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.