## 4 Discussion
Thus, future studies should recruit more diverse ethnic populations and include a wider pediatric age spectrum to enhance the findings' external validity. Moreover, this study was conducted in a single pediatric outpatient clinic, further limiting external validity. Factors such as environmental conditions, genetic predispositions, and healthcare practices may differ considerably across settings, influencing therapeutic outcomes. Therefore, subsequent research should involve larger, multicenter trials across diverse geographic regions to validate these preliminary findings and ensure broader generalizability and applicability. Additionally, this study relied exclusively on subjective symptom-based assessments, such as the I-NOSE questionnaire and VAS, lacking objective biomarkers to elucidate underlying inflammatory or viral mechanisms associated with AR. Integrating objective measures like nasal swabs for viral detection, inflammatory cytokine profiling (e.g., IL-6,TNF-\(\alpha\)), or systemic biomarkers such as C-reactive protein (CRP) would significantly enhance the mechanistic understanding of treatment effects. Future studies should therefore incorporate these objective assessments to complement clinical evaluations. While our results support previously reported antimicrobial, mucolytic, and anti-inflammatory properties attributed to mullein, thyme, and polyphosphates, the present study does not offer detailed insights into the cellular and molecular pathways involved. Future research would greatly benefit from complementary in vitro or ex vivo investigations, particularly focusing on nasal epithelial cell responses. Studies examining changes in epithelial barrier integrity, mucus production, ciliary function, and inflammatory gene expression would enrich our understanding of the therapeutic mechanisms, strengthening the clinical evidence derived from current and subsequent clinical trials. Additionally, our study compared the effectiveness of _\"Elysium Naso-gola\"_ solely against placebo (standard isotonic saline solution), without incorporating active comparator groups representative of other established non-pharmacological therapies such as hypertonic saline nasal irrigation, steam inhalation methods, or honey-based treatments. Moreover, future studies should include head-to-head comparisons with conventional pharmacological treatments like antihistamines and nasal corticosteroids to clearly determine the relative efficacy, safety profile, and clinical positioning of _\"Elysium Naso-gola\"_. Such comparative studies would substantially enhance the therapeutic value and inform clinical decisions within pediatric AR management. Finally, this pilot trial lacked qualitative data collection concerning patient experiences and caregiver satisfaction. Gathering subjective feedback through structured interviews, surveys, or open-ended questionnaires would significantly contribute to understanding treatment acceptability, perceived effectiveness, and practical implications for families. Future research should therefore incorporate qualitative methodologies to offer comprehensive insights into patient-centered outcomes, thus ensuring the broader relevance and applicability of _\"Elysium Naso-gola\"_ in pediatric care. The strengths of this study include its rigorous randomized, double-blind, placebo-controlled design, which minimizes bias and enhances the validity of the findings. The use of validated tools such as the I-NOSE questionnaire and VAS scale ensures robust assessment of symptom severity [25; 26]. Moreover, the focus on a natural, well-tolerated formulation aligns with the increasing demand for safe and effective non-pharmacological treatments, particularly in pediatric care. Compared to conventional saline solutions, _\"Elysium Naso-gola\"_ offers additional therapeutic benefits. While standard saline irrigation primarily facilitates mechanical mucus clearance, the active ingredients in this formulation provide complementary anti-inflammatory, antiviral, and antimicrobial effects [18].