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Echinacea
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Active Forms Absorption Dietary Sources |
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In the 1920s, a respected medicinal herb manufacturing company, the Lloyd Brothers Pharmaceutical Company of Cincinnati, Ohio, began making an herbal extract of E. angustifolia root. The company reported the Echinacea medicine as its largest selling product during that time. In Europe, physicians took up the American interest in E. angustifolia with enthusiasm. Demand soon outstripped the supply coming from America, and in an attempt to rapidly plant echinacea locally, the German firm Madeus and Company mistakenly purchased a quantity of Echinacea purpurea seeds, and by chance, Echinacea purpurea became the largest selling and most studied of the echinacea species. Another family member, Echinacea pallida, is also used in medicinal products and research in Europe. Echinacea products were one of the most widely used cold and flu remedies in the United States until its replacement by sulfa containing antibiotics in the 1950s. Echinacea has non-specific stimulatory effects on the immune system.(2, 3) There have been many studies supporting echinacea's value to the immune system, with research indicating that echinacea may stimulate the alternate and complementary pathway and activate white blood cells to scavenge for bacteria and cellular debris.(4) It has been used to improve wound healing,(5) is reported to have antibacterial and antifungal activity,(6) and to help in the treatment of colds and influenza.(7, 8) Should echinacea products be consumed on a cyclical basis or is it safe to use echinacea chronically for indefinite periods of time? The length of time to dose Echinacea has been a subject of debate for some time. The concern began following the publication of the work of Jurcic, et al.(9) The data seemed to indicate that with use of Echinacea greater than 5 days, the increase in phagocytic activity eventually returned to pretreatment levels, indicating that Echinacea may lose its effectiveness. A recent review of the data suggests its misinterpretation, noting that the levels of phagocytic activity only began declining following the discontinuation of Echinacea.(10) Several clinical studies have been completed indicating the safety of Echinacea with longer-term use. A study involving an 8-week treatment period demonstrated no significant difference in the occurrence of side effects between the Echinacea group and the placebo group.(11) Another study concluded that "adverse events on oral administration [of Echinacea] for up to 12 weeks are infrequent and consist mainly of unpleasant taste."(12) The safety of Echinacea when used for periods greater than 8 to 12 weeks has not been evaluated. |
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| Toxicities & Precautions | Back to Top | |||||||||
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General No known toxicity and side effects are very rare.(13, 14) Allergy A study out of Australia has demonstrated the potential for allergic reactions to the use of echinacea. Reactions documented include anaphylaxis, mild to acute asthma attacks and a maculopapular rash. Pooling patients from the author's office practice, 20% of 100 atopic subjects who had never taken echinacea had positive skin prick testing results to echinacea.(15) Health Conditions Individuals with kidney disease or acute infections should not take for longer than 10 days. Use with caution in extended periods by individuals with compromised immunity.(16) Pregnancy/Breast-Feeding If pregnant or nursing, consult a physician before use. A recent study of 206 women using echinacea products during pregnancy (112 women used the herb in the first trimester) concluded that echinacea use is not associated with an increased risk for major malformations.(17) Age Limitations Do not use in children under 2 years of age unless recommended by a physician. |
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| Footnotes | Back to Top | |||||||||
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1 PDR for Herbal Medicines, 2nd edition. Montvale, NJ:
Medical Economics Company; 2000:264.
2 Sun LZ, Currier NL, Miller SC. The American Coneflower: A Prophylactic Role Involving Nonspecific Immunity. J Altern Complement Med. Oct1999;5(5):437-46. View Abstract 3 Snow JM. Echinacea (Moench) spp. Asteraceae. Protocol Journal of Botanical Medicine. 1996;2(2): 18-23. 4 Vomel VT. The Effect of a Nonspecific Immunostimulant on the Phagocytosis of Erythrocytes and Ink by the Reticulohistiocyte System in the Isolated, Perfused Liver of Rats of Various Ages. Arzneim Forsch/Drug Res. 1984;34:691-95. View Abstract 5 Dorsch W. Clinical Application of Extracts of Echinacea purpurea or Echinacea pallida. Critical Evaluation of Controlled Clinical Studies. Z Arztl Fortbild. (Jena). 1996;90(2):117-22. View Abstract 6 Roesler J, Steinmuller C, Kiderlen A, et al. Application of Purified Polysaccharides from Cell Cultures of the Plant Echinacea purpurea to Mice Mediates Protection Against Systemic Infections with Listeria monocytogenes and Candida albicans. Int J Immunopharmacol. 1991;13(1):27-37. View Abstract 7 See DM, et al. 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. Immunopharmacology. 1997;35(3):229-35. View Abstract 8 Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. Feb2004;29(1):75-83. View Abstract 9 Jurcic K, Melchart D, Holzmann M, Martin P, et al. Zwei Probandenstudien zur Stimulierung der Granulozyten-phagozytose durch Echinacea-Extrakt-haltige Präparate. Z Phytother. 1989;10(2):67-70. 10 Bone K. Echinacea: When Should it be Used? Alt Med Rev. 1997;2(6):451-458. 11 Grimm W, et al. A Randomized Controlled Trial of the Effect of Fluid Extract of Echinacea purpurea on the Incidence and Severity of Colds and Respiratory Infections. Am J Med. Feb1999;106(2):138-43. View Abstract 12 Parnham MJ. Benefit-Risk Assessment of the Squeezed Sap of the Purple Coneflower (Echinacea purpurea) for Long-Term Oral Immunostimulation. Phytomedicine. 1996;3(1):95-102. View Abstract 13 Bradley PR, ed. British Herbal Compendium. Vol 1. Bournemouth: British Herbal Medicine Association; 1992:81-83. 14 Mengs U, Clare CB, Poiley JA. Toxicity of Echinacea purpurea. Acute, Subacute and Genotoxicity Studies. Arzneimittelforschung. Oct1991;41(10):1076-81. View Abstract 15 Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Annals of Allergy, Asthma, & Immunology. 2002;88:42-51. View Abstract 16 Rakel: Conn's Current Therapy 2001, 53rd ed. W B Saunders Company; 2001:1267. 17 Gallo M, Sarkar M, Au W, et al. Pregnancy Outcome Following Gestational Exposure to Echinacea: A Prospective Controlled Study. Arch Intern Med. Nov2000;160(20):3141-3. View Abstract |
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