The effects of butterbur on the histamine and allergen cutaneous response

Background: Butterbur or Petasites hybridus is an herbal remedy that exhibits antihistamine and antileukotriene activity and has been shown to attenuate the response to adenosine monophosphate challenge in patients with allergic rhinitis and asthma. However, no data are available regarding its effects on the histamine and allergen cutaneous response. Objective: To evaluate the effects of butterbur compared with fexofenadine and montelukast on the histamine and allergen wheal and flare cutaneous responses.

Methods: Atopic patients were randomized into a double-blind, double-dummy, crossover study to receive for 2 week butterbur, 50 mg twice daily (8 AM and 10 PM); fexofenadine, 180 mg once daily (10 PM), and placebo once daily (8 AM); montelukast, 10 mg once daily (10 PM), and placebo once daily (8 AM); or placebo twice daily (8 AM and 10 PM). Patients attended the department at 10 AM and had measurements of the cutaneous wheal and flare responses to histamine, allergen, and saline control at 10-minute intervals for 60 minutes.

Results: Twenty patients completed the study. The mean +/-SE histamine wheal and flare responses, respectively, were significantly attenuated (P <.05) by fexofenadine (9.4 +/- 1.8 mm(2) and 13.5 +/- 3.2 mm(2)) compared with placebo (15.5 +/- 3.3 mm(2) and 179.8 +/- 74.3 mm(2)) but not by butterbur (16.4 +/- 2.1 mm(2) and 297.7 +/- 121.2 mm(2)) or montelukast (19 +/- 1.9 mm(2) and 240.2 +/- 66.6 mm(2)). The allergen wheal and flare responses, respectively, were also significantly attenuated (P <.05) by fexofenadine (31.1 +/- 6.3 mm(2) and 256.9 +/- 86.5 mm(2)) compared with placebo (65.4 +/- 15.2 mm(2) and 1,014.5 +/- 250.0 mm(2)) but not by butterbur (50.4 +/- 9.2 mm(2) and 1,110.3 +/- 256.1 mm(2)) or montelukast (58.8 +/- 9.1 mm(2) and 1,463.6 +/- 295.6 mm(2)).

Conclusions: Butterbur did not produce any significant effects on the histamine and allergen cutaneous response compared with placebo, whereas mediator antagonism with fexofenadine but not montelukast produced significant attenuation. This finding would suggest that butterbur may not be effective in allergic skin disease.