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What Doctors Don't Tell You

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July 2020 (Vol. 5 Issue 5)

Natural vs medical - Butterbur vs antihistamines for hay fever

About the author: 
Joanna Evans

Natural vs medical - Butterbur vs antihistamines for hay fever image

Should you trust a herbal remedy rather than an antihistamine to tackle your hay fever symptoms? Joanna Evans investigates

Antihistamines are the standard treatment for those dreaded symptoms of hay fever that affect some 15–20 per cent of people in the UK at around this time of year. But the side-effects can sometimes be as bad as all the sneezing, swelling and itching. Drowsiness, dizziness, dry mouth, impaired thinking, headaches and blurred vision are some of the more common ones. Even the so-called second-generation antihistamines, supposedly non-sedating and better tolerated, can make you feel drowsy and fatigued,1 and some have even been associated with ‘cardiotoxicity’—causing heart muscle damage or dysfunction.2

Pregnant women especially should steer clear of antihistamines, as none of them have been classified as safe for use during pregnancy.3

Butterbur is one natural remedy that’s been touted as an effective alternative for relieving hay fever. But does it really work?

Butterbur basics

Butterbur (Petasites hybridus) is a shrub-like plant found in Europe and parts of Asia and North America. It has a long history of medicinal use. During the Middle Ages, it was used to treat the plague and fever and, in the 17th century, it was a common remedy for cough, asthma and skin wounds. Today, butterbur has become a popular alternative treatment for hay fever, and its extracts are commonly found in supplements on health-food store shelves.

Better than placebo

There are a lot of natural remedies marketed for hay fever relief, but butterbur is among the few that actually has convincing scientific evidence that it works. In one randomized controlled trial (RCT)—considered the ‘gold-standard’ of scientific testing—186 hay fever sufferers were given either a high or low dose of a standardized extract of butterbur called Zeller’s extract (Ze339) or a placebo (dummy pill), every day for two weeks.

Not only did the researchers find that the butterbur extract was significantly better at improving symptoms than the placebo, but they also discovered that the higher dose was more effective than the lower dose—a sign that the herbal remedy was actually causing the changes.4

An antihistamine alternative

Zeller’s extract has also been pitted against two commonly used antihistamines, cetirizine and fexofenadine, with impressive results.

When compared with cetirizine (Zyrtek in the UK, Zyrtec in the US), an antihistamine available over the counter in pharmacies and supermarkets, the butterbur treatment worked just as well as the drug at improving hay fever symptoms like itchy eyes and a runny nose. But the big difference was the side-effects. Despite being classed as a non-sedating antihistamine, cetirizine was associated with sleep-inducing effects like drowsiness and fatigue—effects not seen with butterbur.

“Butterbur should be considered for treating seasonal allergic rhinitis [the medical term for hay fever] when the sedative effects of antihistamines need to be avoided,” the researchers said.5

Ze339 also appears to be just as effective as fexofenadine (marketed as Telfast and Allegra), a prescription-only drug available in three strengths: 30 mg, 120 mg and 180 mg. When the herbal extract was tested against the highest-strength formula in an RCT of 330 hay fever patients, both treatments were better than the placebo and equally effective at reducing symptoms.6

Reviewing the evidence

Although one small trial reported that butterbur had no “significant effect”,7 a review of all the butterbur trials so far concluded there is “encouraging evidence” that the herb may be effective for treating hay fever.8

Still, there’s a need for more independent studies, the reviewers said, as three large trials had received funding from the makers of Zeller’s extract.

As for how butterbur extract might work, one trial found that it reduces levels of nasal inflammatory mediators like histamine and leukotrienes—molecules involved in the inflammatory response that causes the usual symptoms of sneezing, a stuffed-up nose and itchy eyes.9

Dosage and safety

The usual dosage of butterbur is 50–75 mg twice daily of a standardized extract of the herb (usually containing at least 7.5 mg of petasin and isopetasin, the main active ingredients). This is generally well tolerated, with only mild gastrointestinal complaints (such as burping) being the most commonly reported side-effects.10

But butterbur is also known to contain toxic compounds called ‘pyrrolizidine alkaloids’ (PAs). These may be harmful to the liver and might even cause cancer, so make sure to choose an alkaloid-free preparation of butterbur to be safe.

Sadly, butterbur is not a good option for pregnant or nursing women as, so far, it hasn’t been tested enough in that population. Young children and anyone with severe kidney or liver disease are also advised to avoid it.

Bottom line

If you want to avoid antihistamines, butterbur may be the answer to your hay fever woes, provided you’re not in one of the groups advised not to take it. If in doubt, consult a qualified herbal practitioner.

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