Butterbur is a plant found throughout Europe and Asia and in parts of North America. The roots have been used in herbal treatments for centuries, but the leaves have more recently been introduced as a new herbal medication.

Researchers from Switzerland and Germany compared butterbur extract with fexofenadine (Allegra), an antihistamine commonly used to treat intermittent allergic rhinitis, better known as hay fever. Common symptoms of hay fever include sneezing, nasal congestion and watery, itchy eyes.

The investigators assigned 330 patients to one of three groups: the first group took butterbur extract (also called petasites), 8 milligram tablets three times a day; the fexofenadine group took a 180-milligram antihistamine tablet in the morning; and the third group received placebo pills.

Then they evaluated the "total symptom score," taking into account sneezing, congestion and all other hay fever symptoms. At the start, all groups scored about 10. Both the antihistamine group and the butterbur group came down in scores about equally. The antihistamine group lowered their score 3.51 and the butterbur group lowered their score 3.86. The placebo group dropped only 0.41.

Pyrrolizidine Alkaloids

"For symptomatic treatment, Butterbur Ze 339 [the formula used in the study] is a very good alternative to antihistamines," said Dr. Andreas Schapowal, a allergy specialist at the Allergy Clinic in Landquart, Switzerland, and the lead author of the study.

The findings were published online Monday in Phytotherapy Research, an international journal on medicinal plant research.

Butterbur is a plant found throughout Europe and Asia and in parts of North America. The roots have been used in herbal treatments for centuries, but the leaves have more recently been introduced as a new herbal medication.

In previous research, butterbur use has been associated with cancer in animals, and it is believed that pyrrolizidine alkaloids are responsible for the cancer-causing effect, said Eric Yarnell, a naturopathic physician and assistant professor in the department of botanical medicine at Bastyr University, Seattle. Those substances were removed from the butterbur used in the Schapowal study.

"Pyrrolizidine alkaloids in the butterbur plant are liver-toxic," said Schapowal. "Therefore, a special plant called Petzell was cultivated in a controlled manner with a low amount of toxic alkaloids. Furthermore, only the leaves are used, whereas other producers are using the roots with 10 times more toxic ingredients. Liver function parameters were monitored closely in all [my] studies and no abnormalities were found. Thus, we consider Butterbur Ze 339 to be a safe drug."

The Swiss government licensed the butterbur formula for hay fever in 2003, he added.

Effective in Treating Migraines

The new study is sound and interesting, said Yarnell, who is familiar with it. "This is definitely the first big study [showing butterbur to be effective in hay fever]," Yarnell said. Other research has found the herb effective in treating migraines, he said.

"I think it's very safe," he said. "The issue [of safety] gets back to the pyrrolizidine alkaloids."

Clinically, Yarnell has been recommending butterbur to patients who have hay fever. "I have been recommending it more and more," he said. The dose used in the study, he added, seems reasonable, although he advised hay fever sufferers to ask their health care practitioner about the best dose.

More information To learn more about butterbur, visit the American Botanical Council.

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