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NCCIH Clinical Digest

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Seasonal Allergies and Complementary Health Practices:
What the Science Says

March 2016
Under a moderately high magnification of 888x, this scanning electron micrograph (SEM) revealed some of the morphologic ultrastructural surface details of one of the very small flower buds clustered in the center of a white dogwood flower, Cornus florida.

Courtesy of CDC/Janice Carr

Clinical Guidelines, Scientific Literature, Info for Patients: 

Natural Products

Saline Nasal Irrigation

There is some evidence to suggest that saline nasal irrigation may modestly improve some seasonal allergy symptoms.

The Evidence Base

  • The evidence base on efficacy of saline nasal irrigation consists of several randomized controlled trials in both adults and children, as well as a systematic review and meta-analysis.


  • A 2012 systematic review and meta-analysis of 10 studies found that saline nasal irrigation administered regularly over a period of up to 7 weeks was observed to have a beneficial effect on nasal symptoms, reduction in medicine consumption, acceleration of mucociliary clearance time, and quality of life in adults and children with allergic rhinitis.
  • A 2012 review of nasal saline irrigation in the management of sinonasal disease found that nasal saline irrigation appears to demonstrate some modest clinical benefits.


  • Nasal irrigation is generally safe; however, neti pots and other rinsing devices must be used and cleaned properly.
  • Most important is the source of water that is used with nasal rinsing devices. According to the U.S. Food and Drug Administration, tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse. Some tap water contains low levels of bacteria and protozoa, including amoebas, which can stay alive in nasal passages and cause potentially serious infections.
  • Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.


There is some evidence that butterbur extract can decrease the symptoms associated with seasonal allergies.

The Evidence Base

  • The evidence base on efficacy of butterbur for seasonal allergies consists of only a few rigorous randomized controlled trials.


  • Findings from a 2007 systematic review of six randomized controlled trials suggest that butterbur is superior to placebo or similarly effective compared with nonsedative antihistamines for intermittent allergic rhinitis. However, firm conclusions could not be drawn because of the financial support from the manufacturer of butterbur to three of the large trials reviewed.
  • A 2003 review of several modalities used to treat ocular allergies found that in one study of 125 participants, butterbur was just as effective as a commonly used oral antihistamine for itchy eyes.


  • Butterbur may cause allergic reactions in people who are sensitive to plants such as ragweed, chrysanthemums, marigolds, and daisies.
  • Raw extracts of this herb contain toxic pyrrolizidine alkaloids, which can cause liver damage and cancer. Extracts of butterbur have been prepared that are almost completely free from these alkaloids. However, no long-term studies of butterbur products have been conducted, including the reduced-alkaloid products, so its long-term safety is unknown.


There is no convincing scientific evidence that honey relieves seasonal allergies.

The Evidence Base

  • The evidence base on efficacy of honey for seasonal allergy symptoms consists of only a few randomized controlled trials.


  • A 2011 randomized controlled pilot study of 44 patients with physician-diagnosed birch pollen allergy found that patients who preseasonally used birch pollen honey had significantly better control of their symptoms compared to those on conventional allergy medication, and they had marginally better control of their symptoms compared to those using regular honey. However, these results should be regarded as preliminary.


  • Eating honey is generally safe; however, children under 1 year of age should not eat honey due to the potential risk of contracting Clostridium botulinum. People who are allergic to pollen or bee stings may also be allergic to honey.

Mind and Body Practices


The scientific evidence currently available on acupuncture has not shown clear evidence of clinically significant benefit in treating seasonal allergies. A 2015 updated clinical practice guidelines for allergic rhinitis by the American Academy of Otolaryngology—Head and Neck lists acupuncture as a treatment option, but cite a low level of confidence in the evidence.

The Evidence Base

  • The evidence base on efficacy of acupuncture for relief of seasonal allergy symptoms consists of several randomized controlled trials, reviews, and clinical practice guidelines.


  • In 2015 updated clinical practice guidelines for allergic rhinitis issued by the American Academy of Otolaryngology—Head and Neck Surgery, acupuncture is listed as a treatment option for clinicians based on “a preponderance of benefit over harm.” However, the guidelines cite a low level of confidence in the evidence.
  • A 2015 review of evidence concluded that given its overall safety, acupuncture can be considered a treatment option for patients interested in the use of complementary approaches for the management of seasonal allergic rhinitis; however, more studies are needed that compare the effects and costs of acupuncture with those of traditional pharmacologic therapy to help clinicians advise their patients on treatment options.
  • A 2015 randomized controlled trial in Australia of 175 participants examined the effects of acupuncture on relief of seasonal allergic rhinitis symptoms. Participants received either real acupuncture or sham acupuncture three times per week over a 4-week period. The researchers found that the real acupuncture group had significantly decreased sneezing and itching of the ears and palate at the end of the treatment compared with the control group, as well as improvement in several quality of life scores at the end of treatment and during follow-up.
  • Results of a 2009 systematic review of 5 studies concluded that the evidence for the effectiveness of acupuncture for the symptomatic treatment or prevention of allergic rhinitis is mixed. Findings from the study failed to show specific effects of acupuncture compared with sham acupuncture in the management of seasonal allergic rhinitis.


  • Relatively few complications from the use of acupuncture have been reported. Still, complications have resulted from inadequate sterilization of needles and from improper delivery of treatments.
  • Practitioners should use a new set of disposable needles taken from a sealed package for each patient and should swab treatment sites with alcohol or another disinfectant before inserting needles. When not delivered properly, acupuncture can cause serious adverse effects, including infections and punctured organs.

Other Approaches

  • Researchers have studied the possibility that omega-3 fatty acids might help to prevent the development of allergic rhinitis, but a systematic review of the research found no clear evidence that they work.
  • The evidence on probiotics is inconsistent, and effects may vary from one probiotic formulation to another.
  • Other natural products, including astragalus, capsaicin, grape seed extract, Pycnogenol (French maritime pine bark extract), quercetin, spirulina, stinging nettle, and an herb used in Ayurvedic medicine called tinospora or guduchi, have been used to treat seasonal allergies, but the scientific evidence is insufficient to make any conclusions about whether they are helpful.


  • Bielory L, Heimall J. Review of complementary and alternative medicine in treatment of ocular allergies. Curr Opin Allergy Clin Immunol. 2003;3(5):395–399.
  • Guo R, Pittler MH, Ernst E. Herbal medicines for the treatment of allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2007;99(6):483–495.
  • Hermelingmeier KE, Weber RK, Hellmich M, et al. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2012;26(5):e119–125.
  • Khianey R, Oppenheimer J. Is nasal saline irrigation all it is cracked up to be? Ann Allergy Asthma Immnol. 2012;109(1):20–28.
  • Lee MS, Pittler MH, Shin BC, Kim JI, Ernst E. Acupuncture for allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2009;102:269e279.
  • Saarinen K, Jantunen J, Haahtela T. Birch pollen honey for birch pollen allergy—a randomized controlled pilot study. Int Arch Allergy Immunol. 2011;155(2):160–166.
  • Seidman MD, Gurgel RK, Lin SY, et al. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. 2015;152(suppl):S1eS43.
  • Xue CC, English R, Zhang JJ, Da Costa C, Li CG. Effect of acupuncture in the treatment of seasonal allergic rhinitis: a randomized controlled clinical trial. Am J Chin Med. 2002;30:1e11.
  • Xue CC, Zhang AL, Zhang CS, et al. Acupuncture for seasonal allergic rhinitis: a randomized controlled trial. Ann Allergy Asthma Immunol. 2015;115:317e324.

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

The National Center for Complementary and Integrative Health is dedicated to exploring complementary health products and practices in the context of rigorous science, training complementary health researchers, and disseminating authoritative information to the public and professionals. For additional information, call NCCIH's Clearinghouse toll-free at 1-888-644-6226, or visit the NCCIH Web site at NCCIH is 1 of 27 institutes and centers at the National Institutes of Health, the Federal focal point for medical research in the United States.


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This page last modified March 08, 2016