Awaiting clinical review. This page is built from sourced entries but has not yet been signed off by a pharmacist or clinician.
Natural remedies for allergies
Direct answer
Butterbur leaf extract is the best-rated option for hay fever (Moderate, 3), performing similarly to cetirizine and fexofenadine in two manufacturer-funded trials, but liver injury has been reported even with PA-free products and the UK regulator advised against unlicensed products in 2012, so it is not a sensible first choice. Nettle is rated Limited (2) after two small trials disagreed, and quercetin is Traditional (1) with little evidence in people. The NHS points people with hay fever to a pharmacist for antihistamines and steroid nasal sprays, which are the standard treatments to try first.
Compare the options
Click a column heading to sort.
| Rated for | Typical form & use | Main caution | |||
|---|---|---|---|---|---|
| Butterbur Petasites hybridus (root, leaf) | Moderate | Hay fever (seasonal allergic rhinitis) | PA-free leaf extract (Ze 339) tablet | Rare liver injury, even with PA-free products | 4+ weeks |
| Nettle Urtica dioica (root and leaf) | Limited | Hay fever (allergic rhinitis) | Root extract or freeze-dried preparation | Allergy to nettle: itching, rash, hives | 4+ weeks |
| Quercetin Plant flavonoid (isolated compound) | Traditional | Hay fever and allergic rhinitis | Capsule; not tested alone for hay fever | Can change how some medicines are absorbed | 4+ weeks |
- Rated for
- Hay fever (seasonal allergic rhinitis)
- Form
- PA-free leaf extract (Ze 339) tablet
- Onset
- 4+ weeks
- Rated for
- Hay fever (allergic rhinitis)
- Form
- Root extract or freeze-dried preparation
- Onset
- 4+ weeks
- Rated for
- Hay fever and allergic rhinitis
- Form
- Capsule; not tested alone for hay fever
- Onset
- 4+ weeks
Quick picks
Nettle has no recorded interactions and its main reported problem is an allergic rash or itching, so it is the lower-risk herb here. It is only Limited (2), though: a 1990 trial of 98 people (69 completed) found it slightly better than placebo on symptom diaries, and a 2017 trial in 74 people (40 completed) found symptoms improved as much on placebo.
Traditional favouriteQuercetinQuercetin is rated Traditional (1) for hay fever. We found no good trial in people, and a 2025 review of 13 trials found polyphenols as a group reduced nasal symptoms only with low to very low certainty, without testing quercetin alone.
Talk to a doctor first if…
Who should avoid
Butterbur: avoid any product not labelled PA-free, liver disease or a history of liver problems, pregnancy and breastfeeding, allergy to ragweed, chrysanthemums, marigolds or daisies, and use beyond about 16 weeks. Nettle leaf is not recommended in pregnancy or breastfeeding or for under-12s (root under 18), and avoid it if you are allergic to it. Quercetin is best avoided in kidney disease, hormone-sensitive cancer (animal data) and pregnancy, where there are no safety data.
Known interactions
No interactions are listed for butterbur or nettle (the EU nettle monographs report none), which is not proof there are none. Quercetin is reported to change how some medicines are absorbed without naming which, so ask a pharmacist before taking it with regular medication, including your hay fever tablets.
Before you reach for an ingredient
Avoiding pollen and rinsing the nose are worth trying before or alongside any supplement, and antihistamines and steroid nasal sprays are the standard treatments to ask a pharmacist about.
- The NHS advises keeping windows and doors shut, showering and changing your clothes after being outside, putting petroleum jelly around your nostrils, wearing wraparound sunglasses, and not drying clothes outside when the pollen count is high.1
- Saline nasal rinsing may improve hay fever symptoms: a Cochrane review of 14 trials (747 people, adults and children) found patient-reported severity may improve compared with no saline, but the evidence was low quality and no trial followed people beyond three months. Trials that reported side effects found none in the saline groups.2
- The NHS says a pharmacist can suggest antihistamine drops, tablets or nasal sprays and steroid nasal sprays, and a GP can prescribe a steroid treatment or refer for immunotherapy if these do not work. See a GP if symptoms get worse or do not improve after pharmacy medicines.1
Questions people ask
Does butterbur work for hay fever, and is it safe?
In two manufacturer-funded trials the Ze 339 extract performed similarly to cetirizine and fexofenadine, but a systematic review said independent replication was needed. It is not reliably safe: NCCIH says even PA-free products have been linked to rare liver injury, and the MHRA advised against unlicensed butterbur products in 2012. If you use it, choose a PA-free product and see a doctor first.
Does nettle work for hay fever?
The evidence is thin and mixed. A 1990 trial found it slightly better than placebo on global assessment, and a 2017 trial of nettle root extract found placebo improved symptoms just as much. Both were small, with many people dropping out.
Does quercetin help hay fever?
We found no good evidence in people. A 2025 review of 13 trials found polyphenols as a group reduced nasal symptoms, but with low to very low certainty, and it did not test quercetin alone.
What should I try first for hay fever?
The NHS suggests reducing pollen exposure and asking a pharmacist about antihistamines or steroid nasal sprays. The supplements here are a distant second, and butterbur in particular carries a liver-safety risk.
Sources
- Health service guidance NHS. Hay fever. National Health Service (page last reviewed 21 March 2024).
- Cochrane review Head K, Snidvongs K, Glew S, et al. Saline irrigation for allergic rhinitis. Cochrane Database Syst Rev. 2018.
- Randomised controlled trial Mittman P. Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis. Planta Med. 1990.
- Randomised controlled trial Bakhshaee M, Mohammad Pour AH, Esmaeili M, et al. Efficacy of supportive therapy of allergic rhinitis by stinging nettle (Urtica dioica) root extract: a randomized, double-blind, placebo-controlled, clinical trial. Iran J Pharm Res. 2017.
- Meta-analysis Lai YR, Liao YH, Huang L, et al. Clinical Effects of Polyphenolic Compounds on Allergic Rhinitis: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2025.
- Systematic review Guo R, Pittler MH, Ernst E. Herbal medicines for the treatment of allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2007.
- Regulator/health agency NCCIH. Butterbur: Usefulness and Safety. National Center for Complementary and Integrative Health.
- Regulator summary Medsafe (New Zealand). Complementary Corner: Butterbur and Liver Toxicity. Prescriber Update, June 2012.
Draft, awaiting clinical review