ArticlePDF Available

Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial

Authors:
Marie Jawad at Macquarie University
Marie Jawad
Roland Schoop at A.Vogel AG
Roland Schoop
  • A.Vogel AG
A Suter
A Suter
A Suter
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Peter Klein
Peter Klein
Show all 5 authorsHide
Download full-text PDFDownload full-text PDF
Read full-text
Download citation

Abstract and Figures

Objective. To investigate the safety (risk) and efficacy (benefit) of Echinacea purpurea extract in the prevention of common cold episodes in a large population over a 4-month period. Methods. 755 healthy subjects were allocated to receive either an alcohol extract from freshly harvested E. purpurea (95% herba and 5% root) or placebo. Participants were required to record adverse events and to rate cold-related issues in a diary throughout the investigation period. Nasal secretions were sampled at acute colds and screened for viruses. Results. A total of 293 adverse events occurred with Echinacea and 306 with placebo treatment. Nine and 10% of participants experienced adverse events, which were at least possibly related to the study drug (adverse drug reactions). Thus, the safety of Echinacea was noninferior to placebo. Echinacea reduced the total number of cold episodes, cumulated episode days within the group, and pain-killer medicated episodes. Echinacea inhibited virally confirmed colds and especially prevented enveloped virus infections (P < 0.05). Echinacea showed maximal effects on recurrent infections, and preventive effects increased with therapy compliance and adherence to the protocol. Conclusions. Compliant prophylactic intake of E. purpurea over a 4-month period appeared to provide a positive risk to benefit ratio.
Figures - uploaded by Ronald Eccles
Author content
All figure content in this area was uploaded by Ronald Eccles
Content may be subject to copyright.
0deec53392d4291aee0000
00.pdf
Content uploaded by Ronald Eccles
Author content
All content in this area was uploaded by Ronald Eccles on Mar 31, 2014
Content may be subject to copyright.
Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Tri
al.pdf
Available via license: CC BY 3.0
Content may be subject to copyright.
A preview of the PDF is not available
... Taylor et al. (2003) [42] and Sumer et al. (2023) [37] allowed for a repetitive therapy of up to three episodes over a prolonged observational time [37,42]. Six prevention studies administered Echinacea for a shorter period of equal or less than one month [21,24,25], three of which employed an artificial inoculation method [16,31,33], whereas the remaining studies employed longer treatment periods between six weeks to five months [14,15,[17][18][19][20]22,23,[26][27][28][29][30]32,34,42]. Awad et al. applied an interval preventive therapy of 6 × 10 days throughout half a year [29]. ...
... A total of 21 studies investigated an Echinacea mono-product, with nine containing further ingredients like vitamin C, Sambucus nigra, Nigella sativa, Thuja occidentalis, Baptisia tinctoria, propolis or homeopathic dilutions as additives [17][18][19][20]22,25,30,39,43]. The majority of the 39 comparisons involved lipophilic Echinacea purpurea extracts based on alcoholic extractions, glycerol or hypercritical CO2 extractions [14,15,[17][18][19]22,[25][26][27]30,32,[36][37][38][39]. Seven preparations contained Echinacea purpurea pressed-juices (hydrophilic) [21,23,24,31,33,40,42], whereas four preparations contained dried, powdered or unspecified Echinacea [16,28,29,43]. ...
... RTI was the studied indication, mostly detected as a patient-reported, physician/nurse-confirmed outcome [14][15][16][18][19][20]23,[26][27][28]30,31,34,[36][37][38][39][41][42][43]. This entity comprised the common cold, rhinitis, non-specified respiratory infections, flu-like infections or flu. ...
Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA)
Article
Full-text available
  • Apr 2024
Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61–0.77) and number of patients with ≥1 RTI, RR = 0.75 [95% CI 0.69–0.81] corresponding to an odds ratio 0.53 [95% CI 0.42–0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46–0.80), RTI complications (RR = 0.44; 95% CI 0.36–0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39–0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11–0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15–0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations.
View
... 83 Large clinical trials have showed significant benefits, with the reduction of episodes of the common cold and participants reporting less associated co-medication use. 84 Echinaforce in the form of a hot drink in combination with European elder berry (Sambucus nigra, Viburnaceae) was reported to be as effective as oseltamivir (Tamiflu ® ; Roche; Switzerland) with early treatment of influenza symptoms and demonstrated a better safety profile. 85 Other Echinacea studies have focused on inflammatory dermatological conditions such as atopic dermatitis (a type of eczema). ...
View
... On the other hand, positive results regarding Echinacea's prophylactic role are discussed in some studies. The beneficial effect of E. purpurea after a long-term treatment of 4 months against common cold was evidenced by [83]. Participants who received Echinacea supplements were susceptible to less common cold virus infections compared to those who were given placebos. ...
Echinacea spp.: The cold-fighter herbal remedy?
Article
Full-text available
  • Feb 2024
  • PHARMACOL RES
Introduction: Echinacea spp. are worldwide known as anti-inflammatory medicinal plants. The phytochemistry of the genus Echinacea is complex, however most notable compounds to which the biological activity is attributed are the alkamides. Much research focuses on the study of certain Echinacea species, namely E. angustifolia, E. pallida, E. purpurea, and E. lannata, to deal with common cold symptoms, however, results between the various studies are inconsistent. There is a historical background for the therapeutic use of the plant against various disorders by many civilizations. Additionally, Echinacea species therapeutic uses in Traditional Chinese Medicine are discussed. Methodology: Databases including PubMed, Google Scholar and ScienceDirect were used for the research using the following keywords: Echinacea, anti-inflammatory, anti-viral, immunostimulatory, cold-fighter, chemistry, alkamides and Traditional Chinese Medicine. The purpose of this review paper is to discuss the existing findings regarding the immunostimulatory, anti-inflammatory, and anti-viral activities of Echinacea species. Results: Echinacea extracts contain a variety of secondary metabolites including caffeic acid, derivates of caffeic acid, flavonoids and alkamides. Alkamides, are the most studied compounds and the pharmacological activities of the plant are mainly attributed to those. Discussion: Data gathered from the in vitro and in vivo studies provide substantiation regarding the anti-inflammatory, immunomodulatory and anti-viral effects of Echinacea species. On the contrary evidence from clinical trials questions the useful effects of the plant in reducing the frequency and length of the common cold. Conclusion: Findings of the studies presented in the manuscript indicate that more research should be performed to evaluate whether Echinacea spp. is indeed a cold-fighter remedy. Additionally, conducting further studies regarding the bioavailability, pharmacokinetics, and toxicity of the plant is highly recommended.
View
... This plant has a reputation for stimulating the immune system to help fight infectious diseases. Standardized preparations of E. purpurea have several applications for respiratory tract infections [5,[15][16][17][18][19][20][21][22][23], viral infections [24][25][26][27], tumor suppression [28], acne, and skin diseases [29,30]. In addition, a mixture of E. purpurea and E. angustifolia was reported to protect against acetic acid-induced ulcerative colitis in rats [31]. ...
Volatile Composition, Antimicrobial Activity, and In Vitro Innate Immunomodulatory Activity of Echinacea purpurea (L.) Moench Essential Oils
Article
Full-text available
Echinacea purpurea (L.) Moench is a medicinal plant commonly used for the treatment of upper respiratory tract infections, the common cold, sore throat, migraine, colic, stomach cramps, and toothaches and the promotion of wound healing. Based on the known pharmacological properties of essential oils (EOs), we hypothesized that E. purpurea EOs may contribute to these medicinal properties. In this work, EOs from the flowers of E. purpurea were steam-distilled and analyzed by gas chromatography-mass spectrometry (GC-MS), GC with flame-ionization detection (GC-FID), and chiral GC-MS. The EOs were also evaluated for in vitro antimicrobial and innate immunomodulatory activity. About 87 compounds were identified in five samples of the steam-distilled E. purpurea EO. The major components of the E. purpurea EO were germacrene D (42.0 ± 4.61%), α-phellandrene (10.09 ± 1.59%), β-caryophyllene (5.75 ± 1.72%), γ-curcumene (5.03 ± 1.96%), α-pinene (4.44 ± 1.78%), δ-cadinene (3.31 ± 0.61%), and β-pinene (2.43 ± 0.98%). Eleven chiral compounds were identified in the E. E. purpurea EO antimicrobial activity showed that they inhibited the growth of several bacterial species, although the EO did not seem to be effective for Staphylococcus aureus. The E. purpurea EO and its major components induced intracellular calcium mobilization in human neutrophils. Additionally, pretreatment of human neutrophils with the E. purpurea EO or (+)-δ-cadinene suppressed agonist-induced neutrophil calcium mobilization and chemotaxis. Moreover, pharmacophore mapping studies predicted two potential MAPK targets for (+)-δ-cadinene. Our results are consistent with previous reports on the innate immunomodulatory activities of β-caryophyllene, α-phellandrene, and germacrene D. Thus, this study identified δ-cadinene as a novel neutrophil agonist and suggests that δ-cadinene may contribute to the reported immunomodulatory activity of E. purpurea.
View
... Particularly, a hydroethanolic extract (65% v/v) from the freshly harvested aerial parts and root of E. purpurea (95% and 5%, respectively), standardized to contain 5 mg/100 g of dodecatetraenoic acid isobutylamide, was found to be effective against a broad number of coronaviruses, including the common cold and the highly pathogenic SARS-CoV-2 strains [92]. These benefits have been also confirmed in randomized clinical trials carried out in adults and children [93][94][95]; however, further clinical confirmations are required to support the use of this Echinacea extract against viral infections [96]. Interestingly, some studies showed chicoric acid, a key phenolic compound from Echinacea aerial parts and roots, to interfere with SARS-CoV-2 proteins, suggesting that it can represent one of the possible bioactive compounds [97,98]. ...
ECHOPvir: A Mixture of Echinacea and Hop Extracts Endowed with Cytoprotective, Immunomodulatory and Antiviral Properties
Article
Full-text available
  • Oct 2023
Respiratory viral infections continue to pose significant challenges, particularly for more susceptible and immunocompromised individuals. Nutraceutical strategies have been proposed as promising strategies to mitigate their impact and improve public health. In the present study, we developed a mixture of two hydroalcoholic extracts from the aerial parts of Echinacea purpurea (L.) Moench (ECP) and the cones of Humulus lupulus L. (HOP) that can be harnessed in the prevention and treatment of viral respiratory diseases. The ECP/HOP mixture (named ECHOPvir) was characterized for the antioxidant and cytoprotective properties in airway cells. Moreover, the immunomodulating properties of the mixture in murine macrophages against antioxidant and inflammatory stimuli and its antiviral efficacy against the PR8/H1N1 influenza virus were assayed. The modulation of the Nrf2 was also investigated as a mechanistic hypothesis. The ECP/HOP mixture showed a promising multitarget bioactivity profile, with combined cytoprotective, antioxidant, immunomodulating and antiviral activities, likely due to the peculiar phytocomplexes of both ECP and HOP, and often potentiated the effect of the single extracts. The Nrf2 activation seemed to trigger these cytoprotective properties and suggest a possible usefulness in counteracting the damage caused by different stressors, including viral infection. Further studies may strengthen the interest in this product and underpin its future nutraceutical applications.
View
... A wide range of herbal medicines and plant based chemicals such as iota-carrageenan and menthol are recommended for prevention and treatment of the common cold. Echinacea and Pelargonium are two of the most popular herbal treatments and they have support for efficacy from clinical trials on common cold (78)(79)(80)(81) although the clinical relevance of the efficacy has been reported as questionable (82). Iotacarrageenan has been studied several clinical trials on common FIGURE 4 Mechanism of symptoms. ...
Common cold
Article
Full-text available
  • Jun 2023
The common cold is a unique human disease, as it is arguably the most common disease and because of the large number of respiratory viruses causing colds it is one of the most complex of human diseases. This review discusses the respiratory viruses and notes that all these viruses may cause the illness complex recognised as the common cold. The common cold is discussed as part of the “iceberg concept” of disease which ranges from asymptomatic infection to severe illness and death. The factors influencing the incidence of colds are discussed: crowding and sociability, stress, smoking and alcohol, immune status, sex, age, sleep, season, chilling, nutrition and exercise. The mechanism of symptoms related to the innate immune response is explained and symptomatic treatments are tabulated. Morbidity associated with common cold is discussed and possible vaccines.
View
Unveiling Moroccan Nature's Arsenal: A Computational Molecular Docking, Density Functional Theory, and Molecular Dynamics Study of Natural Compounds against Drug-Resistant Fungal Infections
Article
Full-text available
  • Jul 2024
Candida albicans and Aspergillus fumigatus are recognized as significant fungal pathogens, responsible for various human infections. The rapid emergence of drug-resistant strains among these fungi requires the identification and development of innovative antifungal therapies. We undertook a comprehensive screening of 297 naturally occurring compounds to address this challenge. Using computational docking techniques, we systematically analyzed the binding affinity of each compound to key proteins from Candida albicans (PDB ID: 1EAG) and Aspergillus fumigatus (PDB ID: 3DJE). This rigorous in silico examination aimed to unveil compounds that could potentially inhibit the activity of these fungal infections. This was followed by an ADMET analysis of the top-ranked compound, providing valuable insights into the pharmacokinetic properties and potential toxicological profiles. To further validate our findings, the molecular reactivity and stability were computed using the DFT calculation and molecular dynamics simulation, providing a deeper understanding of the stability and behavior of the top-ranking compounds in a biological environment. The outcomes of our study identified a subset of natural compounds that, based on our analysis, demonstrate notable potential as antifungal candidates. With further experimental validation, these compounds could pave the way for new therapeutic strategies against drug-resistant fungal pathogens.
View
View
Therapeutic potential of selective medicinal plants and their phytoconstituents in respiratory diseases: A review with an emphasis on COVID-19
Article
Full-text available
  • Jan 2024
Respiratory diseases, spanning from the common cold to severe conditions such as pneumonia and COVID-19, pose significant challenges to global health and contribute significantly to morbidity and mortality. The emergence of COVID-19 has heightened the requirement for effective therapeutic strategies. This review article examines the potential of specific medicinal plants, namely Black Cumin, Licorice, and Echinacea, and their phytoconstituents in the treatment of respiratory diseases, with a focus on COVID-19. It synthesizes extant knowledge on the therapeutic efficacy of these plants, which have been used traditionally in Unani, Ayurvedic, and Chinese medicine to alleviate respiratory symptoms and boost immune functions. This review also discusses the immunomodulatory and antiviral properties of these three specific medicinal plants, as well as their function in the treatment of a number of life-threatening diseases. Incorporating insights from ethnomedicine and contemporary scientific research, this review highlights the urgency of exploring herbal medicines as complementary therapies for respiratory diseases and offers perspectives on incorporating these natural remedies into contemporary treatment paradigms, particularly in the fight against COVID-19.
View
Atividade imunomoduladora e antiviral de extratos de Echinacea purpurea: uma revisão da literatura
Article
Full-text available
  • Dec 2022
Desde a antiguidade, a humanidade possui o hábito de utilizar plantas medicinais como tratamento profilático para enfermidades, principalmente aquelas que acometem o sistema respiratório como as infecções virais. A Echinacea purpurea (EP) contém um amplo espectro de propriedades terapêuticas que podem ser úteis nas infecções virais. Esse trabalho teve como objetivo descrever, por meio de um estudo de revisão bibliográfica, as atividades imunomoduladora e antiviral de extratos obtidos a partir da planta EP, bem como as concentrações e constituintes químicos relacionados à atividade contra os vírus da Herpes e Influenza. Para isso, foi realizada uma busca na literatura científica, utilizando as bases de dados PubMed, Scielo, Sapientia e Google Acadêmico. A análise dos estudos demonstrou que extratos de EP e seus constituintes apresentam atividade antiviral e imunomoduladora útil na prevenção e tratamento de infecções virais, entretanto, se faz necessário a realização de outros estudos para elucidar os mecanismos de ação dos constituintes da planta.
View
Randomised, Double Blind, Placebo-Controlled Trial of Echinacea Supplementation in Air Travellers
Article
Full-text available
  • Jan 2012
  • EVID-BASED COMPL ALT
Objective. To identify whether a standardised Echinacea formulation is effective in the prevention of respiratory and other symptoms associated with long-haul flights. Methods. 175 adults participated in a randomised, double-blind placebo-controlled trial travelling back from Australia to America, Europe, or Africa for a period of 1-5 weeks on commercial flights via economy class. Participants took Echinacea (root extract, standardised to 4.4 mg alkylamides) or placebo tablets. Participants were surveyed before, immediately after travel, and at 4 weeks after travel regarding upper respiratory symptoms and travel-related quality of life. Results. Respiratory symptoms for both groups increased significantly during travel (P < 0.0005). However, the Echinacea group had borderline significantly lower respiratory symptom scores compared to placebo (P = 0.05) during travel. Conclusions. Supplementation with standardised Echinacea tablets, if taken before and during travel, may have preventive effects against the development of respiratory symptoms during travel involving long-haul flights.
View
Anti-viral Properties and Mode of Action of Standardized Echinacea purpurea Extract Against Highly Pathogenic Avian Influenza Virus (H5N1, H7N7) and Swine-origin H1N1 (S-OIV)
Article
Full-text available
  • Nov 2009
  • VIROL J
Influenza virus (IV) infections are a major threat to human welfare and animal health worldwide. Anti-viral therapy includes vaccines and a few anti-viral drugs. However vaccines are not always available in time, as demonstrated by the emergence of the new 2009 H1N1-type pandemic strain of swine origin (S-OIV) in April 2009, and the acquisition of resistance to neuraminidase inhibitors such as Tamiflu (oseltamivir) is a potential problem. Therefore the prospects for the control of IV by existing anti-viral drugs are limited. As an alternative approach to the common anti-virals we studied in more detail a commercial standardized extract of the widely used herb Echinacea purpurea (Echinaforce, EF) in order to elucidate the nature of its anti-IV activity. Human H1N1-type IV, highly pathogenic avian IV (HPAIV) of the H5- and H7-types, as well as swine origin IV (S-OIV, H1N1), were all inactivated in cell culture assays by the EF preparation at concentrations ranging from the recommended dose for oral consumption to several orders of magnitude lower. Detailed studies with the H5N1 HPAIV strain indicated that direct contact between EF and virus was required, prior to infection, in order to obtain maximum inhibition in virus replication. Hemagglutination assays showed that the extract inhibited the receptor binding activity of the virus, suggesting that the extract interferes with the viral entry into cells. In sequential passage studies under treatment in cell culture with the H5N1 virus no EF-resistant variants emerged, in contrast to Tamiflu, which produced resistant viruses upon passaging. Furthermore, the Tamiflu-resistant virus was just as susceptible to EF as the wild type virus. As a result of these investigations, we believe that this standard Echinacea preparation, used at the recommended dose for oral consumption, could be a useful, readily available and affordable addition to existing control options for IV replication and dissemination.
View
Induction of multiple pro-inflammatory cytokines by respiratory viruses and reversal by standardized Echinacea, a potent antiviral herbal extract
Article
Full-text available
  • Jun 2009
Several viruses associated with upper respiratory diseases have been shown to stimulate the secretion of pro-inflammatory cytokines, including chemokines, sometimes in the absence of viral cytopathology. We evaluated the ability of a standardized preparation of the popular herbal medicine Echinacea (Echinaforce, an ethanol extract of herb and roots of E. purpurea, and containing known concentrations of marker compounds) to inhibit the viral induction of various cytokines in a line of human bronchial epithelial cells (BEAS-2B), and in two other human cell lines. All of the viruses tested, rhinoviruses 1A and 14, influenza virus, respiratory syncytial virus, adenovirus types 3 and 11, and herpes simplex virus type 1, induced substantial secretion of IL-6 and IL-8 (CXCL8), in addition to several other chemokines, depending on the virus, although only viable viruses were able to do this. In every case however Echinacea inhibited this induction. The Echinacea preparation also showed potent virucidal activity against viruses with membranes, indicating the multi-functional potential of the herb. These results support the concept that certain Echinacea preparations can alleviate "cold and flu" symptoms, and possibly other respiratory disorders, by inhibiting viral growth and the secretion of pro-inflammatory cytokines.
View
View
View
View
View
Aging and the Immune System
Article
  • Nov 1994
Publisher Summary This chapter discusses the molecular and cellular aspects of aging. Aging represents the most incisive personal, medical, and socioeconomic problem of the society. Therefore, studying age-related biological phenomena is not only a fascinating theoretical subject but also one with tremendous practical implications. The World Health Organization (WHO), together with the National Institute of Aging (NIA), identified four major areas of gerontology (the science of research on aging) that its member states were urged to concentrate their scientific efforts on. These were (1) nutrition (worldwide undernutrition, paradoxically atherosclerosis in developed countries), (2) the nervous system (e.g., Alzheimer's and Parkinson's diseases), (3) the immune system (infections, tumors, autoimmune diseases), and (4) the endocrine system (e.g., osteoporosis). The chapter summarizes the most popular examples of stochastic and deterministic theories of aging. A description of general cellular age-dependent morphological and functional changes leading to the aging of the immune system is also provided in the chapter. The chapter concludes with a discussion on the possible ways of intervention for age-related problems of the immune reactivity—such as treatment with hormones and cytokines as well as by tissue engineering.
View
Antivirals for the common cold
Chapter
  • Nov 2009
Despite a 60-year history of discovery, trial and evaluation of scores of different compounds, there are no currently licensed effective antivirals for the common cold. The history of the development and abandonment of all potential compounds so far teaches us some important lessons for the continuation of our fight against colds. First, the common cold is a benign self-limiting condition, making the consumption of ‘harmless’ antivirals a requisite of prime importance for regulators. Second, the common cold is a syndrome caused by a myriad of known and unknown agents, which reduces the effectiveness of compounds that interfere with single specific agents or types of agents. The multifactorial nature of the genesis of colds makes it difficult for compounds showing in vitro efficacy to ‘make the jump’ to field effectiveness. Last, despite the heavy burden that the cold imposes on society, the vagueness and shortness of symptoms make it difficult for sufferers to present in time for physicians to prescribe antivirals, which are only effective if taken within a short time frame. Attention should be paid to the development of compounds with a non-virus-specific action.
View
A scale for assessing the severity of diseases and adverse drug reactions. Application to drug benefit and risk
Article
  • May 1979
Physicians were interviewed to assess their willingness to risk adverse drug reactions among patients. These untoward reactions were ranked according to severity and weighted against the primary illness being treated. A specially designed questionnaire in the form of a matrix was used. Severity was divided into seven classes denoted by progressively increasing numerical scores, W1 to W7, whose values could be calculated from analysis of the completed questionnaires. The questionnaires presented several cases, in each of which an illness of specified severity was to be treated with a drug whose untoward reactions differ in severity from that of the primary illness. Each case involved a different permutation of the severities. Analysis of the completed questionnaires yielded the mean values of the scores which were found to range from W1 = 1.00 (the mildest case) to W7 = 817 (the most serious case). It is our opinion that this type of scale is preferable to nonnumerical descriptions of severity such as "mild" or "serious," since, when combined with data on frequency of occurrence, a numerical scale permits a determination of expectation of both benefit and risk.
View