This post is part of our series called “AAFA Explains: What Is the Difference Between Alternative and Complementary Medicine?"
This blog series is about complementary and alternative medicine (CAM) for asthma and allergies. It can help guide you as you decide between choices that may be “likely safe” or “potentially unsafe.”
When new drugs and medical procedures are developed, they go through rigorous scientific study. CAM treatments usually do not go through the same type of research. As a result, whether it works (called efficacy) is unproven for most treatments.
Most herbal remedies for rhinitis fall into that category.
What is rhinitis?
Rhinitis means “inflammation (swelling) of the nose.” It is caused by allergies to things in the air, in your home, work or school, such as pollens, dust mites, mold and animals. Rhinitis can happen at certain times of the year. This is called seasonal allergic rhinitis. Or it can happen all year-round. This is called perennial allergic rhinitis. The main symptoms are itchy nose and eyes, sneezing, stuffy nose, runny nose, and mucus in the throat.
What are herbal remedies?
Many medicines originated (came) from plants. They are reformulated (remade) into medicines that go through strict review from the Food and Drug Administration (FDA) for safety and efficacy. Herbal remedies, or herbal supplements, are treatments made from plants or plant extracts that are not reformulated in the same way medicines are. They do not go through review from the FDA. Herbal remedies can be liquids that you drink, parts of the plant/herb or pills/powders that you can drink or eat, or can be put on the skin or used internally, like in enemas (colon cleansing). There are many different herbal remedies.
What does science tell us about herbal remedies?
There have been some scientific studies done to see if herbal remedies help rhinitis. Unfortunately, there are often flaws with the design or conduct of these studies.
Some researchers have also done “meta-reviews.” This means they checked to see if other people had already done high-quality studies. High-quality studies are randomized controlled trials, like the clinical studies done for prescription medications.
One meta-review of CAM for rhinitis found only two clinical trials for butterbur extract. These studies showed that for rhinitis, butterbur extract worked as well as antihistamines. One of these studies showed that butterbur worked as well as cetirizine over a two-week period for seasonal allergy sufferers. The other showed butterbur worked as well as fexofenadine over a six-week period in those with perennial rhinitis. You may know cetirizine as Zyrtec®, and fexofenadine as Allegra® or Mucinex® Allergy.
What about using butterbur to treat seasonal rhinitis? It’s hard to say as most people need rhinitis treatments for longer than 2-6 weeks.
Another meta-review looked at the results of six studies of butterbur for seasonal rhinitis. Those six studies showed that butterbur worked as well as antihistamines. But the company that made the butterbur helped pay for three of the six studies. So the results may not be trustworthy.
There was one randomized controlled trial about grapeseed extract and rhinitis. Would grapeseed extract work to treat ragweed-induced rhinitis? The answer was no – the grapeseed extract did not make a difference.
Are herbal remedies safe?
Herbal remedies are potentially unsafe. Certainly, they are not always safe for all people.
Many herbal remedies can cause allergic reactions and side effects. They can also interact with prescription and other medications that the person is taking.
For example, raw extracts of butterbur contain a toxin that can cause liver damage and cancer. Extracts of butterbur are available that have almost none of this toxin. There are no long-term studies of butterbur products, so it’s hard to say if it is safe.
You should also be aware that herbal remedies are not regulated the same way prescription medicines are. Because of this, there are other possible problems with herbal remedies. Non-labeled ingredients might be included in the remedy. The plants might be collected the wrong way. The remedy itself might be made incorrectly. The amount of herb in a recommended dose could be wrong.
Other herbs are related to the ragweed family and can make your allergies worse. These include chamomile and echinacea.
What herbs might be safe even if they are not effective? Warm mint (peppermint, spearmint) teas may make your rhinitis feel better even if they don’t help with your allergies.
The bottom line:
Herbs have not been studied in large numbers of people the same way prescription drugs have. We don’t know how they perform over time. Herbal remedies have the potential to interact with other medicines. Always tell your doctor if you are taking an herb.
- Randomized controlled trials: Participants are randomly placed into two groups. One group does not receive any treatment. The other group receives the treatment under consideration. Researchers follow both groups over time. At the end of the study, they compare results.
- Efficacy: Whether or not a treatment works, and by how much.
Passalacqua G., Bousquet PJ., Carlsen KH., Kemp J., Lockey RF., Niggemann B., Pawankar R., Price D., Bousquet J. (2006). ARIA update: I—Systematic review of complementary and alternative medicine for rhinitis and asthma. The Journal of Allergy and Clinical Immunology.
Medical Review May 2016.