Butterbur (Petasites hybridus) in hay fever

A study in the British Medical journal has compared the tolerability and effectiveness of butterbur (Petasites hybridus) with cetirizine in 125 patients with seasonal rhinitis.

Butterbur (carbon dioxide extract ZE 339 - standardised for petasin content) did not produce the sedative side-effects associated with antihistamines and was well tolerated. The study said butterbur was similar in effect to cetirizine in the treatment of hay fever.

Though well-designed, there are two criticisms of the study:

1. the trial showed lack of difference in effectiveness but was too small to show equivalence
2. the study used a short treatment period of two weeks in context of a condition where symptoms may vary markedly with daily pollen count changes

Petasites hybridus is a shrub that is found in America, Asia and Europe. Petasin, the active constituent of preparations derived Petasites hybridus, is claimed to have anti-inflammatory (anti-leukotriene) and anti-spasmodic activity.

Note - the MHRA advised against the use of butterbur, and unlicensed butterbur products were withdrawn from the UK market in 2012 after reports of severe liver injury. Long-term use of butterbur may lead to reversible cholestatic hepatitis. (2)

Reference:

1. BMJ (2002), 334 (7330), 144-6.
2. D'Andrea G, Cevoli S, Cologno D. Herbal therapy in migraine. Neurol Sci. 2014 May;35 Suppl 1:135-40.