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Letters to the Editor
June 2005

Addressing the Long-term Safety Aspects of Butterbur Therapy: A Call for Immediate Action

Arch Otolaryngol Head Neck Surg. 2005;131(6):539-540. doi:10.1001/archotol.131.6.539-c

Schapowal1 is to be commended for reporting the results of a carefully conducted 2-week study on the dose-response of butterbur therapy in patients with intermittent allergic rhinitis. The author’s follow-up trial of a previous non–placebo-controlled study2 sheds further light into the potential therapeutic role of butterbur in the treatment of allergic airway disease. Recent trials of butterbur in which objective measures were used have consistently shown its beneficial effects. Treatment with butterbur has been found to attenuate the response to nasal provocation testing with adenosine monophosphate compared with placebo in patients with intermittent allergic rhinitis.3 Also, when compared with fexofenadine hydrochloride, a modern histamine H1-receptor antagonist, butterbur has been demonstrated to confer protection against nasal adenosine monophosphate challenge while improving nasal symptoms in patients with persistent allergic rhinitis.4 Importantly, the anti-inflammatory effects of butterbur are not confined only to the upper airway but also extend into the lower airway, where, compared with placebo, butterbur has been shown to improve airway hyperreactivity after bronchial adenosine monophosphate challenge in patients with asthma who were receiving inhaled corticosteroids.5

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