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Evaluation of Echinacea for the prevention and treatment of the common cold: A meta-analysis
Abstract
Echinacea is one of the most commonly used herbal products, but controversy exists about its benefit in the prevention and treatment of the common cold. Thus, we did a meta-analysis evaluating the effect of echinacea on the incidence and duration of the common cold. 14 unique studies were included in the meta-analysis. Incidence of the common cold was reported as an odds ratio (OR) with 95% CI, and duration of the common cold was reported as the weighted mean difference (WMD) with 95% CI. Weighted averages and mean differences were calculated by a random-effects model (DerSimonian-Laird methodology). Heterogeneity was assessed by the Q statistic and review of L'Abbé plots, and publication bias was assessed through the Egger weighted regression statistic and visual inspection of funnel plots. Echinacea decreased the odds of developing the common cold by 58% (OR 0.42; 95% CI 0.25-0.71; Q statistic p<0.001) and the duration of a cold by 1.4 days (WMD -1.44, -2.24 to -0.64; p=0.01). Similarly, significant reductions were maintained in subgroup analyses limited to Echinaguard/Echinacin use, concomitant supplement use, method of cold exposure, Jadad scores less than 3, or use of a fixed-effects model. Published evidence supports echinacea's benefit in decreasing the incidence and duration of the common cold.
... However, outcomes from clinical studies on botanical-derived NP efficacy for health maintenance and disease risk reduction often yield mixed results, driven in part by the varying composition of the experimental interventions investigated (4). Clinical trials studying the effect of Echinacea species in respiratory infections, for example, investigate varying doses and different species and plant parts (5)(6)(7). Since the early 2000's, seminal papers have described the need for sufficient reporting in clinical research on botanicals, dietary supplements, and traditional medicines, including elaborations on the Consolidated Standards of Reporting Trials (CONSORT) guidelines (8)(9)(10)(11). However, even though recent studies have found an overall improved reporting quality in studies of certain NPs, there is still an indication that insufficient reporting details on methodology and characterization continue to be an issue. ...
... To meet industry and research needs for quantitative reference materials that were not tied to compendial testing, NIH-ODS collaborated with NIST to develop CRMs for dietary ingredients and supplement products. 6 CRMs issued by NIST are called Standard Reference Materials (SRMs), the majority of which are characterized for chemical composition. NIST is the national metrology institute (NMI) within the U.S.; while most matrix CRMs for chemical content are produced by NMIs in their respective countries, they are often distributed worldwide. ...
... NIH-ODS Analytical Methods and Reference Materials Program: https://ods.od. nih.gov/Research/AMRMProgramWebsite.aspx.6 NIST Measurements and Standards for Botanical Dietary Supplements: https:// www.nist.gov/programs-projects/measurements-and-standards-botanicaldietary-supplements. ...
Insufficient assessment of the identity and chemical composition of complex natural products, including botanicals, herbal remedies, and dietary supplements, hinders reproducible research and limits understanding mechanism(s) of action and health outcomes, which in turn impede improvements in clinical practice and advances in public health. This review describes available analytical resources and good methodological practices that support natural product characterization and strengthen the knowledge gained for designing and interpreting safety and efficacy investigations. The practice of validating analytical methods demonstrates that measurements of constituents of interest are reproducible and appropriate for the sample (e.g., plant material, phytochemical extract, and biological specimen). In particular, the utilization of matrix-based reference materials enables researchers to assess the accuracy, precision, and sensitivity of analytical measurements of natural product constituents, including dietary ingredients and their metabolites. Select case studies are presented where the careful application of these resources and practices has enhanced experimental rigor and benefited research on dietary supplement health effects.
... increasing. An estimate in 2002, suggested that 20% of the population in the US, used a HMP, and 40.3% o f this proportion used an Echinacea preparation (Shah et al., 2007). where people spontaneously developed colds (Linde et al., 2006;Shah et al., 2007,). ...
... An estimate in 2002, suggested that 20% of the population in the US, used a HMP, and 40.3% o f this proportion used an Echinacea preparation (Shah et al., 2007). where people spontaneously developed colds (Linde et al., 2006;Shah et al., 2007,). ...
... The three most influential meta-analyses were conducted by Linde et al., (2006), Schoop et al., (2006) and Shah et al., (2007). The overall conclusion from these studies was that Echinacea preparations are efficacious both therapeutically (reducing symptom duration) and in terms o f prophylaxis (prevention of symptom occurrence) against the common cold. ...
Despite the increasing use and popularity of Echinacea in the treatment of upper respiratory tract infections, little is known about its interactions with conventional medicines. Recent legislation changes have made it necessary to investigate potential interactions between herbal medicinal products and the CYP P450 system. To address this knowledge gap we measured the CYP P450 inhibition of Echinaforce® and nine more commercial Echinacea liquid preparations (ELP), along with selected constituents, with a modified fluorogenic assay. We demonstrated that all Echinacea preparations and all alkylamides assessed, directly inhibited CYP3A4. In addition Echinaforce® weakly inhibited CYP2D6, CYP2C19 and CYP1A2, while alkylamides 1 and 2 inhibited 2D6 and 2C19, but not 1A2. We observed no inhibition with caffeic acid but the results for three caffeic acid derivatives were inconclusive. Separation of six ELP (including Echinaforce®) into ethanol and water soluble components showed that most of the inhibitory activity resided in the ethanol fraction. Multivariate data analysis of 1H-NMR spectra of the ethanol fractions identified peaks linked with inhibitory activity. SPE fractionation of the ethanol fraction of Echinaforce® produced three active fractions. These were further analyzed by LC-MS (positive ion mode), revealing two major components, with molecular ion [M-H]+ masses of 282 and 248. Tandem MS and accurate mass analysis revealed that the 248 ion is in fact alkylamide 1, while ion 282 is most likely an unknown compound with molecular formula C18H36NO+ for which we have deduced a tentative structure. To assay for CYP3A4 induction we exposed HepG2 cells to relevant concentrations of Echinaforce® and alkylamides 1 and 2, but no significant changes in mRNA steady state levels were seen. Overall our results (in agreement with the available pharmacovigilance data) suggested that ELP are unlikely to cause clinically observable interactions with prescription medicines via the CYP P450 system, but that the observed effects vary widely in accordance with the products' chemical composition.
... Traditional medicinal extracts from a wide range of plants including North American (Panax quinquefolius) and Asian (Panax ginseng) Ginseng and Hoodia gordonii have been used for centuries as traditional remedies against (respiratory tract) infections [4][5][6][7]. Their alleged efficacy is mostly based on preclinical in vitro and animal studies. Large randomized controlled trials are rare. ...
... As measured from GalA H-4 signal area, 2 mol/mol compared to Rha, 3 measured from the Rha CH3 signal,4 O-acetylation of GalA (1 OAc/GalA set as 100%),5 GalA methyl esterification level as estimated from the GalA H-4 signal splitting, n.d.: not distinguishable. In vitro phagocytosis stimulating activity is expressed as average normalized % phagocytosis of at least 2 blood donors, -: 0-20%, +/-: 20-40%, +: 40-80%, ++: >80% stimulation of positive control (LPS). ...
The prevalence of acute respiratory infections and their impact on quality of life underlies the need for efficacious solutions that are safe, sustainable and economically viable. Polysaccharides in several (traditional) plant extracts have been shown to be immunostimulatory, and some studies suggest beneficial effects against respiratory infections. The aim of this study was to (i) identify the active polysaccharide constituents from affordable and renewable crops (bell pepper and carrot) using activity-guided fractionation, (ii) evaluate in vitro effects on innate immune responses (phagocytosis and cytokine secretion), microbiota modulation and production of short chain fatty acids, followed by (iii) the evaluation of effects of a bell pepper extract enriched for the active component in a human proof of concept study. We identified rhamnogalacturonan-I (RG-I) as the nutricophore responsible for the immunostimulatory activity with substantial structural and functional equivalence between bell pepper (bp) and carrot (c). The in vitro studies showed that bpRG-I and cRG-I comprise similar immune- and microbiota modulatory potential and the human study demonstrated that bpRG-I was well tolerated and enhanced innate immune responsiveness in vivo. This is an important step towards testing the efficacy of RG-I from bpRG-I or cRG-I in an infection trial in humans.
... Moreover, different outcome measures and clinical scoring systems were used to assess treatment efficacy. While one review considered each identified trial individually (Nahas and Balla, 2011), the authors of another review performed a formal meta-analysis although the trials used different products based on different species and parts of the plants (Shah et al., 2007). This procedure was questioned by the authors of a recently updated Cochrane review on Echinacea (Karsch-V€ olk et al., 2014), who again refrained from pooling the results of trials investigating the efficacy of Echinacea products in the treatment of CC and argued that meta-analysis may only lead to meaningful results if all trials investigate the same treatment for the same purpose. ...
... This procedure was questioned by the authors of a recently updated Cochrane review on Echinacea (Karsch-V€ olk et al., 2014), who again refrained from pooling the results of trials investigating the efficacy of Echinacea products in the treatment of CC and argued that meta-analysis may only lead to meaningful results if all trials investigate the same treatment for the same purpose. Moreover, since some of the trials indicated a moderate beneficial effect of the investigated Echinacea products on CC duration and/or symptom intensity whereas others did not, it is not surprising that the efficacy conclusions drawn by the reviewers were mixed (Karsch-V€ olk et al., 2014;Nahas and Balla, 2011;Shah et al., 2007). ...
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
... debated in the literature with previous reviews and meta-analyses reaching differing conclusions., 4,[8][9][10][11][12] A number of double-blind placebo-controlled trials were registered between 2005 and 2013, which have yet to be published or included in any systematic reviews and existing reviews and meta-analyses include errors in their methodology and data extraction. For these reasons we decided to undertake a new systematic review to assess the current evidence from double-blind randomised placebo-controlled trials for the safety and efficacy of echinacea preparations in the prevention and treatment of URTIs. ...
... See Fig. 1 for an example search strategy adapted from searches performed in two previous systematic reviews 4, 10 We also reverse searched systematic reviews. 4,[8][9][10] We contacted academics and study sponsors of registered trials where we were unable to find a report of the trial. Both reviewers independently screened the list of records by title and abstract to exclude any entries that were clearly irrelevant. ...
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 evidence also indicates that Echinacea might reduce the risk of recurrent respiratory infections and related complications (David and Cunningham, 2019). Another meta-analysis including 14 RCTs investigating the effects of this plant on the incidence and duration of the common cold found that Echinacea supplementation reduced the cases of the common cold by 58% and the duration of the cold by 1.4 days (Shah et al., 2007). In general, the duration of the studies varied from 4 to 12 weeks, highlighting that the enhancement of immune activity needs chronic administration and that the final efficacy strongly depends on the subject's compliance. ...
Dietary supplementation with nutraceuticals can promote optimal immune system activation, modulating different pathways that enhance immune defenses. Therefore, the immunity-boosting effects of nutraceuticals encompass not only immunomodulatory but also antioxidant, antitumor, antiviral, antibacterial, and antifungal properties, with therapeutic effects against diverse pathological conditions. However, the complexity of the pathways that regulate the immune system, numerous mechanisms of action, and heterogeneity of the immunodeficiencies, and subjects treated make their application in the clinical field difficult. Some nutraceuticals appear to safely improve immune system function, particularly by preventing viral and bacterial infections in specific groups, such as children, the elderly, and athletes, as well as in frail patients, such as those affected by autoimmune diseases, chronic diseases, or cancer. Several nutraceuticals, such as vitamins, mineral salts, polyunsaturated omega-3 fatty acids, many types of phytocompounds, and probiotic strains, have the most consolidated evidence in humans. In most cases, further large and long-term randomized clinical trials are needed to confirm the available preliminary positive data.
... Echinacea purpurea products prevent or treat URTI in adults 13,32 . Taking E. purpurea as a preventative measure has been shown 13,33 to reduce the risk of catching a cold by 58% and shorten its duration by 1.4 days (both statistically significant). In 2006, the echinacea's effectiveness in treating URTIs was reviewed 34 . ...
In the present study, we reviewed the efficacy of traditional herbal formulas on human immunity. A literature survey was performed in PubMed, UpToDate, Proquest Central Databases of Kırıkkale University, Google and Google Scholar databases from the internet. Search key words were "immune", "immune system", "herbal", "Pelargonium Sidoides", "Echinacea Purpurea", "Sambucus Nigra", "Beta Glucan", "Vitamin C", "Zinc". The immune system is a natural self-defense mechanism made up of cells that assist the body in distinguishing between self and non-self-molecules. All immune system components must be regularly modified in order to keep the body defenses up against the ever-evolving microbes that are constantly looking for new ways to attack the host. A Chinese herbal formulation is a combination of several herbs. The practitioner begins with one or two major substances that are intended to treat the ailment. The reproducibility of the efficacy of herbal medicines is dependent on the consistency of the quality of each unique raw herb. Pelargonium Sidoides, Echinacea Purpurea, Sambucus Nigra, Beta Glucan, Vitamin C, and Zinc are some herbal treatments utilized for their benefits on human immunity. Herbal remedies are undoubtedly valuable in boosting impaired immune function, particularly where damage has occurred due to malnutrition, chronic disease or previous infections. At present, however, an invincible immune system remains firmly in the realm of fantasy.
... Most research on echinacea focuses on its abilities to treat the common cold. Many studies have found that extracts and infusions of echinacea root can decrease the length of the common cold and lessen the chances of infection with a cold 9 . Echinacea treatments may also prevent respiratory conditions caused by bacterial infections, as researchers discovered that extracts of echinacea stop the growth of bacteria causing strep throat and pneumonia 8 . ...
Humans have used plants to treat illnesses since prehistoric times. Though modern Western medicine consists of pills and injections rather than leaves and flowers, the plant-derived compounds in many medications show evidence of this history. This project aims to connect medicinal plants’ traditional and historical uses with the findings of modern scientists. Medicinal Plants of Iowa provides Iowa residents who are interested in herbal remedies with a resource that describes the healing properties of plants commonly found in the state. As well as healing properties, a description of each plant’s appearance and preferred habitat type is provided, allowing users to identify plants more easily. The book uses jargon-free, comprehensible language to describe the outcomes of clinical trials involving medicinal plants and compare these findings to the plants’ uses in traditional medicine. Traditional medicine practices were built through generations of experimentation but are often intertwined with religion and ritual. While this can paint traditional medicine in an unscientific light, it is evident that these practices have inspired contemporary scientific research and have thus contributed to modern medicine as we know it.
... In the case of the Western herb Echinacea, the strongest data for its potential use in the treatment of URIs is likely in the form of Echinacea purpurea. [11][12][13][14][15][16][17] In the case of the mineral zinc, the greatest potential benefit of its usage in the management of URIs may be in ionizable forms of zinc, such as zinc acetate. [18][19][20][21] The utility of vitamin C supplementation in either the prevention or treatment of URIs has yielded mixed results in randomized clinical trials (RCTs), but may provide more benefit in the prevention of URIs in patients doing heavy exercise and undergoing similar short term physical stress. ...
Background:
Growing antibiotic resistance is among the most serious threats to public health, with antibiotic misuse considered a leading driver of the problem. One of the largest areas of misuse is in outpatient upper respiratory infections (URIs). The purpose of this research is to evaluate the efficacy of EZC Pak, a combination Echinacea-Zinc-Vitamin C dose pack with or without Vitamin D, on the duration of illness and symptom severity of non-specific URIs as an alternative to antibiotics when none are deemed clinically necessary. A secondary analysis was carried out on patient satisfaction.
Methods:
A total of 360 patients across the United States were enrolled and randomized in a double-blind manner across two intervention groups, EZC Pak, EZC Pak+Vitamin D, and one placebo group. The study utilized a smartphone-based app to capture data. Once a participant reported the first URI symptom, they were instructed to take the intervention as directed and complete the daily symptom survey score until their symptoms resolved.
Results:
The average EZC Pak participant recovered 1.39 days (90% CI 1.05 to 1.73) faster than the average placebo participant (p=0.017). The average EZC Pak participant reported a 17.43% (90% CI 17.1 to 17.8) lower symptom severity score versus placebo (p=0.029). EZC Pak users reported 2.9 times higher patient satisfaction versus placebo users (p=0.012). The addition of Vitamin D neither benefited nor harmed illness duration or symptom severity.
Conclusion:
The findings support the potential use of EZC Pak as an alternative to patient request for antibiotics when none are deemed clinically necessary at the time of initial clinical presentation. The decision to replete vitamin D in the acute phase of URI is an individualized decision left to the patient and their clinician. EZC Pak may play a critical role in improving outpatient URI management and antibiotic stewardship (ClinicalTrials.gov number, NCT04943575).
... The tested new formulations reduced time to recovery by 1-1.4 days, which is similar to the reduction in symptom duration for the common cold by 1.4 days compared to placebo in a large meta-analysis (22). Comparison of our results with previous data is hampered by the variety of different Echinacea products and formulations available worldwide which vary in plant species and parts used, harvesting region and season, extraction methods, formulation, and dosages (23). ...
Background
Echinacea purpurea has clinical antiviral activity against respiratory viruses and modulates immune functions. In this study, we compared higher doses of new Echinacea formulations with conventional formulations at lower, preventive doses for therapy of respiratory tract infections (RTIs).
Methods
In this randomized, blinded, controlled trial, healthy adults (n = 409) were randomized between November 2018 and January 2019 to one of four Echinacea formulations, which were taken in case of an RTI for up to 10 days. New formulations A (lozenges) and B (spray) delivered an increased dose of 16,800 mg/d Echinacea extract during days 1–3 and 2,240–3,360 mg/d afterward; as controls, conventional formulations C (tablets) and D (drops) delivered a lower daily dose of 2,400 mg, usually taken for prevention. The primary endpoint was time to clinical remission of first RTI episodes based on the Kaplan–Meier analysis of patient-reported, investigator-confirmed, respiratory symptoms assessed for up to 10 days. In a sensitivity analysis, the mean time to remission beyond day 10 was calculated by extrapolating the treatment effects observed on days 7 to 10.
Results
A total of 246 participants (median age 32 years, 78% female participants) were treated for at least one RTI. Recovery by day 10 (complete absence of symptoms) was achieved in 56 and 44% of patients with the new and conventional formulations, respectively, showing a median time to recovery of 10 and 11 days, respectively (p = 0.10 in intention-to-treat analysis, p = 0.07 in per-protocol analysis). In the extrapolated sensitivity analysis, new formulations resulted in a significantly shorter mean time to remission (9.6 vs. 11.0 days, p < 0.001). Among those with an identified respiratory virus, viral clearance until day 10 based on real-time PCR from nasopharyngeal swabs was more frequent with new formulations (70 vs. 53%, p = 0.046). Tolerability and safety (adverse events: 12 vs. 6%, p = 0.19) were good and similar between formulations. There was one severe adverse event with a potential hypersensitivity reaction in a recipient of the novel spray formulation.
Conclusion
In adults with acute RTI, new Echinacea formulations with higher doses resulted in faster viral clearance than conventional formulations in prophylactic dosages. The trend for faster clinical recovery was not significant by day 10 but became so upon extrapolation. A dose increase during acute respiratory symptoms might improve the clinical benefits of orally administered Echinacea formulations.
Trial registration
The study was registered in the Swiss National Clinical Trials Portal (SNCTP000003069) and on ClinicalTrials.gov (NTC03812900; URL https://clinicaltrials.gov/ct2/show/NCT03812900?cond=echinacea&draw=3&rank=14).
... On the other hand, this plant is a herbal medicine used by Native Americans to increase the human immune system. Echinacea was introduced as the most popular herbal supplement in 2012 used by the US adults (14)(15)(16) and the annual sale of echinacea in the US alone was in the range of $10 -$100 million. Flavonoids, alkyl amides, polysaccharides, chicoric acid, polyacetylenes, and essential oils are the active components of echinacea (12). ...
Background: The efficacy of echinacea products to treat upper respiratory tract infections (URTI) has been shown in some studies, however, there are few studies considering the efficacy of echinacea to prevent URTI. Therefore this study aimed to assess the effect of echinacea in the prevention of URTI in these children. Materiala and Methods: This retrospective cross-sectional study was conducted on 60 children with ALL in Shahid Sadoughi hospital from September 2020 to September 2021. These Children were divided into two groups (n=30). The case group received immunogen syrup, containing echinacea purpura root extract (200 mg/ml). This syrup was prescribed in the intervention group as 2 ml for children in the age range of 2-8 years and 0.5 ml for children in the age range of 1-2 years old for 3 months. The control group did not receive echinacea syrup. These patients were followed for 3 months regarding URTI. Results: The frequency of URTI in the case and control groups was 40% and 66.7%, respectively, and a significant difference was noted between the two groups in terms of the frequency of URTI (P<0.05). Moreover, 23.3% of patients who received echinacea developed a second URTI, while 53.3% of patients who did not receive echinacea developed a second URTI (P<0.05). The mean time for the second URTI in the case and the control groups was 42.3±13.93, and 48.3±13.96 days, respectively (P=0.086). Regarding reducing the duration of URTS symptoms, there was no significant difference between the two groups (P>0.05). Conclusion: According to the results, echinacea can be effective in decreasing the occurrence of URTI in these children. Therefore, regarding the efficacy of echinacea in decreasing URTI, it is recommended to use echinacea in the prevention of URTI.
... We focus on Echinacea purpurea (L.) Moench (Compositae), a North American medicinal plant traditionally used for treating colds and flus, due to its antimicrobial and immunomodulatory properties (David & Cunningham, 2019;Linde, Barrett, Wölkart, Bauer, & Melchart, 2006;Shah, Sander, White, Rinaldi, & Coleman, 2007). Ethnobotanical reports show that various species of Echinacea are also extensively used in pain management by indigenous population, for example, tooth ache by the Niitsitapi (Blackfoot First Nation), arthritis by the Tsestho'e (Cheyenne tribes) and rheumatism or burns by thě Sak owis (Dakota and Lakota First Nations) (Binns, 2002;Moerman, 1998). ...
Chemotherapy‐induced neuropathy represents the main dose‐limiting toxicity of several anticancer drugs, such as oxaliplatin, leading to chronic pain and an impairment of the quality of life. Echinacea purpurea n‐hexane extract (EP4–RE; rich in alkamides) and butanolic extract (EP4–RBU; rich in polyphenols) have been characterized and tested in an in vivo model of oxaliplatin‐induced neuropathic pain, addressing the endocannabinoid system with alkamides and counteracting the redox imbalance with polyphenols. Thermal hypersensitivity was evaluated by the Cold Plate test. EP4–RE showed a dose‐dependent anti‐hyperalgesic profile. The extract was more effective than its main constituent, dodeca‐2 E,4 E,8Z,10 E/Z‐tetraenoic acid isobutylamide (18 mg kg−1, twofold to equimolar EP4–RE 30 mg kg−1), suggesting a synergy with other extract constituents. Administration of cannabinoid type 2 (CB2) receptor‐selective antagonist completely blocked the anti‐allodynic effect of EP4–RE, differently from the antagonism of CB1 receptors. EP4–RBU (30 mg kg−1) exhibited anti‐neuropathic properties too. The effect was mainly exerted by chicoric acid, which administered alone (123 μg kg−1, equimolar to EP4–RBU 30 mg kg−1) completely reverted oxaliplatin‐induced allodynia. A synergy between different polyphenols in the extract had not been highlighted. Echinacea extracts have therapeutic potential in the treatment of neuropathic pain, through both alkamides CB2‐selective activity and polyphenols protective properties.
... The drugs from E. increase the combat capability of blood cells. Thanks to this, it is possible to prevent the cold, shorten its duration, and relieve symptoms [5]. E. is a native North American plant in the aster family [6], where its leaves and roots have long been used by the Indians to treat wounds, whereas, in Europe, E. is grown as an ornamental plant [7]. ...
... The drugs from E. increase the combat capability of blood cells. Thanks to this, it is possible to prevent the cold, shorten its duration, and relieve symptoms [5]. E. is a native North American plant in the aster family [6], where its leaves and roots have long been used by the Indians to treat wounds, whereas, in Europe, E. is grown as an ornamental plant [7]. ...
E. purpurea has amazing medicinal properties that effectively deal with human diseases. Today, we find frightening figures in the WHO news about the increase in coronavirus infection and the number of deaths. This article presents a simple way of self-defense by increasing the body’s immune reactivity. In order to alleviate the condition and prevent not only COVID but also a variety of viral, as well as bacterial, and fungal infections, doctors can use the ornamental plant Echinacea (E.), which was once used by the indigenous people of America, the Indians, for almost all occasions. This article presents a small list of important biologically active components of E. and the range of their use, as well as a simple recipe for making a healing solution.
... are widely used in medicine. E. purpurea is a perennial herb with a medical history dating back more than 300 years (Shah et al., 2007) and was introduced in China as a flower in the 1970s. It is currently cultivated on a large scale in China as a medicinal plant. ...
Chicoric acid has been widely used in food, medicine, animal husbandry, and other commercial products because of its significant pharmacological activities. However, the shortage of chicoric acid limits its further development and utilization. Currently, Echinacea purpurea (L.) Moench serves as the primary natural resource of chicoric acid, while other sources of it are poorly known. Extracting chicoric acid from plants is the most common approach. Meanwhile, chicoric acid levels vary in different plants as well as in the same plant from different areas and different medicinal parts, and different extraction methods. We comprehensively reviewed the information regarding the sources of chicoric acid from plant extracts, its chemical synthesis, biosynthesis, and bioactive effects.
... The existing tools for reporting are not user friendly in terms of the details required to be filled in by the CHWs. The data tools were reported to be bulky making it costly to photocopy as it was a culture of photocopying data tools due to shortages of the tools and forms (ROK, 2010;Shah, et al., 2007). ...
Globally, the reported attrition rates of Community Health Workers (CHWs) vary between 3.2% and 77% with high rates being associated with volunteer CHWs. In Kenya, retention rate is estimated at 67% while in Makueni it varies between 50% and 98%. The success of community programmes is often hampered by low retention rates which affects the sustainability of interventions and increases training costs, since it needs continuous replacement which makes the programme difficult to manage. The main objective of this study was to establish predictors of community health workers retention in service in Makueni County. The study used a crosssectional study design employing mixed methods of data collection incorporating researcher-administered questionnaires, Focus Group Discussions and Key Informant Interviews. The study population consisted of 2,800 CHWs commissioned by the Ministry of Health in Makueni County. Sample size of the study was 603 CHWs selected through Cluster sampling. 552 CHWs participated in the study. Purposive sampling was used to select participants for Focus Group Discussions and Key Informant Interviews. Quantitative data was subjected to descriptive, cross-tabulation and logistic regression analysis using SPSS version 20 software. Thematic analysis was done using Nvivo to gain an in-depth understanding of the study results and
triangulate quantitative findings. Results showed that of the 552 CHWs interviewed,
87.7% were married, 78.2% were aged between 30-49 years, 68.1% were females,
59.6% had completed secondary level of education, 97.6% were Christians, 62% were
subsistence farmers and 64% were residents in lowland zone. The retention rate
among the study participants was 69.4%. Logistic regression results showed that the
predictors of retention of CHWs in Makueni County included; financial incentives
(p=0.000, OR= 129.477), provision of health updates (p=0.000, OR=4.489),
belonging to a self-help group (p= 0.004, OR=2.555), provision of reporting tools
(p=0.000. OR=0.022 and provision of essential medical kits (p=0.000, OR=4.768). In
conclusion, there is need to review community health strategy implementation
guidelines to harmonize provision of regular financial incentives, essential medical
kits, reporting tools and health updates (through more comprehensive training
programmes, refresher trainings and regular dissemination and sharing of new health
information). The national and county government and partners of the community
health strategy should also create effective mechanisms for livelihood support of
CHWs such as establishing self-help groups as a sustainability measure for the
community health strategy.
... Echinacea purpurea (purple coneflower) is most commonly used as herbal medicine to treat respiratory infections and in immune intervention studies. Echinacea has been observed to minimize the common cold incidence by around 58% and lessen the duration of infection by about 1.4 days (Shah et al., 2007). The administration of commercial-grade of Echinacea purpurea supplement for 28 days has been observed to improve the immune functions in the mucosal area after strenuous exercise in three consecutive 30 s Wingate cycling tests by reducing the magnitude of exercise-induced decrease in salivary IgA concentration and release (Hall et al., 2007). ...
Physical activity (PA) and nutrition are the essential components of a healthy lifestyle, as they can influence energy balance, promote functional ability of various systems and improve immunity. Infections and their associated symptoms are the common and frequent challenges to human health that are causing severe economic and social consequences around the world. During aging, human immune system undergoes dramatic aging-related changes/dysfunctions known as immunosenescence. Clinically, immunosenescence refers to the gradual deterioration of immune system that increases exposure to infections, and reduces vaccine efficacy. Such phenomenon is linked to impaired immune responses that lead to dysfunction of multiple organs, while lack of physical activity, progressive loss of muscle mass, and concomitant decline in muscle strength facilitate immunosenescence and inflammation. In the present review, we have discussed the role of nutrition and PA, which can boost the immune system alone and synergistically. Evidence suggests that long-term PA is beneficial in improving immune system and preventing various infections. We have further discussed several nutritional strategies for improving the immune system. Unfortunately, the available evidence shows conflicting results. In terms of interaction with food intake, PA does not tend to increase energy intake during a short time course. However, overcoming nutritional deficiencies appears to be the most practical recommendation. Through the balanced nutritious diet intake one can fulfill the bodily requirement of optimal nutrition that significantly impacts the immune system. Supplementation of a single nutrient as food is generally not advisable. Rather incorporating various fruits and vegetables, whole grains, proteins and probiotics may ensure adequate nutrient intake. Therefore, multi-nutrient supplements may benefit people having deficiency in spite of sufficient diet. Along with PA, supplementation of probiotics, bovine colostrum, plant-derived products and functional foods may provide additional benefits in improving the immune system.
... It is used in many multi-compo- nent products for relieving cough. A multi-component product containing camphor, menthol, and eucalyptus oils in a petrolatum base, was superior to petrolatum alone or no treatment in reducing cough in children [87]. ...
The post-viral acute cough (PAC) is a widespread symptom, mainly in childhood and adolescence, and is usually associated with an acute upper respiratory infection, namely the common cold. The use of cough relievers is, therefore, impressive, as documented by the market data. There are many medical devices and dietary supplements for treating PAC, which contain non-pharmacological components. Ancient people used traditional herbs to treat PAC. Thus, a well-established tradition considers natural remedies as an effective and safe way to relieve PAC. The herbal agents include polyphenols, flavonoids, saponins, glucosides, and alkaloids. Also, the European Medicine Agency has recognized the value of plant extracts and other natural substances to treat PAC. Nevertheless, a few studies investigated the role of non-pharmacologic remedies for PAC. There is some evidence for honey, glycerol, Althea officinalis, Drosera rotundifolia, Grindelia, Hedera helix, Pelargonium sidoides, Sambucus nigra, Thymus vulgaris, hyaluronic acid, and saline solutions. However, further rigorous studies should confirm natural products' efficacy and safety to relieve PAC.
... Table 6 • While in H5N1 prophylaxis (mean = 1.9189 ± 0.10408), H1N1 treatment (mean = 1.7816 ± 0.09360), SARS-CoV-1 prophylaxis (mean = 1.7525 ± 0.10284), and SARS-CoV treatment (mean = 1.7059 ± 0.10756), the results tend between mild and no improvement effect, as shown in Table 6. Despite the presence of many previous studies that have shown similar results about using these herbs in the treatment and prophylaxis of some diseases such as common cold and influenza, [15,16] I failed to find any study that has explored any information about using of herbal medications in the treatment and prophylaxis of other influenza virus infections, including H5N1, H1N1, SARS-CoV, and SARS-CoV-2. However, new research should be conducted for creating stronger evidence. ...
Background: Herbs are plants or plant parts used for their scent, flavor, or
therapeutic properties. Herbal medicine is one type of dietary supplement
that has been used for thousands of years for treatment or prophylaxis
of many diseases including influenza virus infection. Although there are
many previous studies about these issues, I did not find many research
about using these herbs in treatment or prophylaxis of other influenza
infections including H5N1, H1N1, severe acute respiratory syndrome
coronavirus (SARS‑CoV), and SARS‑CoV‑2. Objective: To collect, evaluate,
and explore new important data about using medicinal herbs in these
disorders’ treatment or prophylaxis. Materials and Methods: I collected
and explored new results and data from 24 professional health‑care
givers who had an experience about using these herbs in treatment
or prophylaxis of these diseases. Then, I evaluated descriptively and
quantitatively the results with alpha significance level ≤5% by tests such as
Chi‑square one‑sample and reliability and validity tests. Results: The study
showed many significant results about using these herbs, through using
descriptive tests including one‑sample Chi‑square test, like in SARS‑CoV‑2
treatment (n = 414) with mean = 2.5870 ± 0.06730 and P < 0.05, while
in SARS‑CoV‑2, prophylaxis (n = 275) with mean = 2.1164 ± 0.06271 and
P < 0.05. Conclusion: This study revealed that there are some particular
herbs that can be used in the treatment and prophylaxis of these diseases
as adjunctives to the main typical treatment regimen, not as a monotherapy.
Furthermore, many studies should be conducted in this field.
... The common cold is the most morbid disease in children and adults. According to a report, in the United States of America, approximately 1 billion people suffer from common cold every year (Shah, Sander et al., 2007). Adults have fewer episodes of common cold compared to children. ...
... On the other hand, a clinical trial on patients inflicted by rhinovirus reported that in comparison with placebo, Echinacea did not alleviate the symptoms [25]. A metanalysis study showed that Echinacea decreased the incidence and duration of common cold [26]. Potentially, Echinacea decreases the risk of respiratory infections and the pertinent side-effects. ...
Objectives
Herbal medicines, as a treatment method, have received a great deal of attention. The effects of two herbal medicines namely Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients were examined.
Methods
A clinical trial with 100 suspected COVID-19 outpatients as participants was conducted. The participants were allocated randomly to two groups of 50 members. The intervention group received concurrent Zingiber officinale (Tablet Vomigone 500 mg II tds) and Echinacea (Tablet Rucoldup I tds) for seven days in addition to the standard treatment. The control group only received the standard treatment (Hydroxychloroquine). After seven days, alleviation of clinical symptoms and hospitalization rate were examined. In addition, 14 days after treatment, the hospitalization was assessed again by telephone follow up.
Results
The two groups were identical in terms of basic characteristics. Improvement level as to coughing, dyspnea, and muscle pain was higher in the intervention group (p value <0.05). There was no significant difference between the two groups in terms of the other symptoms. In addition, the hospitalization rate in the intervention and control groups were 2 and 6% respectively, which are not significantly different (p value >0.05).
Conclusions
Taking into account the efficiency and trivial side-effects of Zingiber officinale and Echinacea, using them for alleviation and control of the clinical symptoms in COVID-19 outpatients is recommended.
... [112] A meta-analysis reported that Echinacea significantly decreased the incidence of the common cold by 58% and the duration of a cold by 1 · 4 days . [113] Another metaanalysis by Schapowal et al. documented that Echinacea effectively lowers the risk of recurrent respiratory infections and associated complications . [114] In a study by Engler and colleagues, Echinacea revealed a dose-dependent reduction of Coronavirus 229E and MERS-CoV activity . ...
An outbreak of a novel coronavirus (COVID-19) infection has posed significant threats to international health and the economy. The role of nutrition in supporting the immune system is well-established. A wealth of mechanistic and clinical documents shows that vitamins, including vitamins A, B2, B3, B6, B12, C, D, E, and folate; trace elements, including zinc and selenium; probiotics and prebiotics; alpha lipoic acid; omega-3 fatty acids and herbal supplements including curcumin, ginger, Echinacea, garlic, green tea, cinnamon, and ginseng play important and complementary roles in supporting the immune system. Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections and as a consequence an increase in disease burden. Against this background the following conclusions are made: (1) supplementation with the above micronutrients, omega-3 fatty acids, and probiotics is a safe, effective, and low-cost strategy to help support optimal immune function; (2) supplementation above the Recommended Dietary Allowance (RDA), but within recommended upper safety limits, for specific nutrients such as vitamins C, D, and selenium is warranted; and (3) public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.
... 116 In general, systematic reviews tend to be positive. [117][118][119][120][121][122][123] One negative review argued that the positive trial results could have reflected inadvertent unblinding with either placebo effect or participant reporting bias that contributed to false-positive results. 124 The possibility also exists that studies with negative results went unreported. ...
... (Especially Echinacea purpurea) in the treatment and prophylaxis of some diseases such as common cold and influenza [31,32,33], but I failed to find studies have explored any information about immunostimulant herbs (Especially Echinacea purpurea) or immunostimulant substances and their uses in the treatment and prophylaxis of the other influenza virus infections, including H5N1, H1N1, SARS-CoV, and SARS-CoV-2. ...
Immunostimulants, some substances stimulate the immune system, have been used in the prevention and treatment of some diseases such as common cold and influenza. Also, there are herbal immunostimulants such as Echinacea, Garlic, and Ginseng which have been explored by many studies that have shown some results about using them in the treatment and prophylaxis of some diseases such as common cold and influenza. However, I failed to find studies that have explored any information about using these immunostimulant substances in the treatment and prophylaxis of other influenza virus infections, including H5N1, H1N1, SARS-CoV, and SARS-CoV-2. Therefore, I collected some related information from healthcare givers and adult people (via surveys) who experienced using of immunostimulant substances in treatment or prophylaxis in these diseases, to detect new results and data about them. Then, I explored some relevant positive results which are calculated and evaluated (with probability value P<0.05). This study revealed some benefits about these issues; however, other studies should be conducted for clearer results.
... The preparations of all existing species, Echinacea angustifolia, Echinacea purpurea and Echinacea pallida, are used to enhance suppressed immune reactivity. Echinacea preparations enhance the cytotoxic activity of macrophages and natural killer cells, activate the metabolism of neutrophils, stimulate the synthesis of interleukin-6 (IL-6), tumor necrosis factor- (TNF-), IL-12, etc. [101,102]. Extracts of root and aerial plant parts of Echinacea purpurea can significantly enhance the antigen presenting activity of dendritic cells by activating Fig. 4 ...
Hepatobiliary system diseases represent an important medical and social problem due to increasing morbidity rates worldwide. Liver and biliary diseases are characterized by complex pathophysiology as well as by multi- and comorbidity. The treatment of such diseases necessitates multitarget drug development. The effectiveness of current drugs in the treatment of hepatobiliary disorders remains low and the incidence of side-effects are profound. This actualizes the search and development of highly effective hepatoprotectors with a low incidence of side effects. Medicinal plants potentially constitute a sourse of such preparations. The review summarizes the data concerning mechanisms of hepatoprotective and immunomodulatory effects of medicinal plants and their phytoconstituents. The prospects for the development and use of herbal remedies in the treatment of hepatobiliary diseases are outlined.
... Echinacea-based drugs contribute to a shortening of the various types of infections and colds [79,80]. This is due to the active ingredients such as polysaccharides, alkaloids, coffee acid derivatives [81], and proteoglycans that have immunomodulatory, antiviral, antioxidant, and anti-inflammatory properties [78]. ...
A pregnant woman’s diet consists of many products, such as fruits, vegetables, cocoa, tea, chocolate, coffee, herbal and fruit teas, and various commercially available dietary supplements, which contain a high number of biological active plant-derived compounds. Generally, these compounds play beneficial roles in women’s health and the development of fetus health. There are, however, some authors who report that consuming excessive amounts of plants that contain high concentrations of polyphenols may negatively affect the development of the fetus and the offspring’s health. Important and problematic issues during pregnancy and lactation are bacterial infections treatment. In the treatment are proposals to use plant immunomodulators, which are generally considered safe for women and their offspring. Additional consumption of biologically active compounds from plants, however, may increase the risk of occurrences to irreversible changes in the offspring’s health. Therefore, it is necessary to carry out safety tests for immunomodulators before introducing them into a maternal diet. Here, we present data from animal experiments for the four most-studied plants immunomodulators genus: Rhodiola, Echinacea, Panax, and Camellia, which were used in maternal nutrition.
... Мета-анализ 234 клинических исследований подтвердил, что профилактическое применение препаратов эхинацеи пурпурной снижает частоту риновирусных инфекций на 55 % [3]. Данные другого мета-анализа, включающего 14 исследований, показали, что эхинацея пурпурная снижает вероятность развития простуды на 58 % и длительность простуды на 1,4дней [4]. Однако, мета-анализ результатов 24 клинических исследований (4631 участник и 33 различных препарата на основе эхинацеи) не выявил существенного эффекта от применения БАДов на основе эхинацеи в качестве средства профилактики и лечения ОРВИ [5]. ...
... The common cold is the most morbid disease in children and adults. According to a report, in the United States of America, approximately 1 billion people suffer from common cold every year (Shah, Sander et al., 2007). Adults have fewer episodes of common cold compared to children. ...
Ivy leaf is used for the treatment of respiratory diseases with the intensive mucus formation, respiratory infections, and irritating cough coming from the common cold. Conferring to clinical trials, the efficacy, and tolerability of ivy leaf is good. The main compounds accountable for biological activity are triterpene and saponins. Ivy leaves show convulsive/antispasmodic, anti-inflammatory, antimicrobial, analgesic, anthelmintic and anti-thrombin activity. Not only ivy but also marshmallow and mustard seeds are used for these indications. This study was conducted to evaluate the efficacy and safety of Cough (EMA; European Medicines Agency) granules used for upper respiratory disorders. This clinical trial was conducted on 150 patients, out of which 75 received the Cough (EMA) granules and 75 received the placebo. The age range of patients was 3 years to above 15 years. The sample paired t-test was applied to evaluate the significant level. Cough (EMA) granules were found effective in the treatment of cough, cold, and flu symptoms. The new treatment Cough (EMA) granules were safe and well tolerated in patient at given specific age group. The study recommends that Cough (EMA) granules can be used effectively in the treatment of upper respiratory tract infection.
Echinacea, an herbal remedy with a rich history rooted in traditional medicine, has captured the attention of researchers, health enthusiasts, and individuals seeking natural approaches to wellness. This review aims to delve into the captivating nature of Echinacea by examining its historical significance, scientific evidence supporting its effectiveness, diverse perspectives and personal anecdotes, recommended usage guidelines, precautions, and potential side effects. Through an overview of research studies, it becomes evident that Echinacea possesses a range of potential benefits. These include its antiviral and immunomodulatory properties, anti-inflammatory effects, wound healing capabilities, and potential in preventing and treating upper respiratory tract infections. Furthermore, studies suggest its potential anti-cancer effects and protection against oxidative stress. The review highlights the different forms of Echinacea products available, including tinctures, capsules and tablets, topical creams and gels, teas, and herbal extracts, with dosage recommendations and usage guidelines provided for each form. Precautions and potential side effects are also discussed to ensure informed decision-making and safe usage. In addition to scientific evidence, the captivating nature of Echinacea is enhanced by the inclusion of positive testimonials and personal anecdotes, demonstrating the impact it has had on individuals' lives. These stories offer a human touch, providing a glimpse into the personal experiences and perspectives of those who have benefited from Echinacea. Ultimately, this review encourages readers to explore Echinacea for themselves, approaching it with an open mind and combining scientific evidence with personal experiences. It acknowledges the potential of Echinacea to contribute to one's health and well-being while emphasizing the importance of an individualized approach to wellness. In conclusion, Echinacea's captivating nature lies in its historical significance, scientific evidence, diverse perspectives, and potential benefits. As readers delve into the world of Echinacea, they are invited to embrace curiosity, open-mindedness, and the beauty of nature's healing treasures, fostering a holistic approach to well-being.
Exercise immunology is the field that studies the effects of exercise on the immune system. In the 1990s, Dr. Nieman formulated the controversial “J-shaped hypothesis” to describe the relationship between acute exercise intensity and the risk of acquiring infections, such as upper respiratory tract infections. This hypothesis suggested that moderate exercise has the ability to improve immune function above sedentary levels, while high intensity exercise depresses the immune system. Since then, current knowledge has exposed some methodological limitations, challenging the idea that any form of exercise can be considered “immunosuppressive”. Overall, acute bouts of moderate exercise have shown to enhance immune-surveillance, while frequent exercise has been associated with an increased immunological competency. Actually, contemporary research interests are focused in understand how immune changes induced by exercise are able to reduce risk for common chronic diseases. To this end, the introduction of -omics approaches (metabolomics, proteomics, lipidomics, and metagenomics) is providing new insights on the interactions between exercise and immunity. In this chapter, we deep into the previous literature addressing the “immunity-exercise axis” in order to critically review the basis of the J-shaped curve and open window hypothesis. In addition, an overview of the components of the immune system and how are affected by exercise considering the gender dimension will help us to unravel the key role of regular physical activity in the prevention and treatment of disease.
Background:
ELOM-080 is a phytomedicine approved for the treatment of acute and chronic inflammatory diseases of the respiratory tract, sinusitis, and bronchitis in particular. This prospective, randomized, placebo-controlled, double-blind clinical trial was conducted to assess efficacy and safety of ELOM-080 in the treatment of acute viral rhinosinusitis (AVRS).
Methods:
Patients with AVRS received oral treatment (4 × 1 capsule per day) with either ELOM-080 or matching placebo. Primary endpoints were the change in major symptom score (MSS) after 7 and 14 days of treatment assessed by the investigator (MSSINV ). Secondary endpoints were changes in MSS assessed by the patients (MSSPAT ), olfactory function (12-item Sniffin' Sticks), 20-Item Sino-Nasal Outcome Test (SNOT-20 GAV; German adapted version), influence of treatment on viral load, and safety.
Results:
Four hundred and sixty-three patients were randomized. At day 4, subjective burden of disease (MSS) was significantly ameliorated compared to placebo (p = 0.012). During the first treatment week MSS scores improved about 1 day earlier, and 3 days earlier in the second week. Effect with ELOM-080 on mean MSSINV was statistically significantly superior to placebo at visit 3 (p = 0.016) and visit 4 (p = 0.014). In chemosensory testing identification scores improved comparably in both treatments. The improvement of the SNOT-20 GAV was more pronounced in ELOM-080 patients. Treatment with ELOM-080 indicated a potential for decreasing viral load. Both treatments were well tolerated.
Conclusion:
ELOM-080 improves the burden of AVRS significantly in comparison to placebo, remission of symptoms occurred 3 days earlier. The results confirm the efficacy and safety of ELOM-080 for treatment of AVRS.
Level of evidence:
1 Laryngoscope, 2022.
SUPER-RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY
AND MYOCARDIAL SCINTIGRAPHY IN PATIENTS WITH HEART FAILURE
Professor E. Ostroumov1, MD; E. Kotina2, PMD; V. Slobodyanik1;
V. Tonkoshkurova1; V. Shmyrov2, Candidate of Physicomathetical Sciences; O. Iryshkin1; Professor D. Shumakov1, MD, Correspondent Member of the Russian Academy of Medical Sciences
1V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs,
Moscow
2Saint Petersburg State University
Cardiac resynchronization therapy (CRT) is a unique treatment for heart failure
(HF) with augmented QRS; in this regard, it seems urgent to find new criteria
for the prediction of a CRT super-response. While searching for these criteria, a
variety of functional parameters may be put in the forefront depending on selected
patient groups and used diagnostic techniques. However, the functional criteria
are reversible in the vast majority of cases if HF is successfully treated. But
cardiosclerosis is irreversible. Scintigraphic methods are shown to play a role in
evaluating both myocardial functional parameters and cardiosclerosis. The results
of the authors’ trials and clinical examples are given.
Key words: ECG-synchronized perfusion tomoscintigraphy, cardiac
resynchronization therapy, heart failure, left and right ventricular scintigraphy,
focal and diffuse cardiosclerosis.
Desde os seus primórdios, a humanidade possui o hábito de utilizar plantas medicinais como forma de tratamento em enfermidades, especialmente, perante aquelas que acometem o sistema respiratório, como infecções bacterianas, virais e fúngicas. Por apresentar diversas propriedades farmacológicas, uma das espécies mais utilizadas nestas situações é a Echinacea purpurea. Desse modo, o objetivo do presente estudo foi revisar a literatura disponível sobre o potencial farmacológico da espécie de Echinacea purpurea e o seu uso frente às infecções respiratórias. O estudo foi do tipo exploratório de caráter qualitativo, com uma revisão de literatura. As pesquisas foram realizadas entre 30 de abril a 31 de julho do ano de 2020. Foram utilizadas como palavras-chave de busca “Echinacea purpurea”, “Constituição da E. purpurea”, “Sistema respiratório” e “Infecções respiratórias”. As buscas foram realizadas sendo utilizadas bases de dados, como: PubMed, SciELO e Google Scholar, nos idiomas português, inglês e espanhol. O estudo demonstrou que a Echinacea purpurea é uma planta bastante utilizada popularmente no tratamento de diversas enfermidades, principalmente, em casos de infecções respiratórias. Esta possui um grande potencial biológico por deter fitoconstituintes que apresentam atividades antibacterianas, antivirais, antifúngicas e imunomoduladoras. Entretanto, ainda se faz necessária a realização de pesquisas mais detalhadas acerca da mesma, visto que não são conhecidos todos os seus constituintes, as doses em que esta se prova eficaz em humanos e o seu mecanismo de ação. Palavras-chave: Echinacea purpurea. Infecções Respiratórias. Sistema Respiratório. Abstract Since its beginnings, mankind has been in the habit of using medicinal plants as a form of diseases treatment, especially when compared to those that affect the respiratory system, such as bacterial, viral and fungal infections. As it presents several pharmacological properties, one of the most used species in these situations is the Echinacea purpurea. Thus, the aim of the present study was to review the available literature on the pharmacological potential of the species of Echinacea purpurea and its use against respiratory infections. The study was an exploratory qualitative study with a literature review. The searches were carried out between April 30th and July 31st of the year 2020. The search keywords "Echinacea purpurea", "Constitution of E. purpurea", "Respiratory system" and "Respiratory infections" were used as search keywords. The searches were performed using databases such as PubMed, SciELO and Google Scholar, in Portuguese, English and Spanish. The study showed that Echinacea purpurea is a plant widely used in the treatment of various diseases, especially in cases of respiratory infections. It has great biological potential because it contains phytochemicals that have antibacterial, antiviral, antifungal and immunomodulatory activities. However, it is still necessary to carry out more detailed research about it, since not all of its constituents are known, the doses at which it proves effective in humans and its mechanism of action. Keywords: Echinacea purpurea. Respiratory Infections. Respiratory System.
Desde os seus primórdios, a humanidade possui o hábito de utilizar plantas medicinais como forma de tratamento em enfermidades, especialmente, perante aquelas que acometem o sistema respiratório, como infecções bacterianas, virais e fúngicas. Por apresentar diversas propriedades farmacológicas, uma das espécies mais utilizadas nestas situações é a Echinacea purpurea. Desse modo, o objetivo do presente estudo foi revisar a literatura disponível sobre o potencial farmacológico da espécie de Echinacea purpurea e o seu uso frente às infecções respiratórias. O estudo foi do tipo exploratório de caráter qualitativo, com uma revisão de literatura. As pesquisas foram realizadas entre 30 de abril a 31 de julho do ano de 2020. Foram utilizadas como palavras-chave de busca “Echinacea purpurea”, “Constituição da E. purpurea”, “Sistema respiratório” e “Infecções respiratórias”. As buscas foram realizadas sendo utilizadas bases de dados, como: PubMed, SciELO e Google Scholar, nos idiomas português, inglês e espanhol. O estudo demonstrou que a Echinacea purpurea é uma planta bastante utilizada popularmente no tratamento de diversas enfermidades, principalmente, em casos de infecções respiratórias. Esta possui um grande potencial biológico por deter fitoconstituintes que apresentam atividades antibacterianas, antivirais, antifúngicas e imunomoduladoras. Entretanto, ainda se faz necessária a realização de pesquisas mais detalhadas acerca da mesma, visto que não são conhecidos todos os seus constituintes, as doses em que esta se prova eficaz em humanos e o seu mecanismo de ação. Palavras-chave: Echinacea purpurea. Infecções Respiratórias. Sistema Respiratório. Abstract Since its beginnings, mankind has been in the habit of using medicinal plants as a form of diseases treatment, especially when compared to those that affect the respiratory system, such as bacterial, viral and fungal infections. As it presents several pharmacological properties, one of the most used species in these situations is the Echinacea purpurea. Thus, the aim of the present study was to review the available literature on the pharmacological potential of the species of Echinacea purpurea and its use against respiratory infections. The study was an exploratory qualitative study with a literature review. The searches were carried out between April 30th and July 31st of the year 2020. The search keywords "Echinacea purpurea", "Constitution of E. purpurea", "Respiratory system" and "Respiratory infections" were used as search keywords. The searches were performed using databases such as PubMed, SciELO and Google Scholar, in Portuguese, English and Spanish. The study showed that Echinacea purpurea is a plant widely used in the treatment of various diseases, especially in cases of respiratory infections. It has great biological potential because it contains phytochemicals that have antibacterial, antiviral, antifungal and immunomodulatory activities. However, it is still necessary to carry out more detailed research about it, since not all of its constituents are known, the doses at which it proves effective in humans and its mechanism of action. Keywords: Echinacea purpurea. Respiratory Infections. Respiratory System.
Meta-analysis is a common feature of quantitative synthesis for systematic reviews, one of the four archetypes in this book.
Acute respiratory infections are an important health concern. Traditionally, polysaccharide-enriched extracts from plants, containing immunomodulatory rhamnogalacturonan-I (RG-1), were used prophylactically. We established the effects of dietary supplementation with carrot-derived RG-I (cRG-I, 0–0.3–1.5 g/day) in 177 healthy individuals (18–65 years) on symptoms following infection with rhinovirus strain 16 (RV16). Primary outcomes were changes in severity and duration of symptoms, and viral load in nasal lavage. Secondary outcomes were changes in innate immune and anti-viral responses, reflected by CXCL10 and CXCL8 levels and cell differentials in nasal lavage. In a nested cohort, exploratory transcriptome analysis was conducted on nasal epithelium. Intake of cRG-I was safe, well-tolerated and accelerated local cellular and humoral innate immune responses induced by RV16 infection, with the strongest effects at 1.5 g/d. At 0.3 g/d, a faster interferon-induced response, induction of the key anti-viral gene EIF2AK2, faster viral clearance, and reduced symptom severity (−20%) and duration (−25%) were observed. Anti-viral responses, viral clearance and symptom scores at 1.5 g/d were in between those of 0 and 0.3 g/d, suggesting a negative feedback loop preventing excessive interferon responses. Dietary intake of cRG-I accelerated innate immune and antiviral responses, and reduced symptoms of an acute respiratory viral infection.
The chapter describes molecular aspects of herbal medicine toxicity. Several studies have shown that certain medicinal herbs can be poisonous and may produce a variety of undesirable or adverse reactions that are life-threatening and even deadly. In industrialized countries, the craze for products of natural origin is a relatively recent phenomenon, developed, in particular, in favour of aggressive marketing campaigns inducing in the public mind notions as false as they are dangerous such as the assertion “what is natural is harmless”. Several intoxications, often deadly, after herbal treatments have been reported which draws attention to the dangers of excessive use and the no control on this therapeutic model.
Background:
Acute rhinopharyngitis, usually called common cold, is a widespread disease, mainly in childhood and adolescence. The use of common cold relievers is, therefore, prevalent as documented by the market data. A well-established tradition considers natural remedies an effective and safe way to relieve the common cold. Hundreds of products for treating the common cold contain non-pharmacological components. Nevertheless, a few studies investigated the role of non-pharmacologic remedies for the common cold.
Methods:
The current study reported the most common non-pharmacological remedies for the common cold, including herbal medicines and other substances.
Results:
As ancient people used traditional herbs to treat and prevent the common cold, various herbs are widely used to clear viral infections. The herbal agents include polyphenols, flavonoids, saponins, glucosides, and alkaloids. Moreover, other non-pharmacological agents are widely used in real-life. Many multi- or mono-component dietary supplements or medical devices contain these substances and are available in the market as tablets, syrups, drops, nasal or oral sprays, and nebulization solutions.
Conclusions:
Many products are available in the market. However, there is some evidence only for some substances. Consequently, further rigorous studies should confirm natural products' efficacy and safety to relieve the common cold.
Purple coneflower ( Echinacea purpurea (L.) Moench) is a popular native North American herbal plant. Its major bioactive compound, chicoric acid, is reported to have various potential physiological functions, but little is known about its biosynthesis. Here, taking an activity-guided approach, we identify two cytosolic BAHD acyltransferases that form two intermediates, caftaric acid and chlorogenic acid. Surprisingly, a unique serine carboxypeptidase-like acyltransferase uses chlorogenic acid as its acyl donor and caftaric acid as its acyl acceptor to produce chicoric acid in vacuoles, which has evolved its acyl donor specificity from the better-known 1- O -β-D-glucose esters typical for this specific type of acyltransferase to chlorogenic acid. This unusual pathway seems unique to Echinacea species suggesting convergent evolution of chicoric acid biosynthesis. Using these identified acyltransferases, we have reconstituted chicoric acid biosynthesis in tobacco. Our results emphasize the flexibility of acyltransferases and their roles in the evolution of specialized metabolism in plants.
Cette thèse s’inscrit dans le domaine de la phytochimie et de la pharmacognosie, et comprend deux parties majeures. La première porte sur l’investigation phytochimique des racines de Nauclea latifolia, un arbuste utilisé en médecine traditionnelle pour ses propriétés thérapeutiques. En 2013, la découverte du tramadol, un médicament de synthèse dans les racines de Nauclea latifolia a été exposée à une couverture médiatique inédite. De ce fait, l’origine naturelle du tramadol a été remise en question. L’objectif principal de ce projet est d’isoler du tramadol à partir de nouveaux lots de racines de Nauclea latifolia dans le but de réaliser des analyses isotopiques 14C pour déterminer l’origine naturelle (ou non) du composé.La purification d’extraits de ces racines par HPLC semi-préparative a permis l’isolement de deux échantillons de tramadol. Les analyses isotopiques en carbone 14 des échantillons ont montré des résultats qui tendent à montrer une origine naturelle. Cependant, l’analyse d’un nouvel échantillon de tramadol issu d’un troisième lot est nécessaire pour confirmer/affirmer son origine.Le deuxième volet de cette thèse a porté sur l’étude phytochimique de deux plantes alpines dans le but de valoriser la flore locale en tant que sources de molécules bioactives. La première plante est l’Helianthemum nummularium, une espèce que l’on retrouve en surprésentation dans le régime alimentaire des ongulés montagnards. Afin d’expliquer cette surconsommation, deux hypothèses étaient possibles : 1) valeurs nutritionnelles importantes et 2) consommation de la plante dans un but d’automédication. Dans ce contexte, nous nous sommes principalement intéressés à la deuxième hypothèse en réalisant une analyse phytochimique des parties aériennes de plante. La purification de l’extrait éthanolique des parties aériennes ont permis l’isolement de 8 dérivés polyphénoliques dont certains ont été rapportés comme de potentiels agents antiparasitaires et pourraient présenter un intérêt pour les ongulés. La deuxième plante est le Chenopodium bonus-henricus, une espèce alpine très utilisée dans le secteur alimentaire local. L’étude phytochimique des extraits dichlorométhane et éthanolique des parties aériennes a permis l’isolement de 6 molécules dont une est nouvelle.La valorisation thérapeutique des extraits et molécules issus des plantes alpine, nous a conduit à conduire des tests biologiques. Dans ce contexte, nous nous sommes penchés sur l’induction d’activation du facteur de transcription Nrf2 par les extraits et les molécules isolées.
American elderberry (Sambucus nigra subsp. canadensis) is a common fruiting shrub native to much of Eastern North America. While the fruit and flowers have been used for eons as food and medicine by both early and contemporary North Americans, its use is seeing a resurgence. This has resulted in a renewed interest in horticultural development and cultivation of elderberry, with numerous new products developed especially in the form of dietary supplements. Recent scientific research continues to underscore the health-benefitting attributes of both elderberry fruit and flowers, and is further fueling the development of a significant elderberry value chain from production, to processing, marketing, and consumption.
SARS-CoV-2 diffuses quite easily among humans, causing a variety of symptoms from a mild flu to a fatal illness mostly involving the lungs and
sometimes the kidneys or the heart, organs that express high concentration of the ACE2 viral receptor. No vaccine is available, although several are
under scrutiny. From the therapeutic side, many different products are being tested, from antiviral to anti inflammatory drugs taken from the repertoire
of other diseases, however with variable success. In fact, the death toll of this viral infection remains quite high. Containment of the infection is based
on mechanical devices (goggles and masks) that shield the entrance doors of the virus (eyes, nose, mouth), and on tight social restrictions to limit the
possibility of contact among people living in a community. Nonetheless, the virus apparently survives for hours on different surfaces and in droplets
suspended in the air and dispersed by the micro particulate that is so abundant in industrialized towns, thus reaching further away from the originator,
and tricking human defenses. In this situation, a possible complementary – however unspecific – approach to limit the infectivity of the virus could be
based on a range of natural compounds which may interfere with the diffusion of the virus within the body, and increase the efficacy of the immune
defenses of the organism. This is meant to be a non-toxic, preventive or adjuvant treatment so that in case of infection, the symptoms might not develop
to full scale, giving the organism more time and strength to fight it.
Keywords: Covid-19, Computational chemistry, Drugs, Epidemiology, Food supplements, Probiotics, Therapy.
Medicinal plants, their extracts and herbal medicinal products occupy a growing share of medicines in the pharmacy worldwide.
Historically, the first medicines were products of plants, as well as some of the most important medicines still in use today. With the development of phytochemistry, as part of the pharmaceutical science, great progress has been made in the isolation and in determining the value of a number of biologically active substances (BAS).
Many plants have yielded pure substances (or natural products) that are applied in modern medical practice. Other compounds are potentially useful or have toxic effects.
Traditional medicine incorporating many herbal medicines remains an important (and in some cases, the only) form of treatment in some countries, with increasing use in medical practice.
On the other hand, the fact that in pediatric patients there is a limitation, mainly moral and ethical, of the number of medications to be administered due to the difficulty of conducting clinical trials in children, stimulates the use of herbal medicines of proven quality, effectiveness and safety among this group of patients.
Pflanzliche Arzneimittel und Pflanzenextrakte (oft gleichgesetzt mit Phytotherapeutika) werden bei Kindern häufig ohne ärztliche Verordnung angewandt. Entgegen der landläufigen Meinung, dass es für pflanzliche Präparate keine evidenzbasierten Studien gäbe, zeigt ein Blick in die wissenschaftliche Literatur, dass für einige klinisch relevante Symptome sehr wohl kontrollierte Studien mit Kindern und Jugendlichen existieren. Zu den am besten untersuchten Indikationsgebieten zählen Magen-Darm-Beschwerden, Atemwegsinfektionen und mit Einschränkung psychische Störungen. Die untersuchten pflanzlichen Arzneimittel oder Pflanzenextrakte zeigten teilweise im Vergleich zu Standardtherapien und/oder Placebo statistisch signifikante und klinisch relevante positive Wirkungen auf den Krankheitsverlauf. Schwerwiegende unerwünschte Ereignisse wurden in den zitierten Studien in keiner Behandlungsgruppe beobachtet. Diese Übersichtsarbeit fasst die Ergebnisse der für den ärztlich-praktischen Alltag relevanten kontrollierten Studien, einschließlich Sicherheitsaspekten, zu den genannten Indikationsgebieten zusammen und gibt praktische Empfehlungen für die Umsetzung.
Abstract
Background: Echinacea purpurea has long been used in folk medicine to prevent and treat a
wide range of diseases like common cold, simple cough, pulmonary infections, dermatologic
disorder and even chronic diseases due to immunodeficiency. This study was conducted to
check the immunomodulatory properties of hydroalcoholic extract of Echinacea purpurea in
NMRI-mice challenged with Sheep Red Blood Cells (SRBCs).
Methods: The study population included 14 NMRI-male mice that were randomly grouped
in two equal groups and immunized with SRBC. Hydroalcoholic extract of Echinacea
pupurea were administered to the treatment group mice per os in daily doses of 0.025 mg
from the beginning of the study and continued for 2 weeks. Specific humoral and cellular
immunity, susceptibility of macrophages respiratory burst and proliferation of immune cells
were measured. The Mann-Whitney test was used in order to compare using SPSS 19
software.
Results: The findings indicated a significant increase (205.267±10.933) in the level of antiSRBC antibody and simultaneously a significant decrease (15.288±4.202) in the level of
cellular immunity in treatment group compared to control group. Lymphocyte proliferation
index in splenocytes was significantly increased (1.821±227) in treatment group. However,
the level of respiratory burst intensity (0.702±0.020) and nitric oxide production
(50.253±2.032) in phagocytic population of splenocytes dramatically decreased in treatment
groups compared to control mice.
Conclusion: Since, the respiratory burst and nitric oxide production of phagocytic cells
decreased, the possible immunostimolatory effectiveness of Echinacea pupurea is doubtful.
However, this data suggest that the hydroalcoholic extract of Echinacea pupurea may be used
as a natural source for purposes of modulating the immune system.
Keywords: Echinacea purpurea, Humoral immunity, Cellular immunity
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
The purpose of this study was to assess the effectiveness of echinacea for the prevention of experimental rhinovirus colds.
Infection occurred in 44 and 57% and illness occurred in 36 and 43% of the echinacea- and placebo-treated subjects, respectively.
This preparation of echinacea had no significant effect on either the occurrence of infection or the severity of illness.
Echinacea is a widely used herbal remedy for treatment of upper respiratory tract infections (URIs). However, there are few data on the efficacy and safety of echinacea in treating URIs in children.
To determine if Echinacea purpurea is effective in reducing the duration and/or severity of URI symptoms in children and to assess its safety in this population.
Randomized, double-blind, placebo-controlled trial of healthy children 2 to 11 years old recruited from a regional practice-based network and an alternative medical center in 4-month periods from 2000 through 2002.
Study patients were randomized to receive either echinacea or placebo for up to 3 URIs over a 4-month period. Study medication was begun at the onset of symptoms and continued throughout the URI, for a maximum of 10 days.
Primary outcomes were duration and severity of symptoms and adverse events recorded by parents; secondary outcomes included peak severity of symptoms, number of days of peak severity, number of days of fever, and a global assessment of severity of symptoms by parents of study children.
Data were analyzed on 707 URIs that occurred in 407 children, including 337 URIs treated with echinacea and 370 with placebo. There were 79 children who completed their study period without having a URI. The median duration of URIs was 9 days (95% confidence interval, 8-10 days); there was no difference in duration between URIs treated with echinacea or placebo (P =.89). There was also no difference in the overall estimate of severity of URI symptoms between the 2 treatment groups (median, 33 in both groups; P =.69). In addition, there were no statistically significant differences between the 2 groups for peak severity of symptoms (P =.68), number of days of peak symptoms (1.60 in the echinacea group and 1.64 in the placebo group; P =.97), number of days of fever (0.81 in the echinacea group vs 0.64 in the placebo group; P =.09), or parental global assessment of severity of the URI (P =.67). Overall, there was no difference in the rate of adverse events reported in the 2 treatment groups; however, rash occurred during 7.1% of the URIs treated with echinacea and 2.7% of those treated with placebo (P =.008).
Echinacea purpurea, as dosed in this study, was not effective in treating URI symptoms in patients 2 to 11 years old, and its use was associated with an increased risk of rash.
In this review, the vitamin C trials with military personnel and with other subjects living under conditions comparable to those of military recruits are analyzed to find out whether vitamin C supplementation affects respiratory infections. For this systematic review, we identified seven trials with military personnel, three trials with students in crowded lodgings, and two trials with marathon runners. Eight of these trials were double blind and placebo controlled and seven were randomized. Five small trials found a statistically significant 45 to 91% reduction in common cold incidence in the vitamin C group. These trials were short and the participants were under heavy exertion during the trial. Furthermore, three other trials found a statistically significant 80 to 100% reduction in the incidence of pneumonia in the vitamin C group. The large number of positive findings seems to warrant further consideration of the role of vitamin C in respiratory infections, particularly in military recruits.
Echinacea has been widely used as an herbal remedy for the common cold, but efficacy studies have produced conflicting results, and there are a variety of echinacea products on the market with different phytochemical compositions. We evaluated the effect of chemically defined extracts from Echinacea angustifolia roots on rhinovirus infection.
Three preparations of echinacea, with distinct phytochemical profiles, were produced by extraction from E. angustifolia roots with supercritical carbon dioxide, 60 percent ethanol, or 20 percent ethanol. A total of 437 volunteers were randomly assigned to receive either prophylaxis (beginning seven days before the virus challenge) or treatment (beginning at the time of the challenge) either with one of these preparations or with placebo. The results for 399 volunteers who were challenged with rhinovirus type 39 and observed in a sequestered setting for five days were included in the data analysis.
There were no statistically significant effects of the three echinacea extracts on rates of infection or severity of symptoms. Similarly, there were no significant effects of treatment on the volume of nasal secretions, on polymorphonuclear leukocyte or interleukin-8 concentrations in nasal-lavage specimens, or on quantitative-virus titer.
The results of this study indicate that extracts of E. angustifolia root, either alone or in combination, do not have clinically significant effects on infection with a rhinovirus or on the clinical illness that results from it.
To evaluate the effectiveness and safety of a preparation containing echinacea, propolis, and vitamin C in the prevention of respiratory tract infections in children during a 12-week winter period.
Randomized, double-blind, placebo-controlled study.
Four hundred thirty children, aged 1 to 5 years, were randomized to an herbal extract preparation (n = 215) or a placebo elixir (n = 215).
Administration of an herbal preparation (Chizukit) containing 50 mg/mL of echinacea, 50 mg/mL of propolis, and 10 mg/mL of vitamin C, or placebo (5.0 mL and 7.5 mL twice daily for ages 1 to 3 years and 4 to 5 years, respectively) for 12 weeks.
Significant mean +/- SD reductions of illnesses were seen in the Chizukit group in the number of illness episodes, 138 vs 308 (55% reduction); number of episodes per child, 0.9 +/- 1.1 vs 1.8 +/- 1.3 (50% reduction, P<.001); and number of days with fever per child, 2.1 +/- 2.9 vs 5.4 +/- 4.4) (62% reduction, P<.001). The total number of illness days and duration of individual episodes were also significantly lower in the Chizukit group. Adverse drug reactions were rare, mild, and transient.
A preventive effect of a product containing echinacea, propolis, and vitamin C on the incidence of respiratory tract infections was observed.
Herbs have long been a part of the human diet. Today herbs are used primarily for seasoning and flavor; but historically herbs had a much broader use. Herbs were the medicines of the day and were often added to the diet to enhance overall health, improve endurance, and increase resistance to infection. In Asian culture ginger was taken with seafood as it was believed to mitigate the ill effects of eating bad fish. Today sushi is still accompanied by (pickled) ginger. Aside from simple folk medicine, herbs and herb combinations were developed and used medicinally in the context of the cultural understanding of health and disease such as Chinese medicine, Ayurvedic medicine, and even early Western herbal traditions. Herbal medicine continues to be practiced this way by many traditional practitioners.
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 objective of this study was to evaluate the efficacy of an anti- cold remedy including vitamin C (100 mg) and Echinacea purpurea (L.) root extract in the treatment of the common cold. The study was randomized single blind, and placebo controlled. Thirty two subjects (17 male and 15 female, age ranging between 18 and 71 years) were enrolled in this study. The evaluation parameter was the duration of the illness based on the rhinorrea and the number of paper tissues used daily by each subject. The length of the common cold was 3,37 days in the verum-treated patients and 4.37 days in the placebo treated patients (p < 0.01). Also the number of tissues used was different between the two groups (882 treated; 1168 placebo). The preparation (Cold-X) including Echinacea was found to be useful and safe for the treatment of the common cold. Other trials under double-blind conditions would be welcomed in order to confirm these results, and basic studies are also necessary in order to elucidate the mechanism of action.
The common cold is characterized by symptoms of rhinorrhea, nasal obstruction, sneezing, throat clearing, postnasal drip, and cough. Some of the many viruses that cause colds may cause mild additional symptoms such as sore throat, weakness, dizziness, and tearing. This article presents data concerning the cause, pathogenesis, and treatment of the common cold as well as discussion of the available diagnostic tests and their use in formulating differential diagnoses.
Propolis is a multifunctional material used by bees in the construction and maintenance of their hives. Use of propolis by humans has a long history, predated only by the discovery of honey. Use of products containing propolis have resulted in extensive dermal contact and it is now increasingly being used a dietary supplement. Unlike many 'natural' remedies, there is a substantive database on the biological activity and toxicity of propolis indicating it may have many antibiotic, antifungal, antiviral and antitumour properties, among other attributes. Although reports of allergic reactions are not uncommon, propolis is relatively non-toxic, with a no-effect level (NOEL) in a 90-mouse study of 1400 mg/kg body weight/day.
To investigate the safety and efficacy of 2 extracts of echinacea for preventing upper respiratory tract infections.
Three-armed, randomized, double-blind, placebo-controlled trial.
Four military institutions and 1 industrial plant.
Three hundred two volunteers without acute illness at time of enrollment.
Ethanolic extract from Echinacea purpurea roots, Echinacea angustifolia roots, or placebo, given orally for 12 weeks.
Time until the first upper respiratory tract infection (time to event). Secondary outcome measures were the number of participants with at least 1 infection, global assessment, and adverse effects.
The time until occurrence of the first upper respiratory tract infection was 66 days (95% confidence interval [CI], 61-72 days) in the E angustifolia group, 69 days (95% CI, 64-74 days) in the E purpurea group, and 65 days (95% CI, 59-70 days) in the placebo group (P = .49). In the placebo group, 36.7% had an infection. In the treatment groups, 32.0% in the E angustifolia group (relative risk compared with placebo, 0.87; 95% CI, 0.59-1.30) and 29.3% in the E purpurea group (relative risk compared with placebo, 0.80; 95% CI, 0.53-1.31) had an infection. Participants in the treatment groups believed that they had more benefit from the medication than those in the placebo group (P = .04). Adverse effects were reported by 18 subjects in the E angustifolia group, 10 in the E purpurea group, and 11 in the placebo group.
In this study a prophylactic effect of the investigated echinacea extracts could not be shown. However, based on the results of this and 2 other studies, one could speculate that there might be an effect of echinacea products in the order of magnitude of 10% to 20% relative risk reduction. Future studies with much larger sample sizes would be needed to prove this effect.
Fluid extracts of Echinacea purpurea are widely used for the prevention and treatment of colds and respiratory infections, although the clinical efficacy of this agent has not been proven.
A total of 109 patients with a history of more than 3 colds or respiratory infections in the preceding year were randomly assigned to receive 4 mL fluid extract of Echinacea purpurea or 4 mL placebo-juice twice a day in a double-blind manner. (One patient withdrew his consent before taking the first dose of the allocated medication; thus, only 108 patients were included for analysis.) The incidence and severity of colds and respiratory infections were determined during 8 weeks of follow-up, based on patient reported symptoms together with findings on physical exam. The severity of each infection was graded by the investigators. Relative risks (RR) and 95% confidence intervals (CI) were estimated.
During the 8-week treatment period, 35 (65%) of 54 patients in the Echinacea group and 40 (74%) of 54 patients in the placebo group had at least one cold or respiratory infection [RR = 0.88; 95% CI (0.60, 1.22)]. The average number of colds and respiratory infections per patient was 0.78 in the Echinacea group, and 0.93 in the placebo group [difference = 0.15; 95% CI (-0.12, 0.41), P = 0.33]. Median duration of colds and respiratory infections was 4.5 days in the Echinacea group and 6.5 days in the placebo group (95% CI: -1, +3 days; P = 0.45). There were no significant differences between treatment groups in the number of infections in each category of severity. Side effects were observed in 11 patients (20%) of the Echinacea group and in seven patients (13%) of the placebo group (P = 0.44).
Treatment with fluid extract of Echinacea purpurea did not significantly decrease the incidence, duration or severity of colds and respiratory infections compared to placebo.
Extracts of the plant Echinacea (family Compositae) are widely used in some European countries and the USA for upper respiratory tract infections.
The objective of this review was to assess the effects of preparations containing extracts of Echinacea in the prevention and treatment of the common cold.
We searched the Cochrane Acute Respiratory Infections Group and Complementary Medicine Field's trials registers, MEDLINE, EMBASE, Phytodok and reference lists of articles. We also contacted researchers and manufacturers. Date of last search: Spring 1998.
Randomised and quasi-randomised trials comparing preparations containing an extract of Echinacea compared with a placebo, no treatment, or another treatment for common colds.
At least two independent reviewers assessed trial quality and extracted data.
Sixteen trials (eight prevention trials, and eight trials on treatment of upper respiratory tract infections) with a total of 3396 participants were included. Variation in preparations investigated and methodological quality of trials precluded quantitative meta-analysis. Overall, the results suggested that some Echinacea preparations may be better than placebo.
The majority of the available studies report positive results. However there is not enough evidence to recommend a specific Echinacea product, or Echinacea preparations for the treatment or prevention of common colds.
Considered to have immunostimulating activity, echinacea is a widely used phytomedicinal for treatment of the common cold and upper respiratory tract infections (URTIs). We reviewed the literature from the MEDLINE database (January 1966-July 1999), International Pharmaceutical Abstracts (IPA) online database, Cambridge Scientific Abstracts Biological Sciences online database, Alt-Health Watch online database, EMBase CD-ROM database, and references from published articles, reviews, and letters to evaluate evidence from clinical trials of echinacea's purported efficacy for treating or preventing URTIs. Twelve clinical studies published from 1961-1997 concluded that echinacea was efficacious for treating the common cold, but the results are unclear due to inherent flaws in study design. Five trials were published since 1997; two showed that echinacea lacked efficacy for treating and preventing URTI symptoms, and three concluded that it was effective in reducing the frequency, duration, and severity of common cold symptoms. Again, these results are unclear because of methodologic uncertainties, such as small populations and use of noncommercially available, nonstandardized dosage forms. Although evidence for echinacea's efficacy is inconclusive, it appears to be safe. Patients without contraindications to it may not be dissuaded from using an appropriate preparation to treat the common cold.
Serial dilutions of 21 commercial ethanolic herbal extracts and tinctures, and 13 related pure plant compounds have been analyzed for their in vitro cytochrome P450 3A4 (CYP3A4) inhibitory capability via a fluorometric microtitre plate assay. Roughly 75% of the commercial products and 50% of the pure compounds showed significant inhibition of CYP3A4 metabolite formation. For each herbal product and pure compound exhibiting dose-dependency, the inhibition values were used to generate median inhibitory concentration (IC50) curves using linear regression. Among the commercial extracts, Hydrastis canadensis (goldenseal), Hypericum perforatum (St. John's wort), and Uncaria tomentosa (cat's claw) had the lowest IC50 values at < 1% full strength, followed by Echinacea angustifolia roots, Trifolium pratense (wild cherry), Matricaria chamomilla (chamomile), and Glycyrrhiza glabra (licorice), which had IC50 values ranging from 1%-2% of full strength. Dillapiol, hypericin, and naringenin had the lowest IC50 values among the pure plant compounds at < 0.5 mM; dillapiol was the most potent inhibitor at 23.3 times the concentration of the positive CYP3A4 inhibitor ketoconazole. Utilizing high-throughput screening methodologies for assessing CYP3A4 inhibition by natural products has important implications for predicting the likelihood of potential herbal-drug interactions, as well as determining candidates for further in-depth analyses.
The aim of this study was to determine the efficacy of an echinacea compound herbal tea preparation (Echinacea Plus) given at early onset of cold or flu symptoms in a random assignment double-blind placebo-controlled study.
A total of 95 subjects with early symptoms of cold or flu (runny nose, scratchy throat, fever) were randomly assigned to receive Echinacea Plus tea five to six cups per day titrating to 1 over 5 days or placebo in a double-blind situation. Each participant completed a questionnaire 14 days after beginning the program. The efficacy, number of days the symptoms lasted, and number of days for change were measured with a self scoring questionnaire.
The study period was 90 days (January 1, 1999 to March 30, 1999). There was a significant difference between the experimental group (Echinacea Plus) and control group (placebo) for all 3 questions measured: p < 0.001. There were no negative effects reported by any of the subjects in either group.
Treatment with Echinacea Plus tea at early onset of cold or flu symptoms was effective for relieving these symptoms in a shorter period of time than a placebo.
Common colds are one of the most frequent acute illnesses with major economical impact. Echinaceae purpureae herba (Echinacin, EC31J0) has shown promising results in the relief of common cold symptoms and the time taken to improvement compared to placebo. This study was aimed to confirm these findings by performing a randomised, double-blind, placebo-controlled clinical trial. A total of 80 adult male or female patients with first signs of a cold were recruited. The number of days of illness with a complete picture of the common cold (defined by the modified Jackson score of at least 5 points and experience of rhinorrhea and/or a subjective sensation of having a cold) was the primary end-point. In the verum group the median time of illness was 6.0 days compared to 9.0 days in the placebo group, assigning zero time for patients without a complete picture (one-sided p = 0.0112). EC31J0 was well tolerated and clinically effective in alleviating symptoms more rapidly than placebo in patients with a common cold.
Echinacea preparations are widely used to treat the common cold.
To assess the efficacy of dried, encapsulated, whole-plant echinacea as early treatment for the common cold.
Randomized, double-blind, placebo-controlled community-based trial.
University of Wisconsin-Madison, Madison, Wisconsin.
148 registered students with common colds of recent onset.
An encapsulated mixture of unrefined Echinacea purpurea herb (25%) and root (25%) and E. angustifolia root (50%) taken in 1-g doses six times on the first day of illness and three times on each subsequent day of illness for a maximum of 10 days.
Severity and duration of self-reported symptoms of upper respiratory tract infection.
No statistically significant differences were detected between the echinacea and placebo groups for any of the measured outcomes. Trajectories of severity over time were nearly identical in the two groups. Mean cold duration was 6.01 days in both groups as a whole, 5.75 days in the placebo group, and 6.27 days in the echinacea group (between-group difference, -0.52 day [95% CI, -1.09 to 0.22 days]). After controlling for severity and duration of symptoms before study entry, sex, date of enrollment, and use of nonprotocol medications, researchers found no statistically significant treatment effect (adjusted hazard ratio, 1.24 [CI, 0.86 to 1.78]). Multivariable regression models assessing severity scores over time failed to detect statistically significant differences between the echinacea and placebo groups.
Compared with placebo, unrefined echinacea provided no detectable benefit or harm in these college students who had the common cold.
Echinacea sales represent 10% of the dietary supplement market in the United States, but there is no guarantee as to the content, quality, variability, or contamination in Echinacea preparations.
To qualitatively and quantitatively assess the contents of Echinacea-only preparations available in a retail setting.
One of each single-herb Echinacea preparations that were available in August 2000 was obtained from several stores in the Denver, Colo, area. Thin-layer chromatography (TLC) was used to determine species and measure quantity. From this information, accuracy of species labeling and comparison of constituent to labeled content were assessed. The samples were stratified by whether they were labeled as standardized, and the standardized and nonstandardized samples were compared by ratio of constituent to labeled content.
Of the samples, 6 (10%) of 59 preparations contained no measurable Echinacea. The assayed species content was consistent with labeled content in 31 (52%) of the samples. Of the 21 standardized preparations, 9 (43%) met the quality standard described on the label. Labeled milligrams were weakly associated with measured constituent (r = 0.35; P =.02).
Echinacea from retail stores often does not contain the labeled species. A claim of "standardization" does not mean the preparation is accurately labeled, nor does it indicate less variability in concentration of constituents of the herb.
A randomized, double-blind, placebo-controlled clinical trial was conducted to evaluate the ability of Echinacea purpurea to prevent infection with rhinovirus type 39 (RV-39). Forty-eight previously healthy adults received echinacea or placebo,
2.5 mL 3 times per day, for 7 days before and 7 days after intranasal inoculation with RV-39. Symptoms were assessed to evaluate
clinical illness. Viral culture and serologic studies were performed to evaluate the presence of rhinovirus infection. A total
of 92% of echinacea recipients and 95% of placebo recipients were infected. Colds developed in 58% of echinacea recipients
and 82% of placebo recipients (P = .114, by Fisher's exact test). Administration of echinacea before and after exposure to rhinovirus did not decrease the
rate of infection; however, because of the small sample size, statistical hypothesis testing had relatively poor power to
detect statistically significant differences in the frequency and severity of illness.
Echinacea is a herbal preparation that is frequently used to treat the common cold. Spending on echinacea in the United States has risen to >300 million dollars annually.
A total of 322 articles related to echinacea and colds, including 9 placebo-controlled clinical trials, were identified using the Medline and PubMed databases. Eleven features of experimental design that affect the accuracy of the measurement of features of interest, the probability of a chance relationship, bias, and blinding were used to evaluate the 9 placebo-controlled studies. The criteria were validated case definition, quantifiable hypothesis, sample-size calculation, randomized assignment, double blinding, proof of blinding, measurement of compliance, measurement of drop-out rate, analysis by intention to treat, description of the methods of analysis, and measurement of probability. Equal weight was given to each criterion, since failure to meet any one of them could potentially invalidate the findings of a clinical trial.
Of the 9 studies, 2 met all 11 criteria. The results of both studies were judged to be negative by the people who performed the studies. Of the remaining 7 studies, 6 were judged to have positive results, and 1 was judged to have negative results. The criterion most commonly not met was proof of blinding.
This structured review suggests that the possible therapeutic effectiveness of echinacea in the treatment of colds has not been established.
The significant burden of upper respiratory tract infection in adults and children, coupled with a lack of specific treatment options, invites the use of alternative therapies. Echinacea is an herb widely used for the prevention or treatment of upper respiratory tract infection. This review article examines the mechanism of action, dose, and types of Echinacea used for these purposes. The principal mode of action of Echinacea is through immunostimulation. Most Echinacea studies were done in Germany, but their results are difficult to interpret because of variability of experimental parameters. Types of Echinacea commonly used are Echinacea purpurea, E pallida, and E angustifolia. Both the plant's upper parts and roots are used. For oral administration, tablets, extracts, fresh pressed juice, teas, and tinctures have been used. Though studies show a beneficial effect, clear conclusions and recommendations of Echinacea use cannot be made due to a lack of standard product, variability in dose, and variability in outcome measures. Therefore, well-designed studies with consistent standardized measures are required.
Echinacea spp. are native to North America and were traditionally used by the Indian tribes for a variety of ailments, including mouth sores, colds and snakebites. The three most commonly used Echinacea spp. are E. angustifolia, E. pallida and E. purpurea. Systematic literature searches were conducted in six electronic databases and the reference lists of all of the papers located were checked for further relevant publications. Information was also sought from the spontaneous reporting programmes of the WHO and national drug safety bodies. Twenty-three manufacturers of echinacea were contacted and asked for data held on file. Finally our own departmental files were searched. No language restrictions were imposed. Combination products and homeopathic preparations were excluded.
Data from clinical studies and spontaneous reporting programmes suggest that adverse events with echinacea are not commonly reported. Gastrointestinal upsets and rashes occur most frequently. However, in rare cases, echinacea can be associated with allergic reactions that may be severe. Although there is a large amount of data that investigates the efficacy of echinacea, safety issues and the monitoring of adverse events have not been focused on.
Short-term use of echinacea is associated with a relatively good safety profile, with a slight risk of transient, reversible, adverse events. The association of echinacea with allergic reactions is supported by the present evaluation. While these reactions are likely to be rare, patients with allergy or asthma should carefully consider their use of echinacea. The use of echinacea products during pregnancy and lactation would appear to be ill-advised in light of the paucity of data in this area.
Alkamides are the major lipophilic constituents of Echinacea angustifolia roots. Due to their structural similarity with anandamide, we have evaluated their ability to bind to rodent cannabinoid receptors CB1 and CB2 by a standard receptor binding assay using [³H]CP-55,940 as a radioligand. The alkamides exhibited selective affinity especially to CB2 receptors and can therefore be considered as CB ligands. Most of the alkamides showed good metabolic stability as indicated by the similarity between affinity to CB1 determined in the presence/absence of the protease inhibitor PMSF. It is suggested that CB2 interactions may be the molecular mode of action of Echinacea alkamides as immunomodulators.
Abbreviations
CB1:cannabinoid receptor 1
CB2:cannabinoid receptor 2
FAAH:Fatty acid amidohydrolase
PMSF:phenylmethanesulfonylfluoride
AEA:arachidonylethanolamide, anandamide
AA:arachidonic acid
IL:interleukin
MCP:monocyte chemoattractant protein
BSA:bovine serum albumin
TNF-α:tumor necrosis factor-alpha
MAPK:mitogen-activated protein kinase
JNK:jun N-terminal kinase
cAMP:cyclic adenosine monophosphate
CREB-1:responsive element binding protein-1
ATF-2:activating transcription factor-2
NF-κB:nuclear factor kappa B
Tris:Tris-(hydroxymethyl)-amino-methane
CP55940:(-)-cis-3-[2-hydroxy-4(1,1-dimethyl-heptyl)phenyl]-trans-4-(3-hydroxypropyl)cyclohexanol
Preparations of the plant Echinacea (family Compositae) are widely used in some European countries and in 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 addition of other components.
The objective of this review was to assess whether there is evidence that Echinacea preparations are 1) more effective than no treatment; 2) more effective than placebo; 3) similarly effective to other treatments in A) the prevention and B) the treatment of the common cold.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005); PubMed (1997 to April 2005), EMBASE (1998 to June 2005), AMED (to August 2005), Centre for Complementary Medicine Research (in Munich) (1988 to May 2005), contacted experts, and screened references of reviews.
We included randomized controlled trials that compared mono-preparations of Echinacea with a placebo, no treatment, or another treatment for the prevention or treatment of common colds. Trials on combinations of Echinacea and other herbs were excluded.
For all studies, at least two authors independently assessed eligibility and trial quality, and extracted data. Outcomes of interest in prevention trials were: numbers of individuals with one or more colds, and severity and duration of colds; and in treatment trials: total symptom scores, nasal symptoms, and duration of colds.
Sixteen trials including a total of 22 comparisons of an Echinacea preparation and a control group (19 with placebo, 2 with no treatment, 1 with another herbal preparation) met the inclusion criteria. All trials except one were described as double-blind. The majority had reasonable to good methodological quality. Three comparisons investigated prevention of colds and 19 comparisons tested treatment of colds. A variety of different Echinacea preparations were used. None of the three comparisons in the prevention trials showed an effect over placebo. Comparing an Echinacea preparation with placebo as treatment, a significant effect was reported in nine comparisons, a trend in one, and no difference in six. More than one trial was available only for preparations based on the aerial parts from Echinacea purpurea (E. purpurea).
Echinacea preparations tested in clinical trials differ greatly. There is some evidence that preparations based on the aerial parts of Echinacea purpurea might be effective for the early treatment of colds in adults but results are not fully consistent. Beneficial effects of other Echinacea preparations, and for preventative purposes might exist but have not been shown in independently replicated, rigorous randomized trials.
For rare outcomes, meta-analysis of randomized trials may be the only way to obtain reliable evidence of the effects of healthcare interventions. However, many methods of meta-analysis are based on large sample approximations, and may be unsuitable when events are rare. Through simulation, we evaluated the performance of 12 methods for pooling rare events, considering estimability, bias, coverage and statistical power. Simulations were based on data sets from three case studies with between five and 19 trials, using baseline event rates between 0.1 and 10 per cent and risk ratios of 1, 0.75, 0.5 and 0.2. We found that most of the commonly used meta-analytical methods were biased when data were sparse. The bias was greatest in inverse variance and DerSimonian and Laird odds ratio and risk difference methods, and the Mantel-Haenszel (MH) odds ratio method using a 0.5 zero-cell correction. Risk difference meta-analytical methods tended to show conservative confidence interval coverage and low statistical power at low event rates. At event rates below 1 per cent the Peto one-step odds ratio method was the least biased and most powerful method, and provided the best confidence interval coverage, provided there was no substantial imbalance between treatment and control group sizes within trials, and treatment effects were not exceptionally large. In other circumstances the MH OR without zero-cell corrections, logistic regression and the exact method performed similarly to each other, and were less biased than the Peto method.
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