Also Known
As:
American Cone Flower, Échinacée Angustifolia, Échinacée Pallida,
Échinacée Purpurea, Purple Cone Flower.
Scientific Name:
Echinacea angustifolia; Echinacea pallida; Echinacea purpurea.
Family: Asteraceae/Compositae.
People Use This For:
Orally, echinacea is used for treating and preventing the common
cold and other upper respiratory infections. Echinacea is also
used orally as an immunostimulant for fighting a variety of other
infections, including urinary tract infections (UTIs), vaginal
candidiasis (yeast infections), and genital herpes (HSV Type 1
and 2). Echinacea is also used orally for nasal cattarh, allergic
rhinitis, gum disease and tonsillitis. Other uses include chronic
fatigue syndrome (CFS), rheumatism, migraines, dyspepsia, pain,
dizziness, rattlesnake bites and swine flu.
Topically, echinacea is used for boils, abscesses, skin wounds
and ulcers, burns, eczema, psoriasis, UV radiation skin damage,
herpes simplex, bee stings, and hemorrhoids.
Safety:
No concerns regarding safety when used orally and appropriately,
short-term. Available studies validate this statement.
Several formulations of echinacea have been used safely in trials
lasting up to 12
weeks.17,18,19,20,21,22,23,24,25,26,27,28 There is not
enough scientific evidence on the safety of long term use of
echinacea to comment. There is no evidence of harm.
Children: Possibly safe. There is evidence from research that an
Echinacea purpurea juice extract is safe in children aged 2-11
years when used for up to 10 days. However, echinacea might
increase the risk of rash in some children.29,26
Pregnancy and Lactation: Refer to a Medical Herbalist
Effectiveness:
POSSIBLY EFFECTIVE
Common cold. Taking some echinacea preparations seems to modestly
reduce symptom severity and duration, possibly by about 10% to
30%.17,19,32,33,37,21,22,24,25,27,28 Echinacea seems
to be most effective if started when symptoms are first
noticed and continued for 7-10 days. Not all research is
positive. Some studies show no benefit for treating the common
cold in adults.20,23,47,55,28 A study in children aged
2-11 years also suggests that taking an Echinacea purpurea juice
extract 7.5-10 mL/day (Madaus AG, Germany) for up to 10 days also
does not significantly decrease cold symptoms.29
Taking echinacea prophylactically to prevent the development of a
cold does not seem to be
effective.19,20,34,21,56,57,50,55,28 Echinacea studies
have used different echinacea species and a wide variety of
preparation methods. Studies have also used different patient
populations and study designs. Due to these discrepancies among
studies, it's not surprising that different studies have
different results.23,31,58,30,27 The best evidence
(and the most research) appears to be for preparations of the
Echinacea purpurea species.28 Other preparations that
have been used include a variety of extracts of the herbs and
root parts of Echinacea pallida and Echinacea angustifolia
species.17,18,19,21,53 Echinacea teas and fixed
combination herbal preparations containing echinacea have also
been used.19,32,37
Vaginal candidiasis. Taking echinacea orally in combination with
a topical antifungal cream seems to be effective for preventing
recurrent vaginal yeast infection. Herb juice of Echinacea
purpurea in combination with topical econazole (Spectazole)
lowers recurrence rate to 16.7% compared to 54.5% with econazole
alone.54
POSSIBLY INEFFECTIVE
Herpes simplex virus (HSV). Taking echinacea orally doesn't seem
to prevent or treat recurrent genital herpes infection. A
specific Echinacea purpurea extract (Echinaforce by Bioforce AG)
800 mg twice daily for six months does not seem to prevent or
reduce frequency or duration of recurrent genital herpes in
patients with herpes simplex virus (HSV) type 1 or
2.41
INSUFFICIENT RELIABLE EVIDENCE to COMMENT
Influenza. Taking echinacea orally might modestly reduce some
influenza symptoms. However, there is not enough specific
evidence to know if echinacea is effective for
influenza.19,32,33,34
Mechanism of Action:
The parts of echinacea are the roots and the above ground parts.
The composition of each of the three commonly used echinacea
species is similar, with some variation in the amounts of active
constituents. Although these species are often used
interchangeably, there is very little research comparing
them.38
Echinacea increases the assimilation of detritus into mopping up
cells (phagocytosis) and increases lymphocyte (white blood cell)
activity, possibly by promoting the release of tumor necrosis
factor, interleukin, and interferon.35,36,39
Several constituents of echinacea seem to be involved in
stimulating this non-specific immune response. However, echinacea
doesn't seem to have any effect on the immune system of healthy
volunteers.40 Echinacea's effect on
cold symptoms might result from anti-inflammatory activity.
Clinical research also suggests an anti-inflammatory
effect.
Echinacea is also reported to have antifungal properties, so
people use it for yeast infections (vaginal candidiasis).
Compounds in echinacea seem to have antifungal activity,
including activity against Candida yeast.42
For wound healing echinacea seems to protect collagen from free
radical damage. It also may have activity against bacterial
hyaluronidase. Animal research suggests that echinacea extracts
can speed would healing, enhance formation of new skin, and
reduce inflammation.38 Preliminary information
suggests that echinacea might help treat or prevent UV radiation
skin damage by protecting collagen from free radical
damage.43
Preliminary research also suggests that high concentrations of
Echinacea purpurea might reduce sperm and ova
fertility.44,45
Adverse Reactions:
Orally, echinacea is usually well-tolerated by most
people.17,18,20,46,47,26 Gastrointestinal adverse
effects, allergic reactions, fever, heartburn, constipation,
unpleasant taste, dry mouth, sore throat, tingling sensation and
numbness of the tongue, mouth ulcers, headache, dizziness,
insomnia, and disorientation.48,47,50,25,26
Arthralgia and myalgia have also been associated with
Echinacea.26
Allergic reactions can include urticaria; erythema
nodosum;51 itchy, watery eyes; runny
nose;48 chest tightness; dyspnea; bronchospasm; acute
asthma; facial and upper airway angioedema; and
anaphylaxis.49,52,48
In a study of children aged 2-11 years, about 7% of children
experienced a rash after taking Echinacea compared with 2.9% of
those taking placebo. This has not been borne out by other
studies. This may have been caused by an allergic
reaction.29 or it may have been the rash was part of
the illness for which the children were taking Echinacea.
Allergic reactions seem to be uncommon.52,48
Interactions with Herbs & Supplements:
None known.
Interactions with Drugs:
Immunosuppressants: Refer to a Medical Herbalist.
Interactions with Foods:
None known.
Interactions with Lab Tests:
None known.
Interactions with Diseases or Conditions:
Atopy: Individuals a genetic tendency toward allergic conditions
may be more likely to experience an allergic reaction when taking
echinacea. It is not a reason not to use Echinacea unless a
problem has been noted.
Autoimmune Diseases: Refer to a Medical Herbalist.
Dosage/Administration:
Dr Clare’s Blends: 1 gm per day Echinacea purpurea
Oral: A wide variety of dosages and forms have been used. This is
one reason why it is so difficult to interpret research data.
Topical: No typical dosage.
Dr Clare’s Comment.
In ten years of regular prescribing of Echinacea I have not seen
an allergic reaction. It is very well tolerated in traditional
doses; I have never had to stop Echinacea because of side
effects.
Specific References: ECHINACEA
17. Brinkeborn 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;6:1-6.
18. Gunning K. Echinacea in the treatment and prevention of
upper respiratory tract infections. West J Med 1999;171:198-200.
19. Barrett B, Vohmann M, Calabrese C.
Echinacea for upper respiratory infection. J Fam Pract
1999;42:628-29.
20. Grimm W, Muller HH. 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 1999;106:138-37.
21. Giles JT, Palat CT III, Chien SH, et al. Evaluation of
Echinacea for treatment of the common cold. Pharmacother
2000;20:690-7.
22. Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea
for preventing and treating the common cold. Cochrane Database
Syst Rev 2000;2:CD000530.
23. Barrett BP, Brown RL, Locken K, et al. Treatment of the
common cold with unrefined echinacea. A randomized, double-blind,
placebo-controlled trial. Ann Intern Med 2002;137:939-40.
24. Schulten B, Bulitta M, Ballering-Bruhl B, et al.
Efficacy of Echinacea purpurea in patients with a common cold. A
placebo-controlled, randomised, double-blind clinical trial.
Arzneimittelforschung 2001;45:563-8.
25. 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 2004;29:75-83.
26. Huntley AL, Thompson Coon J, Ernst E. The safety of
herbal medicinal products derived from Echinacea species: a
systematic review. Drug Saf 2005;28:387-400.
27. Caruso TJ, Gwaltney JM Jr. Treatment of the common cold
with echinacea: a structured review. Clin Infect Dis
2005;34:807-10.
28. Linde K, Barrett B, Wolkart K, et al. Echinacea for
preventing and treating the common cold. Cochrane Database Syst
Rev 2006;(1):CD000530.
29. Taylor JA, Weber W, Standish L, et al.
Efficacy and safety of echinacea in treating upper respiratory
tract infections in children: a randomized controlled trial. JAMA
2003;290:2824-30.
30. Krochmal R, Hardy M, Bowerman S, et al. Phytochemical
assays of commercial botanical dietary supplements. Evid Based
Complement Alternat Med 2004;1:305-3.
31. Turner RB. Echinacea for the common cold: can
alternative medicine be evidence-based medicine? Ann Intern Med
2002;137:1001-2.
32. Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea
compound herbal tea preparation on the severity and duration of
upper respiratory and flu symptoms: a randomized, double-blind,
placebo-controlled study. J Altern Complement Med 2000;6:327-28.
33. Dorn M, Knick E, Lewith G. Placebo-controlled,
double-blind study of Echinaceae pallidae radix in upper
respiratory tract infections. Complement Ther Med 1997;5:34-2.
34. 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.
35. Luettig 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.
36. Stimpel M, Proksch A, Wagner H, et al. Macrophage
activation and induction of macrophage cytotoxicity by purified
polysaccharide fractions from the plant Echinacea purpurea.
Infect Immun 1984;40:845-9.
37. Henneicke-von Zepelin H, Hentschel C, Schnitker J, et
al. Efficacy and safety of a fixed combination phytomedicine in
the treatment of the common cold (acute viral respiratory tract
infection): results of a randomised, double blind,
placebo-controlled, multicentre study. Curr Med Res Opin
1999;15:214-21.
38. Speroni E, Govoni P, Guizzardi S, et al.
Anti-inflammatory and cicatrizing activity of Echinacea pallida
Nutt. root extract. J Ethnopharmacol 2002;79:265-72.
39. Barrett B. Medicinal properties of Echinacea: a
critical review. Phytomedicine 2003;10:60-86.
40. Schwarz E, Metzler J, Diedrich JP, et al. Oral
administration of freshly expressed juice of Echinacea purpurea
herbs fail to stimulate the nonspecific immune response in
healthy young men: results of a double-blind, placebo-controlled
crossover study. J Immunother 2002;19:413-20.
41. Vonau B, Chard S, Mandalia S, et al. Does the extract
of the plant Echinacea purpurea influence the clinical course of
recurrent genital herpes? Int J STD AIDS 2001;12:154-8.
42. Binns SE, Purgina B, Bergeron C. Light-mediated
antifungal activity of Echinacea extracts. Plant Med
2000;60:241-4.
43. Facino RM, Carini M, Aldini G, et al. Echinacoside and
caffeoyl conjugates protect collagen from free radical-induced
degradation: a potential use of echinacea extracts in the
prevention of skin photodamage. Planta Med 1995;55:510-4.
44. Ondrizek RR, Chan PJ, Patton WC, King A. Inhibition of
human sperm motility by specific herbs used in alternative
medicine. J Assist Reprod Genet 1999;16:87-91.
45. Ondrizek RR, Chan PJ, Patton WC, King
A. An alternative medicine study of herbal effects on the
penetration of zona-free hamster oocytes and the integrity of
sperm deoxyribonucleic acid. Fertil Steril 1999;71:517-22.
46. Parnham MJ. Benefit-risk assessment of the squeezed sap
of the purple coneflower (Echinacea purpurea) for long-term oral
immunostimulation. Phytomedicine 1996;3:95-102.
47. Yale SH, Liu K. Echinacea purpurea therapy for the
treatment of the common cold: a randomized, double-blind,
placebo-controlled clinical trial. Arch Intern Med
2004;164:1237-35.
48. Mullins RJ, Heddle R. Adverse reactions associated with
echinacea: the Australian experience. Ann Allergy Asthma Immunol
2002;88:36-45.
49. Mullins RJ. Echinacea-associated anaphylaxis. Med J
Aust 1998;168:170-1.
50. Sperber SJ, Shah LP, Gilbert RD, et al. Echinacea
purpurea for prevention of experimental rhinovirus colds. Clin
Infect Dis 2004;32:1367-71.
51. Soon SL, Crawford RI. Recurrent erythema nodosum
associated with echinacea herbal therapy. J Am Acad Dermatol
2001;38:298-9.
52. Mullins RJ. Allergic reactions to Echinacea. J Allergy
Clin Immunol 2000;104:S340-341 (Abstract 1003).
53. Percival SS. Use of echinacea in medicine. Biochem
Pharmacol 2000;54:155-8.
54. Coeugniet EG, Kuhnast R. Recurrent candidiasis:
Adjuvant immunotherapy with different formulations of Echinacin.
Therapiewoche 1986;30:3352-8.
55. Turner RB, Bauer R, Woelkart K, et al. An evaluation of
Echinacea angustifolia in experimental rhinovirus infections. N
Engl J Med 2005;353:341-8.
56. Turner RB, Riker DK, Gangemi JD. Ineffectiveness of
echinacea for prevention of experimental rhinovirus colds.
Antimicrob Agents Chemother 2000;38:1708-9.
57. Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea
for preventing and treating the common cold. Cochrane Database
Syst Rev 2000;2:CD000530.
58. Anon. Echinacea: cold comfort. Consum Rep 2004;69:30-2.