Rutgers Cancer Institute of New Jersey
195 Little Albany Street
New Brunswick, NJ 08903-2681
About 7% of all Americans suffer from hay fever, an allergic condition that can cause runny nose, sneezing, and teary eyes. It is known officially as allergic rhinitis, allergic sinusitis, or allergic conjunctivitis, depending on whether symptoms manifest mainly in the nose, sinuses, or eyes, respectively. Hay fever usually peaks when particular plants are pollinating or when molds are flourishing. People who suffer from year-round hay fever (perennial rhinitis) may be allergic to persistent allergens in the environment coming from such sources as dust mites, mice, and cockroaches.
Here's how hay fever works. In response to the triggers noted above, an individual prone to allergies develops an exaggerated immune response. Substances known as IgEs flood the nasal passages, white blood cells called eosinophils arrive by the millions and billions, and inflammatory substances such as histamine, prostaglandins, and leukotrienes are released in massive amounts. The overall effect is the familiar one of swelling, dripping, itching, and aching.
The mechanism of allergic response is fairly well understood. Why allergic people react so excessively to innocent bits of pollen, however, remains a complete mystery.
Conventional treatment for hay fever primarily involves nonsedating antihistamines and nasal steroids and is usually quite effective.
The herb butterbur is best known as a promising new treatment for migraine headaches. However, butterbur may also be helpful for allergic rhinitis.
In a 2-week, double-blind, placebo-controlled study of 186 people with intermittent allergic rhinitis, use of butterbur at a dose of three standardized tablets daily, or one tablet daily, reduced allergy symptoms as compared to placebo.34 Significantly greater benefits were seen in the higher dose group. Such "dose dependency" is taken as a confirming sign that a treatment really works.
In another double-blind study, 330 people were given either butterbur extract (one tablet three times daily), the antihistamine fexofenadine (Allegra), or placebo.44 The results showed that butterbur and fexofenadine were equally effective, and both were more effective than placebo.
A previous 2-week, double-blind study of 125 individuals with hay fever (technically, seasonal allergic rhinitis) compared a standardized butterbur extract against the antihistamine drug cetirizine.18 According to ratings by both doctors and patients, the two treatments proved about equally effective. Unfortunately, this study did not use a placebo group.
Two much smaller studies produced inconsistent results.27,35
For more information, including dosage and safety issues, see the full Butterbur article.
An alternative to allergy shots known as sublingual immunotherapy (SLIT) involves using allergenic substances placed under the tongue. Numerous double-blind, placebo-controlled studies indicate that SLIT can improve all major symptoms of allergic rhinitis when the offending allergens are known.32,43,48,49,51,63,68,69 However, in a 2008 comprehensive review of SLIT for grass pollen and house dust mite allergies, researchers raised questions regarding the quality and consistency of these and other studies.65
If SLIT is effective, it may require 2-3 years for significant benefit to develop.54 One placebo-controlled study found that 3 years of treatment was more effective than 2 years.56 In addition, to provide benefits for grass allergy season, SLIT must be started at least 8 weeks prior to the onset of the grass allergy season; even longer lead times lead to even better results.58 Putting all this evidence together, it appears that SLIT may work best if used year round, and year-after-year.
One study suggests that SLIT is not only effective for treating allergy, but may be useful in preventing the development of new allergies or mild persistent asthma in children with allergic rhinitis or intermittent asthma.70
While SLIT is fairly well accepted in conventional medicine, another form of “alternative” allergy shots remains firmly in the alternative medicine field: enzyme potentiated desensitisation (EPD). This method involves injections of allergens combined with certain enzymes. In one double-blind, placebo-controlled study, EPD failed to prove more helpful than placebo for seasonal allergic rhinitis.33
Several natural products have shown potential benefit for allergic rhinitis in one or more preliminary controlled trials. These include a water-extract of hops, a freeze-dried extract of stinging nettle,1 various probiotics,36,52,57 an extract of soy sauce (Shoyu polysaccharides),37,38 the herbs Tinospora cordifolia39 and <Astragalus membranaceus>, <72> rosmarinic acid (a substance found in the herb rosemary, and many other herbs, including Perilla frutescens),28,40 and an Ayurvedic herbal formula containing Commiphora mukul, Tinospora cordifolia, Rubia cordifolia, Emblica officinalis, Moringa pterygosperma, and Glycyrrhiza glabra.19,22
Traditional Chinese herbal medicine has shown some promise for allergies as well.23,24,29 Another traditional Chinese treatment, acupuncture, is commonly recommended for allergies, but a controlled trial of 40 people failed to find significantly more benefit with real acupuncture than with fake acupuncture.30 However, another study found benefit with real acupuncture plus real traditional Chinese herbs as opposed to placebo acupuncture and nonspecific Chinese herbs.41
Acupuncture alone has mixed results for treatment success. A review of 7 placebo-controlled trials failed to find convincing evidence for acupuncture’s effectiveness against allergic rhinitis.67 In contrast, a randomized trial with 175 adults found acupuncture provided significant improvement in symptom severity when compared to sham acupuncture. Participants used the treatment for 4 weeks.75
One rather unusual study tested a nasal spray containing capsaicin, the “hot” in cayenne and other hot peppers.31 It is not clear how practical this is—researchers had to use local anesthetic in the nose prior to using the spray!
A 12-week, double-blind, placebo-controlled study of 40 people tested the supplement conjugated linoleic acid (CLA) as a treatment for people with allergies to birch pollen and found some evidence of benefit.62
Test tube studies suggest that flavonoids—biologically active compounds found in many plants—may help reduce allergy symptoms.2-5 A particular flavonoid, quercetin, seems to be one of the most active.6-11 Many texts on natural medicine claim that quercetin works like the drug cromolyn (Intal), by stopping the release of allergenic substances in the body. However, while we have direct evidence that cromolyn is effective, there have not been any published studies in which people were given quercetin and their allergic symptoms decreased. It is a long way from test tube studies to real people.
Tomato extract has been advocated for the treatment of allergic rhinitis, but the one double-blind study said to demonstrate benefit actually proves almost nothing at all due to major flaws in its statistical analysis.55
Oligomeric Proanthocyanidins (OPCs) from grape seed or pine bark are also often said to be effective. However, an 8-week, double-blind trial of 49 individuals found no benefit from grape seed extract (dose not stated).12
The last several substances discussed (vitamins E and C, flavonoids, and OPCs) are antioxidants. One study failed to find evidence of benefit with a mixture of antioxidants: beta-carotene (9 mg/day), vitamin C (1500 mg/day), vitamin E (130 mg/day), zinc (45 mg/day), selenium (76 mg/day), and garlic (150 mg/day).53
Adrenal extracts, bee pollen, Bacopa monniera(brahmi), barberry, vitamin B6, vitamin B12, cat's claw, Coleus forskohlii, methyl sulfonyl methane (MSM), and betaine hydrochloride are sometimes recommended for hay fever, but there is as yet no significant evidence that they are effective. A 2009 review of 6 high-quality trials with over 1,000 children found that neither omega-3 nor omega-6 oil consumption prevented allergic diseases in high-risk children. Allergic diseases included eczema, asthma, allergic rhinitis or food allergy; and omega-3 and omega-6 sources included gamma-linolenic acid (GLA), fish oil, canola oil, and borage oil.71 A review of 8 trials of 3,366 pregnant and breastfeeding women found that fish oil had limited affect on the development of allergies their children. Most benefits were limited to food allergies in children with at high risk of alleriges.74
It has often been suggested that consumption of honey can reduce symptoms of hay fever. However, the one published study designed to test this suggestion failed to find benefit.50 Another study failed to find the bee product royal jelly effective.59
Acupuncture has also shown some promise for allergic rhinitis.46 In a randomized, placebo-controlled trial enrolling 80 adult subjects, real acupuncture was superior to sham acupuncture after 8 weeks of treatment for symptoms of persistent allergic rhinitis.64
Helminth therapy involves infecting a person with a type of worm, like hookworms or whipworms, that live in the human intestines. It is thought that this type of therapy can help the body adjust its immune response to allergens. A systematic review that included 2 placebo-controlled trials involving 130 patients with allergic rhinitis did not find any evidence to support the use of helminth therapy to reduce allergy symptoms.73
1. Mittman P. Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis. Planta Med. 1990;56:44-47.
2. Middleton E Jr, Drzewiecki G, Tatum J. The effects of citrus flavonoids on human basophil and neutrophil function. Planta Med. 1987;53:325-328.
3. Amellal M, Bronner C, Briancon F, et al. Inhibition of mast cell histamine release by flavonoids and biflavonoids. Planta Med. 1985;51:16-20.
4. Gabor M. Anti-inflammatory and anti-allergic properties of flavonoids. Prog Clin Biol Res. 1986;213:471-480.
5. Middleton E Jr. Effect of flavonoids on basophil histamine release and other secretory systems. Prog Clin Biol Res. 1986;213:493-506.
6. Ogasawara H, Middleton E Jr. Effect of selected flavonoids on histamine release (HR) and hydrogen peroxide (H2O2) generation by human leukocytes [abstract]. J Allergy Clin Immunol. 1985;75(suppl 1, pt 2):184.
7. Middleton E Jr, Drzewiecki G. Flavonoid inhibition of human basophil histamine release stimulated by various agents. Biochem Pharmacol. 1984;33:3333-3338.
8. Pearce FL, Befus AD, Bienenstock J. Mucosal mast cells. III. Effect of quercetin and other flavonoids on antigen-induced histamine secretion from rat intestinal mast cells. J Allergy Clin Immunol. 1984;73:819-823.
9. Middleton E Jr, Drzewiecki G, Krishnarao D. Quercetin: an inhibitor of antigen-induced human basophil histamine release. J Immunol. 1981;127:546-550.
10. Yoshimoto T, Furukawa M, Yamamoto S, et al. Flavonoids: potent inhibitors of arachidonate 5-lipoxygenase. Biochem Biophys Res Commun. 1983;116:612-618.
11. Middleton E Jr. Effect of flavonoids on basophil histamine release and other secretory systems. Prog Clin Biol Res. 1986;213:493-506.
12. Bernstein CK, Deng C, Shuklah R, et al. Double blind placebo controlled (DBPC) study of grapeseed extract in the treatment of seasonal allergic rhinitis (SAR) [abstract]. J Allergy Clin Immunol. 2001;107:1018.
13. Bucca C, Rolla G, Oliva A, et al. Effect of vitamin C on histamine bronchial responsiveness of patients with allergic rhinitis. Ann Allergy. 1990;65:311-314.
14. Bellioni P, Artuso A, Di Luzio Paparatti U, et al. Histamine provocation in allergy. The role of ascorbic acid [in Italian]. Riv Eur Sci Med Farmacol. 1987;9:419-422.
15. Fortner BR Jr, Danziger RE, Rabinowitz PS, et al. The effect of ascorbic acid on cutaneous and nasal response to histamine and allergen. J Allergy Clin Immunol. 1982;69:484-488.
16. Kim HM, Lee EH, Cho HH, et al. Inhibitory effect of mast cell-mediated immediate-type allergic reactions in rats by spirulina. Biochem Pharmacol. 1998;55:1071-1076.
17. Yang HN, Lee EH, Kim HM. Spirulina platensis inhibits anaphylactic reaction. Life Sci. 1997;61:1237-1244.
18. Schapowal, A. Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ. 2002;324:144-146.
19. Sharma S, Bhargava R, Singhal K. Double blind study to assess the efficacy of in acute rhinitis. Indian J Pharmac. 1990;22:103-105.
20. Shahani S, Dhadkar VN, Maroli S. The antihistaminic activity of Septilin and its role in topical eosinophillia. Ind J Pharmacol. 1993;25:114.
21. Rao CS, Raju C, Gopumadhavan S, et al. Immunotherapeutic modification by an ayurvedic formulation Septilin. Indian J Exp Biol. 1994;32:553-558.
22. Koti ST. Evaluation of Septilin in persistent low-grade infections in school-children: a placebo-controlled study. Probe. 1992;31:325.
23. Japan's Health Ministry confirms efficacy of another of Tsumura's Kampo drugs. Kampo Today [serial online]. 2000:4. Available at: http://www.tsumura.co.jp/english/kthp/4-1-01.htm. Accessed November 4, 2002.
24. Hu G, Walls RS, Bass D, et al. The Chinese herbal formulation biminne in management of perennial allergic rhinitis: a randomized, double-blind, placebo-controlled, 12-week clinical trial. Ann Allergy Asthma Immunol. 2002;88:478-487.
25. Thomet OA, Simon HU. Petasins in the treatment of allergic diseases: results of preclinical and clinical studies. Int Arch Allergy Immunol. 2002;129:108-112.
26. Lee D, Carstairs I, Haggart K, et al. Butterbur, a herbal remedy, attenuates adenosine monophosphate induced nasal responsiveness in seasonal allergic rhinitis. Clin Exp Allergy. 2003;33:882-886.
27. Lee DK, Gray RD, Robb FM, et al. A placebo-controlled evaluation of butterbur and fexofenadine on objective and subjective outcomes in perennial allergic rhinitis. Clin Exp Allergy. 2004;34:646-649.
28. Takano H, Osakabe N, Sanbongi C, et al. Extract of Perilla frutescens enriched for rosmarinic acid, a polyphenolic phytochemical, inhibits seasonal allergic rhinoconjunctivitis in humans. Exp Biol Med (Maywood). 2004;229:247-54.
29. Xue CC, Thien FC, Zhang JJ, et al. Treatment for seasonal allergic rhinitis by Chinese herbal medicine: a randomized placebo controlled trial. Altern Ther Health Med. 2003;9(5):80-87.
30. Magnusson AL, Svensson RE, Leirvik C, et al. The effect of acupuncture on allergic rhinitis: a randomized controlled clinical trial. Am J Chin Med. 2004;32:105-15.
31. Van Rijswijk JB, Boeke EL, Keizer JM, et al. Intranasal capsaicin reduces nasal hyperreactivity in idiopathic rhinitis: a double-blind randomized application regimen study. Allergy. 2003;58:754-761.
32. Wilson DR, Torres LI, Durham SR. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev. 2003;CD002893.
33. Radcliffe MJ, Lewith GT, Turner RG, et al. Enzyme potentiated desensitisation in treatment of seasonal allergic rhinitis: double blind randomised controlled study. BMJ. 2003;327:251-254.
34. Schapowal A. Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg. 2004;130:1381-1386.
35. Gray RD, Haggart K, Lee DK, et al. Effects of butterbur treatment in intermittent allergic rhinitis: a placebo-controlled evaluation. Ann Allergy Asthma Immunol. 2004;93:56-60.
36. Ishida Y, Nakamura F, Kanzato H, et al. Clinical effects of Lactobacillus acidophilus Strain L-92 on perennial allergic rhinitis: a double-blind, placebo-controlled study. J Dairy Sci. 2005;88:527-533.
37. Kobayashi M, Matsushita H, Shioya I, et al. Quality of life improvement with soy sauce ingredients, Shoyu polysaccharides, in perennial allergic rhinitis: a double-blind placebo-controlled clinical study. Int J Mol Med. 2004;14:885-889.
38. Kobayashi M, Matsushita H, Tsukiyama R, et al. Shoyu polysaccharides from soy sauce improve quality of life for patients with seasonal allergic rhinitis: a double-blind placebo-controlled clinical study. Int J Mol Med. 2005;15:463-467.
39. Badar VA, Thawani VR, Wakode PT, et al. Efficacy of Tinospora cordifolia in allergic rhinitis. J Ethnopharmacol. 2004;96:445-449.
40. Osakabe N, Takano H, Sanbongi C, et al. Anti-inflammatory and anti-allergic effect of rosmarinic acid (RA); inhibition of seasonal allergic rhinoconjunctivitis (SAR) and its mechanism. Biofactors. 2005;21:127-131.
41. Brinkhaus B, Hummelsberger J, Kohnen R, et al. Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial. Allergy. 2004;59:953-690.
42. Shahar E, Hassoun G, Pollack S. Effect of vitamin E supplementation on the regular treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2004;92:654-658.
43. Smith H, White P, Annila I, et al. Randomized controlled trial of high-dose sublingual immunotherapy to treat seasonal allergic rhinitis. J Allergy Clin Immunol. 2004;114:831-837.
44. Treating intermittent allergic rhinitis: a prospective, randomized, placebo and antihistamine-controlled study of Butterbur extract Ze 339. Phytother Res. 2005 Aug 22. [Epub ahead of print]
45. Montano Velazquez BB, Jauregui-Renaud K, Banuelos Arias Adel C, et al. Vitamin E effects on nasal symptoms and serum specific IgE levels in patients with perennial allergic rhinitis. Ann Allergy Asthma Immunol. 2006;96:45-50.
46. Ng DK, Chow PY, Ming SP, et al. A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis. Pediatrics. 2004;114:1242-1247.
47. Langewitz W, Izakovic J, Wyler J, et al. Effect of self-hypnosis on hay fever symptoms—a randomised controlled intervention study. Psychother Psychosom. 2005;74:165-172.
48. Penagos M, Compalati E, Tarantini F, et al. Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials. Ann Allergy Asthma Immunol. 2006;97:141-148.
49. Cox LS, Linnemann DL, Nolte H, et al. Sublingual immunotherapy: a comprehensive review. J Allergy Clin Immunol. 2006;117:1021-35.
50. Rajan TV, Tennen H, Lindquist RL, et al. Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Ann Allergy Asthma Immunol. 2002;88:198-203.
51. Rak S, Yang WH, Pedersen MR, et al. Once-daily sublingual allergen-specific immunotherapy improves quality of life in patients with grass pollen-induced allergic rhinoconjunctivitis: a double-blind, randomised study. Qual Life Res. 2006 Oct 11. [Epub ahead of print]
52. Tamura M, Shikina T, Morihana T, et al. Effects of probiotics on allergic rhinitis induced by Japanese cedar pollen: randomized, double-blind, placebo-controlled clinical trial. Int Arch Allergy Immunol. 2006 Dec 29. [Epub ahead of print]
53. Dunstan JA, Breckler L, Hale J, et al. Supplementation with vitamins C, E, beta-carotene, and selenium has no effect on anti-oxidant status and immune responses in allergic adults: a randomized controlled trial. Clin Exp Allergy. 2007;37:180-187.
54. Worm M. Efficacy and tolerability of high dose sublingual immunotherapy in patients with rhinoconjunctivitis. Allerg Immunol (Paris). 2006;38:355-360.
55. Yoshimura M, Enomoto T, Dake Y, et al. An evaluation of the clinical efficacy of tomato extract for perennial allergic rhinitis. Allergol Int. 2007 Jun 1. [Epub ahead of print]
56. Tahamiler R, Saritzali G, Canakcioglu S. Long-term efficacy of sublingual immunotherapy in patients with perennial rhinitis. Laryngoscope. 2007;117:965-969.
57. Giovannini M, Agostoni C, Riva E, et al. A randomized prospective double blind controlled trial on effects of long-term consumption of fermented milk containing Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res. 2007 Jun 25. [Epub ahead of print]
58. Calderon MA, Birk AO, Andersen JS, et al. Prolonged preseasonal treatment phase with Grazax sublingual immunotherapy increases clinical efficacy. Allergy. 2007;62:958-961.
59. Andersen AH, Mortensen S, Agertoft L, et al. Double-blind randomized trial of the effect of Bidro on hay fever in children. Ugeskr Laeger. 2005;167:3591-3594.
60. Segawa S, Takata Y, Kaneda H, et al. Effects of a hop water extract on the compound 48/80-stimulated vascular permeability in ICR mice and histamine release from OVA-sensitized BALB/c mice. Biosci Biotechnol Biochem. 2007;71:1577-1581.
61. Segawa S, Takata Y, Wakita Y, et al. Clinical effects of a hop water extract on Japanese Cedar Pollinosis during the pollen season: a double-blind, placebo-controlled trial. Biosci Biotechnol Biochem. 2007 Aug 7. [Epub ahead of print]
62. Turpeinen AM, Ylonen N, von Willebrand E, et al. Immunological and metabolic effects of cis-9, trans-11-conjugated linoleic acid in subjects with birch pollen allergy. Br J Nutr. 2008 Jan 2. [Epub ahead of print]
63. Mosges R, Bruning H, Hessler HJ, et al. Sublingual immunotherapy in pollen-induced seasonal rhinitis and conjunctivitis: a randomized controlled trial. Acta Dermatovenerol Alp Panonica Adriat. 2007;16:143-148.
64. Acupuncture for persistent allergic rhinitis: a randomised, sham-controlled trial. SourceMedical Journal of Australia. 2007;187:337-341.
65. Hoeks SB, de Groot H, Hoekstra MO. Sublingual immunotherapy in children with asthma or rhinoconjunctivitis: not enough evidence because of poor quality of the studies; a systematic review of literature. Ned Tijdschr Geneeskd. 2008;152:261-268.
66. Cingi C, Conk-Dalay M, Cakli H, et al. The effects of spirulina on allergic rhinitis. Eur Arch Otorhinolaryngol. 2008 Mar 15.
67. Roberts J, Huissoon A, Dretzke J, et al. A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis. BMC Complement Altern Med. 2008 Apr 22.
68. Pfaar O, Klimek L. Efficacy and safety of specific immunotherapy with a high-dose sublingual grass pollen preparation: a double-blind, placebo-controlled trial. Ann Allergy Asthma Immunol. 2008;100:256-263.
69. Dahl R, Kapp A, Colombo G, et al. Sublingual grass allergen tablet immunotherapy provides sustained clinical benefit with progressive immunologic changes over 2 years. J Allergy Clin Immunol. 2008;121:512-518.e2.
70. Marogna M, Tomassetti D, Bernasconi A, et al. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008;101:206-211.
71. Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy. 2009;64:840-8.
72. Matkovic Z, Zivkovic V, Korica M. Efficacy and safety of Astragalus membranaceus in the treatment of patients with seasonal allergic rhinitis. Phytother Res. 2010 Feb;24(2):175.
73. Croft AM, Bager P, Kumar S. Helminth therapy (worms) for allergic rhinitis . Cochrane Database Syst Rev. 2012;4:CD009238.
74. A review of 8 trials of 3,366 pregnant and breastfeeding women found limited evidence that fish oil prevented eczema their children. The controlled trials compared fish oil supplements to placebo or no supplementation. There were no significant differences in childhood eczema between the groups.
75. Xue CC, Zhang AL, Zhang CS, et al. Acupuncture for seasonal allergic rhinitis: a randomized controlled trial. Ann Allergy Asthma Immunol. 2015;115(4):317-324.
Last reviewed December 2015 by EBSCO CAM Review Board Last Updated: 12/15/2015