Allergic Rhinitis and Butterbur

Butterbur is a plant that grows along rivers, ditches, and marshy areas in northern Asia, Europe, and parts of North America. It is also known as bog rhubarb, blatterdock, bogshorns, butter-dock, butterly dock, capdockin, flapperdock, and langwort. Butterbur has a long history of use as an anti-spasmodic, thought to be effective for such conditions as headaches, stomach cramps, whooping cough, and asthma. A handful of studies also suggest that butterbur extracts may be useful in treating allergic rhinitis.

The exact effect of butterbur on allergic rhinitis is not clear. Butterbur may help by reducing the inflammation that leads to most of the problematic symptoms of allergic rhinitis.

Read more details about Butterbur.

A handful of studies support the use of butterbur extract as a potentially effective treatment for allergic rhinitis.

IIn a 2-week, double-blind, placebo-controlled study of 186 people with intermittent allergic rhinitis, use of butterbur at a dose of three standardized tablets daily, or one tablet daily, reduced allergy symptoms as compared to placebo.⁴ Significantly greater benefits were seen in the higher dose group. Such "dose dependency" is taken as a confirming sign that a treatment really works.

In another double-blind study, 330 people were given either butterbur extract (one tablet three times daily), the antihistamine fexofenadine (Allegra), or placebo.⁵ The results showed that butterbur and fexofenadine were equally effective, and both were more effective than placebo.

A previous 2-week, double-blind study of 125 individuals with hay fever (technically, seasonal allergic rhinitis) compared a standardized butterbur extract against the antihistamine drug cetirizine.⁶ According to ratings by both doctors and patients, the two treatments proved about equally effective. Unfortunately, this study did not use a placebo group.

The usual dosage of butterbur is 50-75 mg twice daily of a standardized extract that has been processed to remove potentially dangerous chemicals called pyrrolizidine alkaloids.

Safety Issues

In studies and postmarketing surveillance involving adults and children, burping and other mild gastrointestinal complaints have been the main side effect of butterbur extract. ¹ Butterbur contains liver-toxic and possibly carcinogenic components called pyrrolizidine alkaloids. ² Fortunately, it is possible to remove these compounds from butterbur products. ³ In Germany, the maximum allowable content of pyrrolizidine alkaloids in butterbur products has been set at 1 microgram per daily recommended dose.

Butterbur should not be used by pregnant or nursing women, young children, or people with severe kidney or liver disease, until further safety testing has been performed.

1. Lipton RB, Gobel H, Einhaupl KM, et al. Petasites hybridus root (butterbur) is an effective preventive treatment for migraine. Neurology. 2004;63:2240-4..
2. Luthy J, Zweifel U, Schmid P, et al. Pyrrolizidine alkaloids in Petasites hybridus L. and P. albus L. [in German; English abstract]. Pharm Acta Helv. 1983;58:98–100.
3. Mauz C, Candrian U, Luthy J, et al. Method for the reduction of pyrrolizidine alkaloids from medicinal plant extracts [in German; English abstract]. Pharm Acta Helv. 1985;60:256–259.

4. Schapowal A. Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg. 2004;130:1381-1386.
5. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res. 2005 Aug 22. [Epub ahead of print]
6. Schapowal, A. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ. 2002;324:144-146.