propolis acting on mast cell-mediated wound healing. Inflammopharmacology. Apr 2012;20(2):99-101.
  26. Olczyk P, Komosinska-Vassev K, Wisowski G, et al. Propolis modulates fibronectin expression in the matrix of thermal injury. Biomed Res Int. 2014;2014:748101.
  27. Sulaiman GM, Ad’hiah AH, Al-Sammarrae KW, et al. Assessing the anti-tumour properties of Iraqi propolis in vitro and in vivo. Food Chem Toxicol. May 2012;50(5):1632-1641.
  28. Lirdprapamongkol K, Sakurai H, Abdelhamed S, et al. A flavonoid chrysin suppresses hypoxic survival and metastatic growth of mouse breast cancer cells. Oncol Rep. Nov 2013;30(5):2357-2364.
  29. Ngatu NR, Saruta T, Hirota R, et al. Brazilian green propolis extracts improve Tinea pedis interdigitalis and Tinea corporis. J Altern Complement Med. Jan 2012;18(1):8-9.
  30. Coutinho A. Honeybee propolis extract in periodontal treatment: a clinical and microbiological study of propolis in periodontal treatment. Indian J Dent Res. Mar-Apr 2012;23(2):294.
  31. Ishikawa H, Goto M, Matsuura N, et al. A pilot, randomized, placebo-controlled, double-blind phase 0/biomarker study on effect of artepillin C-rich extract of Brazilian propolis in frequent colorectal adenoma polyp patients. J Am Coll Nutr. Oct 2012;31(5):327-337.
  32. Abdulrhman M, Elbarbary NS, Ahmed Amin D, et al. Honey and a mixture of honey, beeswax, and olive oil-propolis extract in treatment of chemotherapy-induced oral mucositis: a randomized controlled pilot study. Pediatr Hematol Oncol. Apr 2012;29(3):285-292.
  33. Tomazevic T, Jazbec J. A double blind randomised placebo controlled study of propolis (bee glue) effectiveness in the treatment of severe oral mucositis in chemotherapy treated children. Complement Ther Med. Aug 2013;21(4):306-312.
  34. Noronha VR, Araujo GS, Gomes RT, et al. Mucoadhesive propolis gel for prevention of radiation-induced oral mucositis. Curr Clin Pharmacol. 2014;9(4):359-364.
  35. Tsai YC, Wang YH, Liou CC, et al. Induction of oxidative DNA damage by flavonoids of propolis: its mechanism and implication about antioxidant capacity. Chem Res Toxicol. Jan 13 2012;25(1):191-196.
  36. Markiewicz-Zukowska R, Car H, Naliwajko SK, et al. Ethanolic extract of propolis, chrysin, CAPE inhibit human astroglia cells. Adv Med Sci. 2012;57(2):208-216.
  37. Calhelha RC, Falcao S, Queiroz MJ, et al. Cytotoxicity of Portuguese propolis: the proximity of the in vitro doses for tumor and normal cell lines. 2014;2014:897361.
  38. Pardo Andreu GL, Reis FH, Dalalio FM, et al. The cytotoxic effects of brown Cuban propolis depend on the nemorosone content and may be mediated by mitochondrial uncoupling. Chem Biol Interact. Feb 25 2015;228:28-34.
  39. Oliveira GA, Ferraz ER, Souza AO, et al. Evaluation of the mutagenic activity of chrysin, a flavonoid inhibitor of the aromatization process. J Toxicol Environ Health A. 2012;75(16-17):1000-1011.
  40. Montoro A, Soriano JM, Barquinero JF, et al. Assessment in vitro of cytogenetic and genotoxic effects of propolis on human lymphocytes. Food Chem Toxicol. Feb 2012;50(2):216-221.
  41. Ozturk G, Ginis Z, Akyol S, et al. The anticancer mechanism of caffeic acid phenethyl ester (CAPE): review of melanomas, lung and prostate cancers. Eur Rev Med Pharmacol Sci. Dec 2012;16(15):2064-2068.
  42. Omene CO, Wu J, Frenkel K. Caffeic Acid Phenethyl Ester (CAPE) derived from propolis, a honeybee product, inhibits growth of breast cancer stem cells. Invest New Drugs. Aug 2012;30(4):1279-1288.
  43. Hsu TH, Chu CC, Hung MW, et al. Caffeic acid phenethyl ester induces E2F-1-mediated growth inhibition and cell-cycle arrest in human cervical cancer cells. FEBS J. Jun 2013;280(11):2581-2593.
  44. Wu NL, Fang JY, Chen M, et al. Chrysin protects epidermal keratinocytes from UVA- and UVB-induced damage. J Agric Food Chem. Aug 10 2011;59(15):8391-8400.
  45. Lirdprapamongkol K, Sakurai H, Abdelhamed S, et al. Chrysin overcomes TRAIL resistance of cancer cells through Mcl-1 downregulation by inhibiting STAT3 phosphorylation. Int J Oncol. Jul 2013;43(1):329-337.
  46. Yang F, Jin H, Pi J, et al. Anti-tumor activity evaluation of novel chrysin-organogermanium(IV) complex in MCF-7 cells. Bioorg Med Chem Lett. Oct 15 2013;23(20):5544-5551.
  47. Hata T, Tazawa S, Ohta S, et al. Artepillin C, a major ingredient of Brazilian propolis, induces a pungent taste by activating TRPA1 channels. PLoS One. 2012;7(11):e48072.
  48. Cheung KW, Sze DM, Chan WK, et al. Brazilian green propolis and its constituent, Artepillin C inhibits allogeneic activated human CD4 T cells expansion and activation. J Ethnopharmacol. Nov 18 2011;138(2):463-471.
  49. de Oliveira PF, de Souza Lima IM, Munari CC, et al. Comparative evaluation of antiproliferative effects of Brazilian green propolis, its main source Baccharis dracunculifolia, and their major constituents artepillin C and baccharin. Planta Med. Apr 2014;80(6):490-492.
  50. Hattori H, Okuda K, Murase T, et al. Isolation, identification, and biological evaluation of HIF-1-modulating compounds from Brazilian green propolis. Bioorg Med Chem. Sep 15 2011;19(18):5392-5401.
  51. Daleprane JB, Schmid T, Dehne N, et al. Suppression of hypoxia-inducible factor-1alpha contributes to the antiangiogenic activity of red propolis polyphenols in human endothelial cells. J Nutr. Mar 2012;142(3):441-447.
  52. Endo S, Matsunaga T, Kanamori A, et al. Selective inhibition of human type-5 17beta-hydroxysteroid dehydrogenase (AKR1C3) by baccharin, a component of Brazilian propolis. J Nat Prod. Apr 27 2012;75(4):716-721.
  53. Endo S, Hu D, Matsunaga T, et al. Synthesis of non-prenyl analogues of baccharin as selective and potent inhibitors for aldo-keto reductase 1C3. Bioorg Med Chem. Oct 1 2014;22(19):5220-5233.
  54. Diaz-Carballo D, Acikelli AH, Bardenheuer W, et al. Identification of compounds that selectively target highly chemotherapy refractory neuroblastoma cancer stem cells. Int J Clin Pharmacol Ther. Sep 2014;52(9):787-801.
  55. Wang K, Zhang J, Ping S, et al. Anti-inflammatory effects of ethanol extracts of Chinese propolis and buds from poplar (Populus x canadensis). J Ethnopharmacol. Aug 8 2014;155(1):300-311.
  56. Orsolic N, Sirovina D, Koncic MZ, et al. Effect of Croatian propolis on diabetic nephropathy and liver toxicity in mice. BMC Complement Altern Med. 2012;12:117.
  57. Budimir V, Brailo V, Alajbeg I, et al. Allergic contact cheilitis and perioral dermatitis caused by propolis: case report. Acta Dermatovenerol Croat. 2012;20(3):187-190.
  58. Ramien ML, Pratt MD. Fixed drug eruption to ingested propolis. Dermatitis. Jul-Aug 2012;23(4):173-175.
  59. Baker L, Litzner B, Le EN, et al. Ectopic periorbital dermatitis and mycosis fungoides-like dermatitis due to propolis. Dermatitis. Nov-Dec 2013;24(6):328-329.
  60. Wu JY, Hsu NY. Propolis-induced descending necrotizing mediastinitis and aspiration pneumonia. Ann Thorac Surg. Apr 2013;95(4):e87-89.
  61. Lin WC, Tseng YT, Chang YL, et al. Pulmonary tumour with high carcinoembryonic antigen titre caused by chronic propolis aspiration. Eur Respir J. Dec 2007;30(6):1227-1230.
  62. Li YJ, Lin JL, Yang CW, et al. Acute renal failure induced by a Brazilian variety of propolis. Am J Kidney Dis. Dec 2005;46(6):e125-129.
  63. Afkhamizadeh M, Aboutorabi R, Ravari H, et al. Topical propolis improves wound healing in patients with diabetic foot ulcer: a randomized controlled trial. Nat Prod Res. 2018 Sep;32(17):2096-2099.
  64. Bruyère F, Azzouzi AR, Lavigne JP, et al. A Multicenter, Randomized, Placebo-Controlled Study Evaluating the Efficacy of a Combination of Propolis and Cranberry (Vaccinium macrocarpon) (DUAB®) in Preventing Low Urinary Tract Infection Recurrence in Women Complaining of Recurrent Cystitis. Urol Int. 2019;103(1):41-48.
  65. Marucci L, Farneti A, Di Ridolfi P, et al. Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer. Head Neck. 2017 Sep;39(9):1761-1769.
  66. AkhavanKarbassi MH, Yazdi MF, Ahadian H, SadrAbad MJ.  Randomized DoubleBlind Placebo-Controlled Trial of Propolis for Oral Mucositis in Patients Receiving Chemotherapy for Head and Neck Cancer. Asian Pac J Cancer Prev. 2016;17(7):3611-4.
  67. Matsumoto Y, Takahashi K, Sugioka Y, et al. Double-blinded randomized controlled trial to reveal the effects of Brazilian propolis intake on rheumatoid arthritis disease activity index; BeeDAI. PLoS One. 2021;16(5):e0252357.
  68. D’Ercole MC. Prolonged use of propolis can increase liver enzymes. J Gastrointestin Liver Dis. Aug 18 2020;29(3):468-469.
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