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updated: 11/28/2011 6:03 AM

Herb butterbur may be allergy alternative

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In the United States, almost 35 million people have allergic rhinitis or hay fever. Allergic rhinitis is an inflammation of the nasal airways caused by an allergic reaction to something in the environment like pollen, dust or animal dander. The symptoms can vary from mild to severe. Although there are good medications to treat allergic rhinitis, butterbur, a simple plant growing along our waterways, seems to be as effective as common medications.

Allergic rhinitis is the sixth most common chronic illness in the United States and direct medical costs are estimated at $7 billion annually. Each year, medications alone cost more than $3 billion.

Allergic rhinitis is the result of a series of steps that ultimately release histamine: an allergen binds to a specific type of immunoglobulin called IgE, which then binds to histamine-containing cells resulting in the release of histamine. Histamine triggers the symptoms of allergic rhinitis -- sneezing, red and watery eyes, swelling of the nasal passages and a production of copious mucus.

There are a number of medications available for the treatment of allergic rhinitis. The most common medications are antihistamines and decongestants. However, drowsiness is a common side effect. Decongestant nasal sprays can be effective, but rebound nasal congestion is always a concern. Steroids also are commonly prescribed but need to be used over a prolonged period of time. Butterbur may be an answer.

Butterbur is an herb, a member of the daisy family that grows throughout North America. Historically it has been used to treat abdominal pain, headaches, asthma, insomnia and as an appetite stimulant. In a recent series of medical studies, it seems to reduce the symptoms of allergic rhinitis.

This excellent series of medical studies originated from a group of researchers in Germany. The initial study demonstrated that an extract from the leaf of butterbur plant is safe. The second study looked for the optimal dose of butterbur for allergic rhinitis. It included 180 participants with allergic rhinitis who were divided into three groups: high-dose butterbur, low-dose butterbur and a placebo.

The high-dose butterbur was more effective than the low dose and both were significantly superior to the placebo. In the third study, butterbur was compared to both placebo and the antihistamine medication fenofexadine (Allegra). Three hundred participants with allergic rhinitis were evenly divided into three groups: fenofexadine, butterbur and placebo. Over the course of the study, both the fenofexadine and butterbur groups had significant relief of symptoms. Interestingly, high-dose butterbur performed as well as fenofexadine. Some additional data demonstrated that the combination of fenofexadine and butterbur was no better than butterbur alone.

Butterbur appears to be effective, have fewer side effects and is much less expensive than many of the common medications used for allergic rhinitis. It may be a reasonable option to medications. However, some butterbur preparations may contain liver toxic chemicals called pyrrolizidine alkaloids. Only certified and labeled "PA-free" products should be used. Always check with a physician familiar with herbs before combining medications and herbs.

• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network. His website is

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