Echinacea

Common name: Purple coneflower

Botanical names: Echinacea purpurea, Echinacea angustifolia, Echinacea pallida

Parts used and where grown

Echinacea is a wildflower native to North America. While echinacea continues to grow and is harvested from the wild, the majority used for herbal supplements comes from cultivated plants. The root and/or the above-ground part of the plant during the flowering growth phase are used in herbal medicine.

Echinacea has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings	Health Concerns
	Common cold/sore throat (for symptoms; effective only for adults) Gingivitis (periodontal disease) (as mouthwash, in combination with sage, peppermint oil, menthol, chamomile tincture, myrrh tincture, clove oil, and caraway oil) Immune function Infection Influenza
	Bronchitis Canker sores Chronic candidiasis Cold sores Ear infections (recurrent) Gingivitis (periodontal disease) HIV support Pap smear (abnormal) Vaginitis Wound healing (topical) Yeast infection
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Science Ratings

Health Concerns

Common cold/sore throat (for symptoms; effective only for adults)

Gingivitis (periodontal disease) (as mouthwash, in combination with sage, peppermint oil, menthol, chamomile tincture, myrrh tincture, clove oil, and caraway oil)

Ear infections (recurrent)

Gingivitis (periodontal disease)

HIV support

Pap smear (abnormal)

Vaginitis

Wound healing (topical)

Yeast infection

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

Echinacea was used by Native Americans for a variety of conditions, including venomous bites and other external wounds. It was introduced into U.S. medical practice in 1887 and was touted for use in conditions ranging from colds to syphilis. Modern research started in the 1930s in Germany.

Active constituents

Echinacea is thought to support the immune system by activating white blood cells.¹ Three major groups of constituents may work together to increase the production and activity of white blood cells (lymphocytes and macrophages), including alkylamides/polyacetylenes, caffeic acid derivatives, and polysaccharides. More studies are needed to determine if and how echinacea stimulates the immune system in humans.

Echinacea may also increase production of interferon, an important part of the body’s response to viral infections.² Several double-blind studies have confirmed the benefit of echinacea for treating colds and flu.³ ⁴ ⁵ ⁶ ⁷ Recent studies have suggested that echinacea may not be effective for the prevention of colds and flu and should be reserved for use at the onset of these conditions.⁸ ⁹ In terms of other types of infections, research in Germany using injectable forms or an oral preparation of the herb along with a medicated cream (econazole nitrate) reduced the recurrence of vaginal yeast infections as compared to women given the cream alone.¹⁰

How much is usually taken?

At the onset of a cold or flu, 3–4 ml of echinacea in a liquid preparation or 300 mg of a powdered form in capsule or tablet, can be taken every two hours for the first day of illness, then three times per day for a total of 7 to 10 days.¹¹

Are there any side effects or interactions?

Echinacea is rarely associated with side effects when taken orally.¹² There is one case report of acute hepatitis occurring in a person taking echinacea, but a cause-and-effect relationship was not proven.¹³ According to the German Commission E monograph, people should not take echinacea if they have an autoimmune illness, such as lupus, or other progressive diseases, such as tuberculosis, multiple sclerosis, or HIV infection. However, the concern about echinacea use for those with autoimmune illness is not based on clinical research and some herbalists question the potential connection. Those who are allergic to flowers of the daisy family should not take echinacea. Cases of allergic responses to echinacea (e.g., wheezing, skin rash, diarrhea) have been reported in medical literature.¹⁴ In the first study to look at echinacea’s possible effect on fetal development and pregnancy outcome, women taking echinacea during pregnancy were found to have no greater incidence of miscarriage or birth defects than women not taking the herb.¹⁵

Echinacea root contains approximately 20% inulin,¹⁶ a fiber widely distributed in fruits, vegetables, and plants. Inulin is classified as a food ingredient (not as an additive) and is considered safe to eat.¹⁷ In fact, inulin is a significant part of the daily diet of most of the world’s population.¹⁸ However, there is a report of a 39-year-old man having a life-threatening allergic reaction after consuming high amounts of inulin from multiple sources.¹⁹ Allergy to inulin in this individual was confirmed by laboratory tests. Such sensitivities are exceedingly rare. Moreover, this man did not take echinacea. Nevertheless, people with a confirmed sensitivity to inulin should avoid echinacea.

Are there any drug interactions?
Certain medicines may interact with echinacea. Refer to drug interactions for a list of those medicines.

References
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1. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunpharmacol 1997;35:229–35.

2. Leuttig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989;81:669–75.

3. Melchart D, Linde K, Worku F, et al. Immunomodulation with Echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245–54.

4. Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinacea pallida redix in upper respiratory tract infections. Comp Ther Med 1997;5:40–2.

5. Hoheisel O, Sandberg M, Bertram S, et al. Echinacea shortens the course of the common cold: a double-blind, placebo-controlled clinical trial. Eur J Clin Res 1997;9:261–8.

6. Braunig B, Dorn M, Knick E. Echinacea purpurea root for strengthening the immune response to flu-like infections. Zeitschrift Phytotherapie 1992;13:7–13.

7. Brikenborn RM, Shah DV, Degenring FH. Echinaforce® and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo-controlled, double-blind clinical trial. Phytomedicine 1999;6:1–5.

8. Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: A double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7:541–5.

9. Grimm W, Müller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory tract infections. Am J Med 1999;106:138–43.

10. Coeugniet E, Kuhnast R. Recurrent candidiasis. Adjuvant immunotherapy with different formulations of Echinacea. Therapiwoche 1986;36:3352–8 [in German].

11. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 63–8.

12. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 121–3.

13. Kocaman O, Hulagu S, Senturk O. Echinacea-induced severe acute hepatitis with features of cholestatic autoimmune hepatitis. Eur J Intern Med 2008;19:148 [Letter].

14. Mullins RJ. Echinacea-associated anaphylaxis. Med J Austral 1998;168:170–1.

15. Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med 2000;160:3141–3.

16. Duke JA. Handbook of phytochemical constituents of GRAS herbs and other economic plants. Boca Raton, FL: CRC Press, 1992.

17. Carabin IG, Flamm WG. Evaluation of safety of inulin and oligofructose as dietary fiber. Regul Toxicol Pharmacol 1999;30:268–82 [review].

18. Coussement PA. Inulin and oligofructose: safe intakes and legal status. J Nutr 1999;129:1412S–7S [review].

19. Gay-Crosier F, Schreiber G, Hauser C. Anaphylaxis from inulin in vegetables and processed food. N Engl J Med 2000;342:1372 [letter].

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

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Parts used and where grown

Historical or traditional use (may or may not be supported by scientific studies)

Active constituents

How much is usually taken?

Are there any side effects or interactions?

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