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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
Sadly, however, despite the optimism regarding the use of butterbur in the literature, one pertinent question remains unanswered: what about possible adverse effects from long-term butterbur therapy? Although the current study did not demonstrate any adverse effects, it should be emphasized that butterbur therapy was evaluated for only a 2-week period. In a previous study in which butterbur was taken by patients with intermittent allergic rhinitis, also only for 2 weeks, liver function appeared to be unaffected.3 However, unpurified butterbur contains toxic pyrrolizidine alkaloids, which have been linked to hepatotoxicity and carcinogenicity in humans, and testosterone production has been shown to be inhibited by butterbur in animals, so no one can really be sure whether the use of butterbur, albeit in its purified form, may have any potential deleterious effects in the long-term. Therefore, as with any licensed therapy, herbal or otherwise, long-term studies should be carried out to investigate the safety aspects of butterbur therapy.
Correspondence: Dr Lee, Department of Respiratory Medicine, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, Suffolk, England (firstname.lastname@example.org).
Lee DKC. 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
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