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Butterbur: Alert Alternative to Antihistamines

Study finds controversial plant extract fights hay fever, dodges drowsiness

FRIDAY, Jan. 18, 2002 (HealthDayNews) -- A controversial plant extract may work as well as an antihistamine for hay fever, and it doesn't come at the price of drowsiness, a new Swiss study says.

The compound, butterbur, could be an alternative to the more traditional drugs that clear heads but are notorious soporifics, say the researchers who did the study, which appears in tomorrow's issue of the British Medical Journal.

However, in its raw form, butterbur has been linked to cancer in animals, and an American allergist cautions that more trials are needed to test the supplement's safety.

Butterbur, or Petasites hybridus, also known as bog rhubarb, butter dock and other names, grows near water in Europe, northern Africa and parts of Asia. Chemicals in the bushy, flowering plant are thought to help treat a wide range of ailments, from headaches to asthma.

In the latest study, Andreas Schapowal, of the Allergy Clinic in Landquart, Switzerland, and his colleagues compared a butterbur extract with the antihistamine cetirizine in 125 adults who had a history of allergic rhinitis, the 25-cent term for hay fever. The adults took four doses a day of the herbal remedy or one dose each night of cetirizine, which is sold as Zyrtec by Pfizer Inc.

After two weeks, those on the herbal treatment reported roughly the same amount of sneezing, runny nose and other allergy symptoms as did those taking the antihistamine, the researchers say. Adverse events were equally common in the two groups, occurring in 16 percent of those on the herb versus 17 percent of those on the antihistamine.

However, although cetirizine is marketed as a non-sedating drug, two-thirds of the complaints from those who took it were for sleepiness -- a problem that didn't dog butterbur.

"Butterbur was well-tolerated, and did not have the sedative effects associated with antihistamines," the researchers write. "We believe butterbur should be considered for treating seasonal allergic rhinitis, particularly in cases where the sedative effects of antihistamines need to be avoided."

But Dr. B. Lauren Charous, a Milwaukee allergist familiar with the latest study, says "Whoa!"

The work is "interesting and provocative," he says, but "the most you could say is that it deserves further trials."

Charous points to Seldane, a popular antihistamine that was pulled from the market over its link to deadly heart rhythm anomalies, and Hismanal, another troubled hay fever drug that had to be withdrawn, as cautionary tales.

Although Charous says he's intrigued by the Swiss findings, he takes issue with several aspects of the study. The researchers didn't have an untreated group in their trial, so they had no way to account for a placebo effect, he says. The group also included, he says, a significant number of smokers, who are typically excluded from antihistamine trials because their habit aggravates allergy symptoms.

What's more, Charous adds, "I have no idea of the long-term safety" of butterbur extract. To promote it as an alternative to antihistamines, he says, "I don't think that's responsible."

Dr. Alexander Mauskop, director of the New York Headache Center in New York City, recently participated in a multi-center study testing butterbur as a treatment for migraines. Those results aren't in yet, he says, but an earlier, though shaky, report found the compound to be an effective painkiller.

The supplement "definitely is worth a look," Mauskop adds.

One German company has purified the substance and is selling its version as Petadolex in that country.

What To Do

As with any dietary supplement, tread cautiously. Don't take herbal remedies before talking to your doctor.

To learn more about supplements, try the Consumer Healthcare Products Association or the National Institutes of Health's Office of Dietary Supplements.

For more on hay fever, check out the American Lung Association, which estimates that 26.1 million Americans struggle with the seasonal allergy each year.

SOURCES: Interviews with B. Lauren Charous, M.D., Allergy and Research Care Center, Milwaukee Medical Clinic, Milwaukee; Alexander Mauskop, M.D., director, New York Headache Center, New York City; Jan. 19, 2002, British Medical Journal
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