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Echinagard treatment shortens the course of the common cold: A double-blind, placebo-controlled clinical trial
... Twenty nine studies (in 31 publications) met our eligibility criteria. 17,18,[27][28][29][30][31][32][33][34][35][36]19,[37][38][39][40][41][42][43][44][45][20][21][22][23][24][25][26] Nine of these reported data for the prevention meta-analysis, [17][18][19]21,22,27,32,39,42 seven for the duration, [18][19][20][22][23][24]27 and 16 for safety. 17,19,[37][38][39]41,42,45,[20][21][22][23]25,27,32,36 Eleven studies did not provide quantitative data for a meta-analysis but met the eligibility criteria to be considered in a narrative summary. ...
... 17,19,[37][38][39]41,42,45,[20][21][22][23]25,27,32,36 Eleven studies did not provide quantitative data for a meta-analysis but met the eligibility criteria to be considered in a narrative summary. 26,28,44,[29][30][31][33][34][35]40,43 Three trials were identified as being potentially relevant but excluded after discussion between the reviewers. The trials by Berg 46 and Turner 2000 47 were excluded as they were not described as doubleblind. ...
... 27,45 Only two of the trials 21,39 used experimental virus inoculation with the rest using natural infection. In terms of the intervention; 16 of the trials reported using echinacea monotherapy; 14 with E. purpurea 17,18,[38][39][40]44,19,25,26,[30][31][32]34,37 two with E. angustifolia 21,29 and two with E. pallidae 28,41 and one trial 22 had separate groups for E. angustifolia and E. purpurea. Three trials did not specify which species of echinacea was used 23,43,45 and the remaining seven trials reported a mixed preparation treatment; 5 with E. purpurea and E. angustifolia 20,24,27,35,42 and two with E. purpurea and E. pallidae. ...
Background:
Echinacea preparations are commonly used to prevent and treat upper respiratory tract infection.
Objectives:
To assess current evidence for the safety and efficacy of echinacea containing preparations in preventing and treating upper respiratory tract infection.
Data sources:
MEDLINE, EMBASE, CAB extracts, Web of Science, Cochrane DARE, clinicaltrials.gov and the WHO ICTRP - 1980 to present day.
Eligibility criteria:
Randomised double-blind placebo-controlled trials using an echinacea preparation to prevent or treat upper respiratory tract infections.
Participants and interventions:
Participants who are otherwise healthy of any age and sex. We considered any echinacea containing preparation.
Study appraisal and synthesis methods:
We used the Cochrane collaborations tool for quality assessment of included studies and performed three meta-analyses; on the prevention, duration and safety of echinacea.
Results:
For the prevention of upper respiratory tract infection using echinacea we found a risk ratio of 0.78 [95% CI 0.68-0.88], for the treatment of upper respiratory tract infection using echinacea we found a mean difference in average duration of -0.45 [95% 1.85-0.94] days, finally for the safety meta-analyses we found a risk ratio of 1.09 [95% CI 0.95-1.25].
Limitations:
The limitations of our review include the clinical heterogeneity - for example many different preparations were tested, the risk of selective reporting, deviations from our protocol and lack of contact with study authors.
Conclusions:
Our review presents evidence that echinacea might have a preventative effect on the incidence of upper respiratory tract infections but whether this effect is clinically meaningful is debatable. We did not find any evidence for an effect on the duration of upper respiratory tract infections. Regarding the safety of echinacea no risk is apparent in the short term at least. The strength of these conclusions is limited by the risk of selective reporting and methodological heterogeneity.
Implications of key findings:
Based on the results of this review users of echinacea can be assured that echinacea preparations are safe to consume in the short term however they should not be confident that commercially available remedies are likely to shorten the duration or effectively prevent URTI. Researchers interested in the potential preventative effects of echinacea identified in this study should aim to increase the methodological strength of any further trials.
Prospero id:
CRD42018090783.
... Clinical studies have been mainly oriented to the treatment and prevention of common cold and infections of the upper respiratory and the urinary tract, since immunomodulation is a pharmacological, but not a therapeutic effect. Positive effects have been demonstrated in clinical studies for a pressed juice preparation from the aerial parts of E. purpurea, for the hydroalcoholic extracts of E. purpurea roots and for a 95:5 mixture of hydroalcoholic extracts of E. purpurea aerial parts and roots [15][16][17][18][19][20][21]23,24] . In case of the pressed juice from E. purpurea aerial parts, clinical studies have only been performed with the cold pressed juice and not with heated materials. ...
... A single centre clinical trial was carried out to investigate the therapeutic efficacy of a pressed juice preparation of Echinacea purpurea aerial parts in 120 patients with initial symptoms of acute, uncomplicated upper airways infection [17] . The verum group (n = 60) received cold pressed Echinacea purpurea pressed juice, stabilized with 20 % (V/V) ethanol, the placebo group (n = 60) coloured diluted ethanol. ...
... In the sub-group of patients with a 'real' cold, the median time for improvement was 4 days in the verum group (n = 24), while it was 8 days in the placebo group (n = 36) [17] . ...
2) (1)Institut für Pharmazeutische Biologie, Heinri h-Heine-Universität Düsseldo f, Germany (2) R & D Departmen Phytopharm. and Phytochem Products, Flachsmann AG, Zurich c r t The knowledge of pharmacological effects of different preparations of Echinacea purpurea has been used for the medical treatment of several complaints for centuries now. Historical traces are going back to the North-American Indians. Actually, the majority of investigations has been carried through with cold pressed juice of the aerial parts of Echinacea purpurea. Recent studies have proved the stimulation of the non-specific immune system as the main action of this pressed juice. In fact, none of the identified compounds of the polar and lipophilic fraction could have been determined to be solely responsible for this activity. Several compounds as alkamides, polysaccharides and glycoproteins are discussed to be potentially part of the "active principle". Since immunomodulation is a pharmacological effect, most of the clinical studies have focused on treatment and prevention of common cold and infections of the upper respiratory and the urinary tract. Recent clinical studies have provided data on the therapeutic effectiveness of pressed juice of Echinacea purpurea, while other, probably also beneficial Echinacea purpurea preparations are not that well documented.
... Twenty studies of the efficacy of Echinacea sp. against URTI were identified; see Table 2 (Dorn et al., 1997;Hoheisel et al., 1997;Melchart et al., 1998;Brinkeborn et al., 1999;Grimm and Muller, 1999;Lindenmuth and Lindenmuth, 2000; Turner Barrett et al., 2002Barrett et al., , 2010Schwarz et al., 2002;Goel et al., 2004Goel et al., , 2005Sperber et al., 2004;Yale and Liu, 2004;Turner et al., 2005;Schoop et al., 2006;Hall et al., 2007;O'Neil et al., 2008;Jawad et al., 2012). ...
... Doses are difficult to compare as the formulations vary and are described in mg root/herb, mg extract or as "a standardized formulation." One study included only men (Schwarz et al., 2002) and 12 studies specifically excluded pregnant women (Hoheisel et al., 1997;Melchart et al., 1998;Grimm and Muller, 1999;Lindenmuth and Lindenmuth, 2000;Schulten et al., 2001;Barrett et al., 2002Barrett et al., , 2010Goel et al., 2004;Sperber et al., 2004;Yale and Liu, 2004;O'Neil et al., 2008;Jawad et al., 2012). ...
... One study was open (Schoop et al., 2006), 19 were randomized, controlled trials (Dorn et al., 1997;Hoheisel et al., 1997;Melchart et al., 1998;Brinkeborn et al., 1999;Grimm and Muller, 1999;Lindenmuth and Lindenmuth, 2000;Turner et al., 2000Turner et al., , 2005Schulten et al., 2001;Barrett et al., 2002Barrett et al., , 2010Schwarz et al., 2002;Goel et al., 2004Goel et al., , 2005Sperber et al., 2004;Yale and Liu, 2004;Hall et al., 2007;O'Neil et al., 2008;Jawad et al., 2012). Twelve studies considered treatment of URTI (Dorn et al., 1997;Hoheisel et al., 1997;Brinkeborn et al., 1999;Lindenmuth and Lindenmuth, 2000;Schulten et al., 2001;Barrett et al., 2002Barrett et al., , 2010Goel et al., 2004Goel et al., , 2005Sperber et al., 2004;Yale and Liu, 2004;O'Neil et al., 2008); one considered only prophylaxis (Schwarz et al., 2002) and seven considered both aspects (Melchart et al., 1998;Grimm and Muller, 1999;Turner et al., 2000Turner et al., , 2005Schoop et al., 2006;Hall et al., 2007;Jawad et al., 2012). ...
This review evaluates the safety of echinacea and elderberry in pregnancy. Both herbs are commonly used to prevent or treat upper respiratory tract infections (URTIs) and surveys have shown that they are also used by pregnant women. The electronic databases PubMed, ISI Web of Science, AMED, EMBASE, Natural Medicines Comprehensive Database, and Cochrane Library were searched from inception to November 2013. Relevant references from the acquired articles were included. No clinical trials concerning safety of either herb in pregnancy were identified. One prospective human study and two small animal studies of safety of echinacea in pregnancy were identified. No animal- or human studies of safety of elderberry in pregnancy were identified. Twenty clinical trials concerning efficacy of various echinacea preparations in various groups of the population were identified between 1995 and 2013. Three clinical trials concerning efficacy of two different elderberry preparations were identified between 1995 and 2013. The results from the human and animal studies of Echinacea sp. are not sufficient to conclude on the safety in pregnancy. The prospective, controlled study in humans found no increase in risk of major malformations. The efficacy of Echinacea sp. is dubious based on the identified studies. Over 2000 persons were given the treatment, but equal amounts of studies of good quality found positive and negative results. All three clinical trials of Elderberry concluded that it is effective against influenza, but only 77 persons were given the treatment. Due to lack of evidence of efficacy and safety, health care personnel should not advice pregnant women to use echinacea or elderberry against upper respiratory tract infection.
... Tabelle 1 zeigt die Charakteristiken der eingeschlossenen Studien. 7 Studien überprüften eine Monotherapie mit E. purpurea (22-25, 27, 30, 32), 1 Studie mit E. angustifolia (14), 1 mit E. pallida (13,16) (22)(23)(24)(25)27). Bei 3 Studien erfolgte die Virusexposition als Rhinoviren-Inokula-tion (14,22,31), und 4 Studien ermittelten die Wirkung von Echinacea mit einem Zusatz (20,(28)(29)(30). ...
... Die Validität der Studien wurde mit folgenden Parametern überprüft: (13)(14)(15)(16)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). ...
... Bei der Auswertung der 5 Studien mit Echinaguard oder Echinacin (22)(23)(24)(25)27) wurde eine ähnlich signifikante Verminderung der Anfälligkeit der Patienten beobachtet, wie es bei der ganzen Untersuchung der Fall war (p = 0,0009). Bei beiden Erkältungsarten, bei der natürlichen Virenexposi-tion und bei der experimentellen Inokulation, wurde eine Verminderung der Erkältungsinzidenz ermittelt. ...
... Given this, this review is limited to studies of E purpurea. Treatment: Of the 11 trials identified that studied echinacea, [8][9][10][11][12][13][14][15][42][43][44] 6 trials evaluated E purpurea in 764 healthy adults with cold symptoms. 10-15 symptom severity was reduced in 4 of 6 trials, 10-12,14 measured using total daily symptom scores and Jackson scores. ...
... 10-15 symptom severity was reduced in 4 of 6 trials, 10-12,14 measured using total daily symptom scores and Jackson scores. Of the Echinacea purpurea No evidence found in 2 RCTs (level IIa) 8,9 Evidence found in 5 of 6 RCTs (level IIa) [10][11][12][13][14][15] Zinc lozenges No trials evaluate prevention Evidence found in 5 of 9 RCTs (level IIa) [16][17][18][19][20][21][22][23][24] Vitamin C Evidence found in meta-analysis of 30 RCTs; more benefit in children and in adults under stress (level I) 25 No evidence found in meta-analysis of 11 RCTs (level I) 25 Ginseng Inconsistent; evidence found in 2 of 4 RCTs (level IIb) [26][27][28][29] No trials evaluate treatment Garlic (allicin) Evidence found in 1 RCT (level IIb) 30 No trials evaluate treatment ...
To review the evidence supporting complementary and alternative medicine approaches to treatment and prevention of the common cold in adults.
MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from January 1966 to September 2009 combining the key words common cold or influenza with echinacea, garlic, ginseng, probiotics, vitamin C, and zinc. Clinical trials and prospective studies were included.
For prevention, vitamin C demonstrated benefit in a large meta-analysis, with possibly increased benefit in patients subjected to cold stress. There is inconsistent evidence for Asian ginseng (Panax ginseng) and North American ginseng (Panax quinquefolius). Allicin was highly effective in 1 small trial. For treatment, Echinacea purpurea is the most consistently useful variety; it was effective in 5 of 6 trials. Zinc lozenges were effective in 5 of 9 trials, likely owing to dose and formulation issues. Overall, the evidence suggests no benefit from probiotics for prevention or treatment of the common cold.
Vitamin C can be recommended to Canadian patients for prevention of the common cold. There is moderate evidence supporting the use of Echinacea purpurea and zinc lozenges for treatment. Ginseng and allicin warrant further research.
... In clinical trials, 120 patients with the first symptoms of acute inflammation of the upper respiratory tract were administered 20 drops of purple coneflower herb juice every 2 h on the first day, followed by 20 drops three times daily. A significantly reduced treatment period was observed in the treated subjects versus the placebo group (4 and 8 days, respectively) [42]. ...
This paper presents raw plant materials and their characteristic compounds which may affect the immune system. Plant-derived agents in specific doses affect the body’s non-specific, antigen-independent defense system. They have immunostimulatory effects on the entire immune regulatory system. They can enhance the immune response through various factors such as macrophages, leukocytes, and granulocytes, as well as through mediators released by the cellular immune system. This paper was inspired by the threats caused by the COVID-19 pandemic. The proper functioning of the immune system is important in limiting the effects of viral infection and restoring the normal functioning of the body. This paper also emphasizes the importance of the skillful use of plant immunostimulants by potential patients, but also by those who prescribe drugs. It is important not only to choose the right plant drug but above all to choose the correct dose and duration of treatment.
... Double-blind RCTs testing echinacea extracts for prevention and treatment of the common cold were initially positive, and several European trials reported positive results. [100][101][102][103][104][105][106][107] More recent trials, including several in North America, reported mixed results, with the higher-quality trials finding no benefit. 108-112 I myself have directed two trials. ...
... In other common cold trials with results demonstrating superiority over placebo using other products, treatment was initiated promptly when patients had a first subjective feeling of CC because the incubation period varies but is just under two days for rhinovirus (Allan and Arroll, 2014;Hoheisel et al., 1997;Mossad et al., 1996;Prasad et al., 2000;Schulten et al., 2001). ...
The efficacy of Pelargonium sidoides preparation EPs 7630 in the common cold (CC) was assessed by performing meta-analyses of randomized, double-blind, placebo-controlled trials. Mean differences (MD) and risk ratios (RR) with their 95% confidence intervals (CI) were computed. Five trials with a total of 833 patients were included. All trials had a treatment period of ten days with visits at days 3, 5, and 10 after baseline and used a ten-symptom Cold Intensity Score (CIS) as the primary outcome. Significant differences favoring EPs 7630 were observed for total CIS reduction (day 5: MD = -2·30; 95%CI = -4·12,-0·49; day 10: MD = -1·16; 95%CI = -2·22,-0·10), proportion of patients with substantial improvement (day 5: RR = 1·73; day 10: RR = 1·06) and complete remission (day 5: RR = 2·52; day 10: RR = 2·13). Subjects treated with EPs 7630 missed fewer days at work, used less paracetamol and had an improved sleep quality. No serious adverse reactions to EPs 7630 were reported. The results support the efficacy of EPs 7630 in adults with CC. : Respiratory system; Infectious disease; Pharmacology; Evidence-based medicine; Clinical research; Common cold, Efficacy, EPs 7630, Meta-analysis, Pelargonium sidoides, Safety Keywords: Respiratory system, Infectious disease, Pharmacology, Evidence-based medicine, Clinical research, Common cold, Efficacy, EPs 7630, Meta-analysis, Pelargonium sidoides, Safety
... A recent Cochrane review 63 found five randomized trials of adequate methodologic quality that investigated the prophylactic efficacy of E. purpurea in spontaneously acquired colds. In two studies, a statistically significant reduction in the incidence of upper respiratory tract infections was observed 64 . One trial found a significantly shorter duration of cold episodes in the E. purpurea treated group 65 . ...
... 32 Another double-blind study suggests that Echinacea cannot only make colds shorter and less severe, it might also be able to stop a cold that is just starting. 33 In this study, 120 people were given E. purpurea or a placebo as soon as they started showing signs of getting a cold. Participants took either Echinacea or placebo at a dosage of 20 drops every 2 hours for 1 day, then 20 drops 3 times a day for a total of up to 10 days of treatment. ...
The immune system is one of nature's most fascinating inventions. It is an amazing protection mechanism designed to defend us against millions of bacteria, viruses, fungi, toxins and parasites. The immune system is very complex. It is made up of several types of cells and proteins that have different jobs to do in fighting against foreign invaders. If our immune system is working properly we are protected from dangers caused by microbes. If not, we suffer sickness and disease. It is possible to intervene in this process and make our immune system stronger using immune boosters. Immune boosters work in many ways. They increase the number of white blood cells in the immune system army, train them to fight against microbes causing diseases. This review article gives an overall view about some natural herbs like Echinaceae purpurea [Cone flower], Panex ginseng [Asian ginseng], Astragalus mambraneous [Milk vetch], Uncaria tomentosa [Cat's claw] and Withania somnifera [Aswagandha] that have been proven clinically for their strong immunostimulatory activities.
... Um estudo clínico realizado com 120 pacientes com infecção aguda do trato respiratório registrou a redução da duração da doença e melhora significativa dos sintomas entre os pacientes tratados com suco estabilizado de E. purpurea do que entre aqueles que foram tratados com placebo (HOHEISEL et al., 1997). Em outro estudo realizado com 59 pacientes com infecção aguda do trato respiratório demonstrouse a redução das queixas relativas a um índice de 12 sintomas em 64% dos pacientes tratados com E. purpurea e 29% entre aqueles que foram tratados com placebo (BRINKEBORN et al., 1999). ...
Passiflora incarnata é comercializada em muitos países como
fitoterápico. Embora a bula da maioria dos fitoterápicos recomende que eles sejam
usados sob supervisão médica, estudos sobre a toxicidade reprodutiva e do
desenvolvimento desses produtos são raros e não obrigatórios para fins regulatórios.
Neste estudo, realizamos uma avaliação da toxicidade reprodutiva da P.
incarnata, administrada a ratas Wistar (30 ou 300 mg/kg, gavagem) durante
a gestação e a lactação. Além disso, considerando as propriedades antioxidantes que
têm sido atribuídas aos flavonoides presentes no gênero Passiflora,
também avaliou-se o equilíbrio antioxidante/pró-oxidante no plasma destas fêmeas e
conduziu-se um teste in vitro para avaliar o potencial antioxidante.
O tratamento com P. incarnata não influenciou o peso corporal das
fêmeas, bem como indicadores de toxicidade reprodutiva (perdas pós-implantação,
número de filhotes vivos e peso da ninhada) e os parâmetros de função hepática
(albumina, AST, ALT, GGT). A propriedade antioxidante da P.
incarnata foi evidenciada tanto in vivo (aumento do
potencial antioxidante total plasmático) quanto in vitro (diminuição
do burst respiratório em neutrófilos). Os resultados deste estudo
indicam que, nas condições experimentais avaliadas, o tratamento com P.
incarnata durante a gestação e lactação apresentou efeito antioxidante,
na ausência de toxicidade reprodutiva materna.
... Principally, the two reviewers (AS and PK) agreed on the selections with the exception of the Berg study, which finally was rejected because of inappropriate blinding and samplesize calculations [27]. Our methodology was very similar to that of the Shah meta-analysis [12], but here we followed a more restrictive approach and excluded the studies by Turner [28,29], Sperber et al. [30], Berg et al. [27], and Hoheisel et al. [33] because of the abovementioned reasons but included the newer trials by Jawad et al. [21] and qualitatively discussed Heinen-Kammerer et al. [34]. Jackson and colleagues [36]. ...
Introduction
Respiratory tract infections are common, and these infections occur frequently in children, susceptible adults, and older persons. The risk for recurrences and complications relates not only to the presence of viruses but also to immune function. Therefore, modulation of the immune system and antiviral interventions such as echinacea might reduce the risk of recurrences and possibly the development of complications.
Methods
MEDLINE, EMBASE, CAplus, BIOSIS, CABA, AGRICOLA, TOXCENTER, SCISEARCH, NAHL, and NAPRALERT were searched for clinical trials that studied recurrent respiratory infections and complications on treatment with echinacea extracts in a generally healthy population. Two independent reviewers selected randomized, placebo-controlled studies of high methodological quality and a Jadad score of ≥4. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated according to a fixed effect model.
Results
Six clinical studies with a total of 2458 participants were included in the meta-analysis. Use of echinacea extracts was associated with reduced risk of recurrent respiratory infections (RR 0.649, 95% CI 0.545–0.774; P
... Users may consume natural products when they have chronic, life-threatening, or incurable conditions-such as cancer, AIDS, neurodegenerative disorders, or diabetes-that cannot be adequately addressed by conventional medicine. Some patients use natural products for self-limited conditions such as the common cold because professional care is not easily accessible, costly and/or known to be non-efficacious ( Hoheisel et al. 1997). ...
This article sets the stage for the discussion of social capital, civil society, and contemporary democracy by attempting to clarify terms and set out the most promising avenues for discussion and debate. The authors argue that current usage of key terms in the debate suffers from three faults: First, the notion of ''social capital'' is generally undertheorized and oversimplified. Second, popular usage and some scholarly accounts tend to suppress the conflictive character of civil society, seeking in society itself and in its inner workings the resolution of conflicts that politics and the political system in other understandings are charged with settling or suppressing. Third, these (mis)understandings conjoin in the suppression of the economic dimension of contemporary social conflict. This introductory article takes up the first two of these points, in an effort to lay out the theoretical and empirical questions that the subsequent articles address.
... [20,23,32]. Dies zeigt den Forschungsbedarf auch bezu È glich der anderen Inhaltsstoffe von Echinacea auf. ...
Pharmaceutical Comparability of Different Therapeutically Used Echinacea RemediesCichoric acid and Dodeca 2E,4E,8Z,10E/Z-tetraenoic acid isobutylamide (alkamides 8,9) are described as immunomodulating active components of Echinacea . We quantified both substances in 25 Echinacea -containing remedies customary in trade. Concerning both active components, we found highly concentrated remedies as well as remedies without any detectable cichoric acid or alkamides. The concentration of both active components varied extremely depending on the type of remedy (homeopathic mother tincture, pressed juice, tablets, spagyric tincture), on the Echinacea -species ( Echinacea angustifolia, Echinacea pallida, Echinacea purpurea ) and on the part of the plant (root, herb, whole plant). Moreover, we found large differences between comparable drugs of different manufacturers and between different charges of the same remedy. We recommend that preclinical and clinical studies with Echinacea -containing drugs should always include the quantification of the potentially active components. We are convinced, that in the long term this will help to clarify how the different active components contribute to the immunomodulating effect of Echinacea.
... With many phytopharmaceuticals, pharmacological effects are thought to be due to a combination of constituents. Stimulation of macrophage phagocytosis appears to be most pro- Plant immunostimulants symptom intensity [10]. However, while Echinacea use for respiratory indications remains extensive, negative outcomes in some studies, possibly due to insufficiently standardised product, mean that evidence for efficacy remains inconclusive [11]. ...
Plants and minerals have been used since ancient times for the treatment of many ailments and diseases. Most were used for
mystical reasons and others relied on the “doctrine of signatures”, which stated that the shape of the plant reflected its
potential medicinal use. The root of the mandrake or ginseng, for instance, is shaped like that of the human body and has
been used as a general tonic for a variety of illnesses [1]. It is claimed by herbalists to have immunostimulant properties.
Siberian ginseng or Taiga root (Eleutherococcus senticosus) is also used as a tonic and has been reported to exhibit immunostimulatory properties. The pharmacological bases of these
actions are unclear, so these plant medicines cannot be considered unequivocally as immunostimulants.
... With many phytopharmaceuticals, pharmacological effects are thought to be due to a combination of constituents. Stimulation of macrophage phagocytosis appears to be most pro- Plant immunostimulants symptom intensity [10]. However, while Echinacea use for respiratory indications remains extensive, negative outcomes in some studies, possibly due to insufficiently standardised product, mean that evidence for efficacy remains inconclusive [11]. ...
... Extracts and pressed juices from aerial parts of the plant Echinacea purpurea are well-known herbal immuno-stimulants. The latter in particular are commonly accepted to be effective phytomedicines for treating the common cold [1]. The putative active compounds comprise low molecular weight compounds like caffeic acid derivatives (cichoric acid, echinacoside), alkamides and polyacetylenes, as well as high molecular weight polysaccharides and glycoproteins. ...
A high molecular weight arabinogalactan protein (AGP) from the pressed juice of Echinacea purpurea, known to exhibit immunomodulatory properties in vitro, was characterized. Alkaline hydrolysis was carried out, leading to
degradation of the protein core and to carbohydrate moieties linked to the amino acid responsible for binding. Gel permeation
chromatography of these AG subunits gave one peak with a molecular weight of 30×103Da. Hydroxyproline (42.9% w/w) was detected as the dominant amino acid after alkaline hydrolysis and was thus identified as
the major amino acid responsible for the binding between the protein and the AG subunits via an O-glycosidic linkage. Large
amounts of glutamine/glutamic acid (24.5% w/w) and asparagine/aspartic acid (17.3% w/w) were also found. Polyclonal antibodies
raised against the intact AGP were shown to bind to the AG subunits too, indicating that the epitopes responsible for such
interactions are localized in the polysaccharide moiety of the AGP.
... Pressed juices from the plant Echinacea purpurea are used as non-specific immunostimulants and are effective drugs in treatment of the common cold (Hoheisel et al. 1997). Besides low molecular weight compounds like caffeic acid derivatives and alkamides, high-molecular-weight polysaccharides and glycoproteins belong to the putative active compounds (for review see Bauer 1998). ...
Suspension cultures of Echinacea purpurea have been established in MS medium supplemented with 2,4-D and an arabinogalactan-protein (AGP) was purified from the secreted
soluble polymers by precipitation with ethanol, followed by precipitation with β-glucosyl Yariv reagent. It revealed typical
features of AGPs: a high amount of polysaccharide (90%w/w) with the dominating monosaccharides galactose and arabinose and
some glucuronic acid, and a small protein moiety (10%w/w) with the main amino acids Ala, Hyp, Glx, Ser, Asx and Thr. Linkage-
and NMR-analyses showed the polysaccharide part to be composed of a branched core-polysaccharide of 3-, 6- and 3,6-linked
Galp residues with terminal Araf, Arap, Galp and GlcAp residues. Compared to an AGP from pressed juice of the aerial parts of Echinacea purpurea, differences particularly in terminal arabinose mono- and oligosaccharides in arabinogalactan (AG) side branches could be
detected. Testing of different AGP-antibodies with both AGPs confirmed the results of the analytical investigations. Binding
of AGPs from plant and cell cultures to LM2, a monoclonal AGP-antibody reacting with a GlcA containing epitope, was comparable.
The reactivity of a monoclonal antibody raised against the AGP from the plant recognizing a galactan epitope was also nearly
similar with both AGPs. In contrast, polyclonal antibodies raised against the AGP from the plant and directed against an Araf-containing epitope of the AG side branches showed nearly no cross reactivity with the AGP from cell culture.
... Echinacea causes an increase in numbers of circulating white blood cells, activation of phagocytosis by human granulocytes, and elevation of body temperature,12 resulting primarily from the aerial portion of E. purpurea13 and the root portion of E. pallida.13 Previous research suggests that Echinacea may be most effective at reducing the severity and duration of the common cold when taken early in the illness14,15 but has little to no preventive benefit.16 A review of five randomized, clinical trials investigating the immunomodulatory activity of Echinacea concluded that Echinacea may be an efficacious immune stimulator.17 ...
To study the potential efficacy and tolerability of a natural multiherbal formula (Immumax) containing Echinacea extract 120 mg, garlic powder 100 mg, Nigella sativa oil 200 mg, and Panax ginseng extract 50 mg plus vitamin C 50 mg and elemental zinc 7.5 mg in the treatment of patients suffering from the common cold.
The study was conducted in a prospective, double-blind, randomized, controlled study design in an outpatient setting.
Sixty-two eligible patients with symptoms of the common cold were randomized to either Immumax or placebo treatment groups for the duration of their symptoms or a maximum of 14 days. Resolution rates were estimated using Kaplan-Meier analysis, and resolution profiles were compared between groups using the log-rank test. The mean percentage change in total symptom severity scores at days 4 and 8 from baseline were compared between the two groups by one-way analysis of variance (ANOVA).
The median (interquartile range) time to resolution of all symptoms was 8 (5-9) days in the placebo group and 4 (3-6) days in the Immumax group. The results of the log-rank test indicate that symptoms resolved significantly faster in the Immumax group than in the placebo group (P < 0.001). The mean percentage reduction in total symptom severity scores from baseline at days 4 and 8 was significantly greater in the Immumax group than in the placebo group by one-way ANOVA (P < 0.01).
We can conclude from our study that Immumax is helpful in reducing the duration and severity of common cold symptoms.
... Während mit dem Mischextrakt aus dem Kraut und der Wurzel signifikant bessere Ergebnisse im Vergleich zu Placebo erreicht wurden, zeigte der reine Wurzelextrakt nur positive Tendenzen.In klinischen Studien mit einem definierten E. purpureae herba Presssaft konnte ebenfalls ein immunmodulierender Effekt gezeigt werden. In zwei neueren Studien wurde der Presssaft an Patienten mit beginnenden Symptomen einer akuten Infektion verabreicht(HOHEISEL et al., 1997, SCHULTEN et al. 2001). Hierbei konnte die vollständige Ausbildung der Erkrankung in vielen Fällen verhindert und die Krankheitsdauer im Falle eines Infektes signifikant verkürzt werden. ...
Düsseldorf, Univ., Diss., 2002. Computerdatei im Fernzugriff.
... b Introduction ! Extracts and pressed juices from Echinacea are used as unspecific immunostimulants, e.g., for treatment of the common cold [1]. The putative active principles may be found among the low molecular weight compounds (caffeic acid derivatives, alkamides, polyacetylenes) and/or the high molecular weight polysaccharides and glycoproteins occuring in these plants (for review, see [2]). ...
From the high molecular weight fraction of an aqueous extract from roots of Echinacea purpurea L. Moench, arabinogalactan-proteins (AGPs), a class of proteoglycans proposed to be involved in cell differentiation and plant growth, were purified and characterized with regard to amino acid composition and structure of the polysaccharide moiety. The protein content of the AGP was 5.0 % (w/w) with the dominating amino acids Glx, Hyp, Asx, Ser, Thr and Ala. The highly branched polysaccharide moiety shows a linkage composition typical of AGPs with 1,3-, 1,6- and 1,3,6-linked galactopyranosyl residues and arabinofuranosyl residues predominantly as terminal and 1,5-linked residues. Terminal units of glucuronopyranose acid were also detected. Furthermore, a new method for the localization of AGPs in plant tissue has been developed. The synthetic (beta- D-Glc)(3) Yariv phenylgycoside (betaGlcY) is known to specifically bind to AGPs. For immunolocalization, polyclonal betaGlcY-antibodies have been generated and were used to label Yariv-treated thin sections of roots from E. purpurea. After addition of the FITC-conjugated secondary antibody, the sections were analyzed by confocal laser scanning microscopy. AGPs are detected mainly in the central cylinder in the area of the xylem. Cell walls of vessels and tracheids are strongly labelled, especially at the inner area of the wall. Furthermore, there is intense labelling of the pit canals.
... A number of trials have shown that patients with upper respiratory tract infections, receiving the equivalent of at least 900 mg=d E. purpurea or E. pallida root as a tincture, experienced signi®cant relief of symptoms (Bra Èunig et al. 1992;). Ingestion of a stabilized expressed juice of E. purpurea tops resulted in a 50 % more rapid recovery of patients with initial symptoms of a common cold (Hoheisel et al. 1997). Bene®cial effects have also been obtained in trials where echinacea was used in conjunction with Eupatorium perfoliatum, Baptisia tinctoria, Arnica montana (Dorn, 1989; Schmidt et al. 1990), Thuja occidentalis and B. tinctoria (Reitz, 1990). ...
An overview is given of the current position of medicinal herbs in general in relation to usage, market and production, types of pharmacological activity and how they differ from conventional drugs. The increasing importance of quality and manufactured products is also discussed. A more detailed consideration of these issues is given in relation to echinacea, valerian and St John's wort as these herbs are well studied, are market leaders and have widespread community usage.
Background Echinacea plant preparations (family Asteraceae) are widely used in Europe and North America for common colds. Most consumers and physicians are not aware that products available under the term Echinacea differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and the addition of other components. Objectives To assess whether there is evidence that Echinacea preparations are effective and safe compared to placebo in the prevention and treatment of the common cold. Search methods We searched CENTRAL 2013, Issue 5, MEDLINE (1946 to May week 5, 2013), EMBASE (1991 to June 2013), CINAHL (1981 to June 2013), AMED (1985 to February 2012), LILACS (1981 to June 2013), Web of Science (1955 to June 2013), CAMBASE (no time limits), the Centre for Complementary Medicine Research (1988 to September 2007), WHO ICTRP and clinicaltrials.gov (last searched 5 June 2013), screened references and asked experts in the field about published and unpublished studies. Selection criteria Randomized controlled trials (RCTs) comparing mono-preparations of Echinacea with placebo. Data collection and analysis At least two review authors independently assessed eligibility and trial quality and extracted data. The primary efficacy outcome was the number of individuals with at least one cold in prevention trials and the duration of colds in treatment trials. For all included trials the primary safety and acceptability outcome was the number of participants dropping out due to adverse events. We assessed trial quality using the Cochrane 'Risk of bias' tool. Main results Twenty-four double-blind trials with 4631 participants including a total of 33 comparisons of Echinacea preparations and placebo met the inclusion criteria. A variety of different Echinacea preparations based on different species and parts of plant were used. Evidence from seven trials was available for preparations based on the aerial parts of Echinacea purpurea. Ten trials were considered to have a low risk of bias, six to have an unclear risk of bias and eight to have a high risk of bias. Ten trials with 13 comparisons investigated prevention and 15 trials with 20 comparisons investigated treatment of colds (one trial addressed both prevention and treatment). Due to the strong clinical heterogeneity of the studies we refrained from pooling for the main analysis. None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference. However a post hoc pooling of their results, suggests a relative risk reduction of 10% to 20%. Of the six treatment trials reporting data on the duration of colds, only two showed a significant effect of Echinacea over placebo. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups. Authors' conclusions Echinacea products have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products: The results of individual prophylaxis trials consistently show positive (if non-significant) trends, although potential effects are of questionable clinical relevance.
Herbal remedies fit very naturally into the natural and holistic system of medicine. As a result, all physicians and laypersons do not appreciate the kind of compartmentalized, organ-based approach to herbal healing that is followed in this book. Indeed, there are two classes of herbal remedies that do not fit into an anatomically oriented scheme: adaptogens and immune stimulants. Adaptogens are agents that are reputed to increase the body’s resistance to physical, chemical, and biological stressors. Immune stimulants are agents that activate the body’s nonspecific defence mechanisms against infectious organisms, particularly viral and bacterial pathogens.
Herbal remedies fit very naturally into the natural and holistic system of medicine. As a result, all physicians and laypersons do not appreciate the kind of compartmentalized, organ-based approach to herbal healing that is followed in this book. Indeed, there are two classes of herbal remedies that do not fit into an anatomically oriented scheme: adaptogens and immune stimulants. Adaptogens are agents that are reputed to increase the body’s resistance to physical, chemical, and biological stressors. Immune stimulants are agents that activate the body’s nonspecific defense mechanisms against infectious organisms, particularly viral and bacterial pathogens.
Pflanzliche Arzneimittel werden gern in Therapiekonzepte im Sinne einer „Natur- und Ganzheitsmedizin“ eingebunden. Die streng organbezogene Zuordnung der einzelnen Phytopharmaka bzw.deren Indikationen, wie sie in diesem Buch vorgenommen worden sind, wird daher nicht von allen Ärzten und Anwendern geteilt. Bei zwei Präparategruppen ist eine solche anatomisch geprägte Zuordnung überhaupt nicht möglich. Es handelt sich dabei um Phytopharmaka, die adaptogen bzw. immunstimulatorisch wirken sollen.Unter Adaptogenen versteht man vorzugsweise Präparate, die einen Organismus gegenüber physikalischen, chemischen und biologischen (nicht infektiösen) „Stressoren“ widerstandsfähiger machen sollen, während die so genannten „Immunstimulanzien“ vor allem die unspezifischen körpereigenen Abwehrmechanismen gegen Krankheitserreger, insbesondere gegen virale und bakterielle Infekte, aktivieren sollen.
Den unkomplizierten Infekten der oberen und unteren Atemwege, landläufig und wissenschaftlich nicht korrekt „Erkältungskrankheiten“ genannt, kommt aus sozialmedizinischer und sozioökonomischer Sicht eine große Bedeutung zu. Wenngleich die Erkrankung keine schwerwiegende Krankheit darstellt und auch ohne medikamentöse Therapie abheilt, beeinträchtigt sie das Befinden und die Arbeitsfähigkeit der Betroffenen und kann, insbesondere bei Risikogruppen, zu schweren Komplikationen führen. Durch Komplikationen und Arbeitsausfall von durchschnittlich 8 Tagen gewinnt die Erkrankung erhebliche Relevanz für die Volkswirtschaft und für die Solidargemeinschaft der Versicherten. Auch die Möglichkeit der Chronifizierung im Falle der Nicht- oder unzureichenden Behandlung ist nicht auszuschließen. Weiterhin ist zu beachten, daß einzelne Symptome dieser aus medizinischer Sicht „banalen Infektionen“ auch im Zusammenhang mit schwerwiegenden Erkrankungen auftreten (z. B. Husten) und im Zweifelsfall differentialdiagnostische Maßnahmen erfordern.
OBJECTIVE: To familiarize pharmacists with the pharmacology, indications, doses, standardization, adverse effects, and interactions of eight of the best-selling herbal supplements-echinacea, garlic, ginkgo, ginseng, kava, saw palmetto, St. John's wort, and valerian-to enable them to better help patients wisely choose herbal supplements, monitor herbal supplement use, and counsel patients regarding potential problems. Specific learning objectives include: Define OSHEA and list the implications of that act for pharmacists and patients. Given an herbal supplement: 1) determine an acceptable indication and dose for that indication; 2) list the common or serious side effects induced by that supplement; and 3) provide information applicable for patient counseling.
DATA SOURCES: Literature references.
CONCLUSION: Given the growth in interest and huge sales volume of herbal supplements, pharmacists must become knowledgeable about these products to help patients sort factual from fraudulent information. Although the Dietary Supplement Health and Education Act of 1994 allows the sales of these products as dietary supplements, they can be sold without evidence of their safety or efficacy. Good manufacturing procedures are being written, but manufacturers as yet have no regulatory control over the quality of the products being produced.
The effects of daily oral pretreatment for 28 days with the pressed juice of Echinacea purpurea (Echinacin EC31®) or magnesium supplements on the changes in immunological variables in response to a triathlon sprint (mean duration ± SD: 69.5 ± 10.1 min) were investigated in a randomised, placebo-controlled, parallel group study. Forty-two male triathletes (mean age 27.5 years), undergoing regular training, all with a VO(2max) > 52 ml/kg/min, were randomised to one of three treatments. Fluorescence activated flow cytometry analysis of blood cell populations, serum and urine levels of interleukin 6 (IL-6) and soluble interleukin 2 receptor (sIL-2R) together with routine sports laboratory, clinical chemical and haematological variables were determined at baseline (day 0), after treatment (day 28) and 1 h and 20 h after the competition (days 29 and 30). Pretreatment with Echinacin produced slight changes in total peripheral (CD3+) T-lymphocytes, NK (CD3-CD56+) cells and CD8+ lymphocyte counts which remained within the range of baseline variation. In comparison to the placebo group, Echinacin markedly decreased sIL-2R in urine before the competition and enhanced the exercise-induced decrease in serum sIL-2R. It further enhanced the exercise-induced increases in urine IL-6 and serum cortisol. None of the Echinacin-treated athletes developed upper respiratory infections, which were reported by 3/13 and 4/13 subjects treated with magnesium and placebo, respectively. Echinacin appears to reduce sIL-2R release, facilitate IL-6 release in response to exercise and in the present study reduced the documented incidence of respiratory infections, possibly as a result of monocyte/macrophage stimulation.
The study of botanical medicine warrants an understanding of the terminology used by herbal medicine practitioners. Herbs are generally administered as whole plants, while botanicals may be derived from parts of plants such as the root, stem, or leaf. Although historical evidence would support that botanical products are generally safe, a lack of consistent report mechanisms for adverse effects makes it difficult to reach the conclusion. As with safety, efficacy of botanical products depends on the presence of active constituents, dosage, and adherence to the recommended dosage regime, product formulation, bioavailability, and biological activity of the botanical product. Botanical products are uniquely different from pharmaceutical agents in that they are comprised of a variety of plant constituents combined in a single plant. The use of botanical and herbal medicinal to reduce the symptoms of and to treat or prevent chronic disease is on the rise. Medical and dietetic professionals are uniquely positioned to provide patients with reliable, scientifically sound advice on the use of these products in the context of a varied, nutritionally sound diet. The use of botanicals and herbal supplements to enhance health is not new to medicine; however, the growing use of these products dictates that dietetics professionals must expand their knowledge and understanding of the growing body of scientific evidence so that optimal nutritional care can be provided to all patients.
There is more and more information indicating that dysfunction of the immune system should be included in the category of degenerative conditions that require prevention and maintenance, rather than reacting strictly after the fact by means of symptomatic treatments or antibiotics. After all, we understand the importance of staying fit. We exercise to maintain muscle, heart and lung function. We stop smoking to prevent lung cancer. We eat more fruits and vegetables to avoid cancer. We watch our weight to help prevent hypertension and diabetes. We should treat our immune system with the same dedication. Although he did not express it in exactly these terms, the use of vitamin C to boost the immune system, and thereby avoid the common cold, was advocated 25 years ago by Linus Pauling. It is really only within the last ten years that the notion that the immune system could be maintained or modulated has become somewhat popular among health care providers and the public. One of the barriers in developing simple preventive approaches for complete immune health is the tremendous complexity of the immune system. Such a complex system can be affected, negatively or positively, in many ways. The immune system is a diffuse interacting whole-body network, rather than a discrete organ or body part. the heart or brain, and can be divided into three sub-systems as show in Fig. 1: phagocytic cells that "ingest" and "digest" parasitic invaders, t-lymphocytes that destroy foreign or infected cells by "cell-mediated" immunity, and B-lymphocytes that produce antibodies.
Plant extracts have been used for their therapeutic properties for thousands of years. Many of the well known drugs still
in widespread use today, such as morphine, digoxin or salicylic acid, were originally isolated from plants such as the poppy,
the foxglove and the willow [1–3]. Yet plant extracts, as such, still have a place in therapy alongside synthetic chemical
products. With increasing concern among both practising physicians and the lay public about the possible risks associated
with drug treatment, there is an understandable desire to treat with traditionally well-tolerated drugs. Over-the-counter
medicines are being used increasingly in the developed countries, particularly for children, and concern has been expressed
as to whether parents are sufficiently well-informed about the benefits and risks of the products they keep at hand in the
kitchen cupboard [4]. Many plant-derived products are regarded as well-tolerated by their proponents and ridiculed as inefficacious
by their critics. In this controversial atmosphere, it is important to assess objectively the facts about individual therapeutic
products.
Objective: To review the evidence of herbs commonly used by women. Data Sources: Articles were located by searching Medline, Cochrane Database of Systemic Reviews, and the Combined Health Information Database and by hand searching the reference lists of recent systematic reviews. The databases were searched in January 2000 and October 2000 by using the Latin and common name of each herb. Methods of Study Selection: Preference was given to randomized, placebo-controlled trials. When available, English language studies were reviewed. If not, data are presented from review articles that summarize the foreign study. Results: Many women use herbal therapies. In the United States, herbs are considered dietary supplements. The Food and Drug Administration (FDA) cannot remove them from the market unless they are proven unsafe. The herb industry plans to improve monitoring. Many prospective randomized controlled trials are being funded. Gingko biloba seems to slow the progression of dementia but increases the risk of bleeding. St John's Wort is efficacious for treating mild to moderate depression but has many drug interactions. Ginseng seems to improve well being in perimenopausal women, but it is often impure and has side effects and drug interactions. Garlic slightly lowers blood pressure and lipids. Echinacea slightly decreases the duration of colds but does not prevent them. Valerian is beneficial for insomnia, but there is no long-term safety data. Black cohosh may help the symptoms of perimenopause, and chasteberry may improve premenstrual syndrome. More study is needed on both herbs. Conclusion: Some herbs are medically useful, but the American public would benefit from increased regulation. Manufacturers should be able to ensure that herbs contain pure ingredients. Side effects and drug interactions should be listed. Well-designed studies are being conducted. The results will be helpful to physicians and patients when the clinical evidence becomes available. Key Words: Phytomedicine, herbal medicine, alternative medicine, herbs
Dis Mon 2002;48:671-696
Arabinogalactan-proteins are glycoproteins that occur in higher plants and are involved in important processes like cell differentiation and plant growth. In the medicinal plant Echinacea purpurea L., they belong to the putative immunomodulating compounds and are structurally well characterized. For microscopic localization of arabinogalactan-proteins, synthetic (β-D-Glc)3 Yariv phenylglycoside that specifically binds to most plant arabinogalactan-proteins was used to label arabinogalactan-proteins in fresh cut sections of stems and petioles of Echinacea purpurea. Polyclonal antibodies against (β-D-Glc)3 Yariv phenylglycoside were used to detect the arabinogalactan-protein-(β-D-Glc)3 Yariv phenylglycoside complex. After addition of fluorescein isothiocyanate-conjugated secondary antibodies, the sections were analyzed by confocal laser scanning microscopy. Arabinogalactan-proteins are localized mainly in the central cylinder in the collateral vascular bundles, especially in the area of the xylem. In cell walls of fully differentiated vessels and tracheids, arabinogalactan-proteins have been detected mainly at the inner area of the wall close to the cell lumina. Intense labeling occurs around pit canals connecting adjacent vessels. Furthermore, arabinogalactan-proteins are present in the lumina of cells of the sclerenchyma caps and in companion cells of the phloem.
The visual effects of oven- and freeze-drying on Echinacea purpurea herb were assessed by image analysis. Aerial parts of full-bloom plants were chopped by hand and randomly allocated to four drying conditions: freeze-drying and oven-drying at 40, 60, and 80°C. Significant differences in various physical traits of the ligulate flowers (level of red, green, blue and gray colors) and the stems (level of red, green, blue and gray colors and the ratio of brown: green color) were observed among the tested drying conditions. Some of the traits appeared to have potential for use as visual markers to surmise the drying environment of echinacea.
One hundred thirty‐eight dietary supplement samples comprised of alfalfa, Circu‐Care, coriander, cumin, echinacea, garlic, ginger, ginkgo, horse chestnut extract, juniper berries, licorice, psyllium, saw palmetto, St. John's wort, valerian, white willow bark, and various vitamins and minerals were obtained from local supermarkets and dietary supplement companies and analyzed for fungal contamination and the presence of aerobic mesophilic bacteria. Results indicated that the highest mold and yeast counts of 5.6 × 10 ⁶ colony forming units (cfu) per gram product were found in alfalfa and the lowest (1.0 × 10 ² cfu/g) were present in ginger supplements. Potentially toxigenic molds were found in alfalfa, coriander, echinacea, garlic, ginkgo, juniper, licorice, psyllium and St. John's wort supplements. The most common fungi were aspergilli, followed by eurotia, penicillia and yeasts . Alternaria alternata, Fusarium, Cladosporium, Rhizopus and Phoma spp. were isolated less frequently. No molds or yeasts were found in synthetic vitamins, minerals, Circu‐Care and valerian. Aerobic mesophilic bacteria were isolated from all commodities tested. The highest aerobic plate count numbers (5.2 × 10 ⁶ –3.8 × 10 ⁷ cfu/g) were recovered from alfalfa, whereas the lowest (<100–5.5 × 10 ² cfu/g) were found in vitamins and minerals.
PRACTICAL APPLICATIONS
With an ever‐increasing population utilizing dietary supplements in order to improve and sustain health and vitality, it is essential that these products are safe for human consumption. A very critical indicator of safety is the bacteriological and mycological quality of these commodities.
The results of this investigation constitute an indicator of mycological/bacteriological contamination of a variety of dietary supplements. Similar testing has not been reported for several of the studied commodities. Therefore, our findings can serve as a basis for future mycological and mycotoxin testing of dietary supplements and eventually for developing guidelines in order to achieve and maintain safe microbial levels in these products.
Products containing Echinacea are some of the best selling and most widely used botanical dietary supplements in the United States. Commercial Echinacea extracts are manufactured primarily from 3 Echinacea species, namely Echinacea purpurea (herb, roots, or seeds), E. angustifolia (roots), and E. pallida (roots). Current recommendations for use of these products include oral administration for the prophylaxis and treatment of the common cold, bronchitis, influenza, and bacterial and viral infections of the respiratory tract.
Unfortunately, much of the clinical data published prior to 1991 suffered from poor methodology and, therefore, was difficult to assess. However, more recent controlled clinical trials have suggested that while Echinacea may not be effective for the prophylaxis of upper respiratory tract infections, these products may be useful in decreasing the symptoms and duration of illness.
In vitro and in vivo studies indicate that the therapeutic effects of Echinacea are due to a stimulation of cellular immune response. The major adverse events reported are allergic reactions, ranging from contact dermatitis to anaphylaxis. Patients with an allergy to plants in the daisy family (Asteraceae) should be instructed not to use products containing Echinacea. No drug interactions have been reported, however, the extracts have been shown to inhibit the activity of cytochrome P 450 and, therefore, have the potential to influence drug metabolism. Echinacea‐ containing dietary supplements may be used safely in conjunction with antibiotics or sulfa drugs. According to the German Commission E, patients with autoimmune disorders, AIDS, HIV infection, or tuberculosis should not use Echinacea , however, there is little scientific data to substantiate these contraindications.
Recommendations for oral dosage and dosage forms are difficult due to the wide variety of preparations and doses used in the clinical trials. However, based on existing data products containing pressed juice or hydroalcoholic extracts, Echinacea purpurea (leaf juice and roots) and E. pallida (roots) have the most convincing data supporting their use.
Echinacea products are widely used to treat and prevent colds and other infections. Three randomized, placebo-controlled trials found no benefit of echinacea-only products in preventing upper respiratory infections (URIs). However, six of seven randomized, placebo-controlled trials did a benefit for several extracts echinacea in treating URIs— E. pallida root, E. purpurea root, and E. purpurea pressed juice (NOTE: trials of E. purpurea root found no effect). Echinacea extracts contain alkylamides, caffeic acid derivatives, ketoalkenes/ketoalkynes glycoproteins, and polysaccharides; it is unknown which compounds are most active. Echinacea products have been associated with allergic skin reactions, asthma, urticaria/angioedema, and anaphylaxis.
Echinacea angustifolia DC. (Asteraceae) is a major North American medicinal plant that has been harvested commercially in north-central Kansas for 100
years, making it one of the longest documented histories of large-scale commercial use of a native North American medicina
herb. We have compiled historical market data and relate it to harvest pressure on wildEchinacea populations. Interviews with local harvesters describe harvesting methods and demonstrate the species’ resilience. Conservation
measures forE. angustifolia also should address the other threats faced by the species and may include restoration and management of its mixed-grass
prairie habitat and protection by private landowners.
We wanted to determine whether the severity and duration of illness caused by the common cold are influenced by randomized assignment to open-label pills, compared with conventional double-blind allocation to active and placebo pills, compared with no pills at all.
We undertook a randomized controlled trial among a population with new-onset common cold. Study participants were allocated to 4 parallel groups: (1) those receiving no pills, (2) those blinded to placebo, (3) those blinded to echinacea, and (4) those given open-label echinacea. Primary outcomes were illness duration and area-under-the-curve global severity. Secondary outcomes included neutrophil count and interleukin 8 levels from nasal wash at intake and 2 days later.
Of 719 randomized study participants, 2 were lost and 4 exited early. Participants were 64% female, 88% white, and aged 12 to 80 years. Mean illness duration for each group was 7.03 days for those in the no-pill group, 6.87 days for those blinded to placebo, 6.34 days for those blinded to echinacea, and 6.76 days for those in the open-label echinacea group. Mean global severity scores for the 4 groups were no pills, 286; blinded to placebo, 264; blinded to echinacea, 236; and open-label echinacea, 258. Between-group differences were not statistically significant. Comparing the no-pill with blinded to placebo groups, differences (95% confidence interval [CI]) were -0.16 days (95% CI, -0.90 to 0.58 days) for illness duration and -22 severity points (95% CI, -70 to 26 points) for global severity. Comparing the group blinded to echinacea with the open-label echinacea group, differences were 0.42 days (95% CI, -0.28 to 1.12 days) and 22 severity points (95% CI, -19 to 63 points). Median change in interleukin 8 concentration and neutrophil cell count, respectively by group, were 30 pg/mL and 1 cell for the no-pill group, 39 pg/mL and 1 cell for the group binded to placebo, 58 pg/mL and 2 cells for the group blinded to echinacea, and 70 pg/mL and 1 cell for the group with open-label echinacea, also not statistically significant. Among the 120 participants who at intake rated echinacea's effectiveness as greater than 50 on a 100-point scale for which 100 is extremely effective, illness duration was 2.58 days shorter (95% CI, -4.47 to -0.68 days) in those blinded to placebo rather than no pill, and mean global severity score was 26% lower but not significantly different (-97.0, 95% CI, -249.8 to 55.8 points). In this subgroup, neither duration nor severity differed significantly between the group blinded to echinacea and the open-label echinacea group.
Participants randomized to the no-pill group tended to have longer and more severe illnesses than those who received pills. For the subgroup who believed in echinacea and received pills, illnesses were substantively shorter and less severe, regardless of whether the pills contained echinacea. These findings support the general idea that beliefs and feelings about treatments may be important and perhaps should be taken into consideration when making medical decisions.
ResearchGate has not been able to resolve any references for this publication.