Butterbur and cetirizine for treating seasonal allergic rhinitis

Dear Editor,

As a regular FACT reader I noticed your commentary of the butterbur and cetirizine trial of Schapoval et al.¹ in the September 2002 issue and I would like to comment on two points because I feel that there are two critical points. You comment on the results as important for clinical/practical use. I think this is not entirely the case.

1. The study group used the SF-36 score as measurement of the effectiveness of both treatments. The SF-36 is a general measurement of patients’ status of well-being. If you want to know the effect of a medication regarding the reduction of symptoms of allergic hay fever, you should use a more specific questionnaire such as the rhinoconjunctivitis quality-of-life questionnaire (RQLQ)²,³ to distinguish between two different treatments of hay fever symptoms. The RQLQ allows a retrospective (1 week) view of a patient’s symptoms such as running nose and eye irritation. Reducing these symptoms are the goals of any hay fever treatment, and patients judge the effectiveness of their doctor’s prescription accordingly. General well-being will not necessarily distinguish between two different treatments.
2. Both groups use their treatment continuously. This is not a reflection of the ‘normal use’ of a symptomatic medication. In practice, patients use their antihistamines only p.r.n. – if they had a bad day or expect a bad day. In this way, they can reduce adverse reactions such as tiredness, and so on. A study of clinical relevance should consider this fact and should give both study groups their medication p.r.n.

References

1. Ernst E. A herbal treatment against allergic rhinitis. Focus Altern Complement Ther 2002; 7: 250–1. [Abstract]
2. Juniper EF. Measuring health-related quality of life in rhinitis. J Allergy Clin Immunol 1996; 2: 742–3.
3. Juniper EF, Guyatt GH, Griffith LE, Ferrie PJ. Interpretation of rhinoconjunctivitis quality of life questionnaire data. J Allergy Clin Immunol 1996; 98: 843–5. [Abstract]

Dr Tobias Nitsch,

Ambulanz für Naturheilverfahren und Umweltmedizin,

Universitätsklinikum Freiburg,

Hugstetter Strasse 55,

D–79106 Freiburg,

Germany.

Email: Nitsch.Tobias@t-online.de