We evaluated the effects of butterbur (BB), a herbal remedy, in comparison to fexofenadine (FEX) and montelukast (ML), assessing the histamine and allergen wheal and flare cutaneous response.

20 atopic patients were randomized into a double-blind, double-dummy, cross-over study to receive for 1 week either BB 50mg bid (8am and 10pm), FEX 180mg qd (10pm) and placebo (PL) qd (8am), ML 10mg qd (10pm) and PL qd (8am), or PL bid (8am and 10pm). Patients attended the department at 10am and had measurements of the cutaneous wheal and flare response to histamine, allergen and saline control at 10-minute intervals over 60 minutes.

The mean (± SEM) histamine wheal and flare response (mm²) respectively was significantly attenuated (p<0.05) by FEX (9.4 ± 1.8 and 13.5 ± 3.2) compared to PL (15.5 ± 3.3 and 179.8 ± 74.3), but not by BB (16.4 ± 2.1 and 297.7 ± 121.2) or ML (19 ± 1.9 and 240.2 ± 66.6). The allergen wheal and flare response (mm²) respectively was also significantly attenuated (p<0.05) by FEX (31.1 ± 6.3 and 256.9 ± 86.5) compared to PL (65.4 ± 15.2 and 1014.5 ± 250.0), but not by BB (50.4 ± 9.2 and 1110.3 ± 256.1), or ML (58.8 ± 9.1 and 1463.6 ± 295.6).

BB did not produce any significant effects on the histamine and allergen cutaneous response compared to PL, whereas mediator antagonism with FEX but not ML produced significant attenuation. This would suggest that BB may not be effective in allergic skin disease.