An evidence-based systematic review of echinacea ( E. angustifolia DC, E. pallida, E. purpurea) by the natural standard research collaboration

Journal of Herbal Pharmacotherapy

Volumn 5, Issue 2, 2005, Pages 57-88

  Basch, Ethan ^a   Ulbricht, Catherine ^b   Basch, Samuel ^c   Dalton, Sean ⁱ   Ernst, Edzard ^d   Foppa, Ivo ^e   Szapary, Phillippe ^f   Tiffany, Natasha ^g   Orlando, Carolyn Williams ⁱ   Vora, Mamta ^h  

^a MEMORIAL SLOAN KETTERING CANCER CENTER   (United States)

^b MASSACHUSETTS GENERAL HOSPITAL   (United States)

^c MOUNT SINAI MEDICAL CENTER   (United States)

^d UNIVERSITY OF EXETER   (United Kingdom)

^e HARVARD UNIVERSITY   (United States)

^f UNIVERSITY OF PENNSYLVANIA   (United States)

^g HARVARD MEDICAL SCHOOL   (United States)

^h NORTHEASTERN UNIVERSITY   (United States)

ⁱ NONE

Author keywords

[No Author keywords available]

Indexed keywords

AMIODARONE; AMOXICILLIN; ANABOLIC AGENT; ASCORBIC ACID; AZATHIOPRINE; BIRACIAL; CYCLOSPORIN; DISULFIRAM; ECHINACEA ANGUSTIFLORA EXTRACT; ECHINACEA EXTRACT; ECHINACEA PALLIDA EXTRACT; ECHINACEA PURPUREA EXTRACT; ECHINACIN; ECHINAFORCE; ECHINAFRESH; ECHINAGUARD; ECONAZOLE; ESBERITOX; KAVA EXTRACT; KETOCONAZOLE; METHOTREXATE; METRONIDAZOLE; PASCOTOX; PREDNISONE; RESISTAN; UNCLASSIFIED DRUG; VITAMIN B GROUP; PLANT EXTRACT;

ABDOMINAL PAIN; ANAPHYLAXIS; ANGIONEUROTIC EDEMA; ANTIINFLAMMATORY ACTIVITY; ANTIMICROBIAL ACTIVITY; BRONCHOSPASM; CLINICAL TRIAL; DROWSINESS; DRUG DOSE REGIMEN; DRUG EFFICACY; DRUG ERUPTION; DRUG HYPERSENSITIVITY; DRUG MECHANISM; DRUG SAFETY; ECHINACEA; ECHINACEA PALLIDA; ERYTHEMA; FEVER; GENITAL HERPES; HEADACHE; HEART ATRIUM FIBRILLATION; HEPATITIS; HUMAN; HYPOTENSION; KIDNEY FAILURE; LEUKOPENIA; LIVER TOXICITY; MUSCLE WEAKNESS; NAUSEA; NONHUMAN; PERIPHERAL EDEMA; PREGNANCY; PRIORITY JOURNAL; PRURITUS; REVIEW; RHABDOMYOLYSIS; SHIVERING; SKIN MANIFESTATION; SORE THROAT; SYSTEMATIC REVIEW; TREATMENT CONTRAINDICATION; TREATMENT INDICATION; UPPER RESPIRATORY TRACT INFECTION; URTICARIA; VOMITING; ADULT; CHILD; CONTROLLED CLINICAL TRIAL; DOSE RESPONSE; EVIDENCE BASED MEDICINE; FEMALE; HERB DRUG INTERACTION; HISTORY; MALE; MEDICAL RESEARCH; MEDICINAL PLANT; METHODOLOGY; PHYTOTHERAPY; RADIATION INJURY; RANDOMIZED CONTROLLED TRIAL; RESPIRATORY TRACT INFECTION; SAFETY; STANDARD;

ADULT; BIOMEDICAL RESEARCH; CHILD; DOSE-RESPONSE RELATIONSHIP, DRUG; ECHINACEA; EVIDENCE-BASED MEDICINE; FEMALE; HERB-DRUG INTERACTIONS; HISTORY, 19TH CENTURY; HUMANS; LEUKOPENIA; MALE; PHYTOTHERAPY; PLANT EXTRACTS; PLANTS, MEDICINAL; PREGNANCY; RADIATION INJURIES; RANDOMIZED CONTROLLED TRIALS; RESEARCH DESIGN; RESPIRATORY TRACT INFECTIONS; SAFETY;

EID: 29644437496     PISSN: 15228940     EISSN: 15229106     Source Type: Journal    
DOI: 10.1300/J157v05n02_06     Document Type: Review

References (95)

1. Gilroy CM, Steiner JF, Byers T, et al. Echinacea and truth in labeling. Arch Intern Med 2003;163(6):699-704.
2. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 2003;290(21):2824-2830.
3. Cohen HA, Varsano I, Kahan E, et al. Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med 2004;158(3):217-221.
4. Viehmann P. [Results of treatment with an Echinacea-based ointment]. Erfahrungsheilkunde 1978;27(6):353-358.
5. Bockhorst H, Gollnick N, Guran S, et al. [Therapy of herpes simplex in practice. Report on the treatment of herpes simplex labialis with Esberitox]. ZFA (Stuttgart) 1982;58(32):1795-1798.
6. See D, Berman S, Justis J, et al. A phase I study on the safety of Echinacea angustifolia and its effect on viral load in HIV infected individuals. J Amer Nutr Assoc 1998;1(1):14-17.
7. Hill N, van Haselen RA. Clinical trial of a homeopathic insect after-bite treatment. Hom Int R&D Newslet 1993;3/4:4-5.
8. Hill N, Stam C, Tuinder S, et al. A placebo controlled clinical trial investigating the efficacy of a homeopathic after-bite gel in reducing mosquito bite induced erythema. Eur J Clin Pharmacol 1995;49(1-2):103-108.
9. Hill N, Stam C, van Haselen RA. The efficacy of Prrrikweg gel in the treatment of insect bites: a double-blind, placebo-controlled clinical trial. Pharm World Sci 1996;18(1):35-41.
10. Coeugniet EG, Elek E. Immunomodulation with Viscum album and Echinacea purpurea extracts. Onkologie 1987;10(3 Suppl):27-33.
11. Reichling J, Fitzi J, Furst-Jucker J, et al. Echinacea powder: treatment for canine chronic and seasonal upper respiratory tract infections. Schweiz Arch Tierheilkd 2003;145(5):223-231.
12. Timmermans LM, Timmermans LG, Jr. [Determination of the activity of extracts of Echinaceae and Sabal in the treatment of idiopathic megabladder in women]. Acta Urol Belg 1990;58(2):43-59.
13. Baetgen D. Erfolge in der keuchhusten-behandlung mit Echinacin. Therapiewoche 1984;34:5115-5119.
14. Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections. Complement Ther Med 1997; 5:40-42.
15. Bräunig B, Dorn M, Limburg E, et al. Enhancement of resistance in common cold by Echinacea purpurea radix. Zeitschrift fur Phytotherpie 1992;13:7-13.
16. Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med 2000; 6(4):327-334.
17. Anonymous. Immunallergische reaktionen nach echinacea-extrakten (Echinacin, Exberitox N U.A.). Arnzei-telegramm 1991;(April):39.
18. Heesen W. Unspezifische behandlungsmoglichkeiten bei tuberkulosen erkrankungen. Erfahrungsheikunde 1964;13:210-217.
19. Volz G. Zur keuchhustenbehandlung mit Myo-Echinacin. Ther Gegenwart 1957;96:312-313.
20. Zimmermann O. Die therapie des keuchhusten mit Myo-Echinacin. Hippokrates 1969;6:223-235.
21. Barrett B, Vohmann M, Calabrese C. Information on additional echinacea trials. J Fam Pract 1999;48(12):1001-1002.
22. Ertel G, Manley H, McQueen C, et al. Information on additional Echinacea trials. J Fam Pract 1999;48(12):1001-1002.
23. Parnham MJ. Benefit-risk assessment of the squeezed sap of the purple coneflower (Echinacea purpurea) for long-term oral immunostimulation. Phytomed 1996;3:95-102.
24. Mengs U, Clare CB, Poiley JA. Toxicity of Echinacea purpurea. Acute, subacute and genotoxicity studies. Arzneimittelforschung 1991;41(10):1076-1081.
25. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol 2002;88(1):42-51.
26. Mullins RJ. Echinacea-associated anaphylaxis. Med J Aust 1998;168(4):170-171.
27. Mullins R. Allergic Reactions to Echinacea. J Allergy Clin Immunol 2000; 105(1 part 2):s268-s269.
28. Bruynzeel DP, van Ketel WG, Young E, et al. Contact sensitization by alternative topical medicaments containing plant extracts. The Dutch Contact Dermatoses Group. Contact Dermatitis 1992;27(4):278-279.
29. Bauer R. [Echinacea drugs-effects and active ingredients]. Z Arztl Fortbild. (Jena) 1996;190(2):111-115.
30. Schonhofer PS, Schulte-Sasse H. [Are botanical immunostimulants effective and harmless?]. Dtsch Med Wochenschr 1989;114(46):1804-1806.
31. Soon SL, Crawford RI. Recurrent erythema nodosum associated with Echinacea herbal therapy. J Am Acad Dermatol 2001;44(2):298-299.
32. Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold: A randomized, placebo controlled, double-blind clinical trial. Phytomedicine 1999;6(1):1-6.
33. Ondrizek RR, Chan PJ, Patton WC, et al. Inhibition of human sperm motility by specific herbs used in alternative medicine. J Assist Reprod Genet 1999;16(2):87-91.
34. Kemp DE, Franco KN. Possible leukopenia associated with long-term use of echinacea. J Am Board Fam Pract 2002;15(5):417-419.
35. Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med 2000;160(20): 3141-3143.
36. Gallo M, Koren WA, Koren G. The safety of Echinacea use during pregnancy: a prospective controlled cohort study. Proceedings of the 11th International Conference of the Organization of Teratology. Teratology 1998;57:283.
37. Coeugniet E, Kuhnast R. Rezidivierende candidiasis. Therapiewoche 1986;36:3352-3358.
38. Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998;158(20):2200-2211.
39. Bauer R, Wagner H. Echinacea species as potential immunostimulatory drugs. In: Wagner H, Farnsworth NR, editors. Economic and Medicinal Plant Research. New York: Academic Press, 1991: 253-321.
40. Stimpel M, Proksch A, Wagner H, et al. Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infect Immun 1984;46(3):845-849.
41. Mose JR. [Effect of Echinacin on phagocytosis and natural killer cells]. Med Welt 1983;34(51-52):1463-1467.
42. Burger RA, Torres AR, Warren RP, et al. Echinacea-induced cytokine production by human macrophages. Int J Immunopharmacol 1997;19(7):371-379.
43. Burger RA, Torres AR, Warren RP, et al. Echinacea purpurea induced cytokine production in human peripheral blood adherent mononuclear cells (PBAC). J Allergy Clin Immun 1997:99(1, part 2):283.
44. Luettig B, Steinmuller C, Gifford GE, et al. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea. J Natl Cancer Inst 1989;81(9):669-675.
45. Jurcic K, Melchart D, Holzmann M. Two proband studies for the stimulation of granulocyte phagocytosis through echinacea extract containing preparations. Z Phytoterapie 1989;10:67-70.
46. Bany J, Siwicki AK, Zdanowska D, et al. Echinacea purpurea stimulates cellular immunity and anti-bacterial defence independently of the strain of mice. Pol J Vet Sci 2003;6(3 Suppl):3-5.
47. See DM, Broumand N, Sahl L, et al. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology 1997;35(3):229-235.
48. Bodinet C, Willigmann I, Beuscher N. Host-resistance increasing activity of root extracts from Echinacea species. Planta Med 1993;59(Suppl):a672-a673.
49. Tragni E, Tubaro A, Melis S, et al. Evidence from two classic irritation tests for an anti-inflammatory action of a natural extract, Echinacina B. Food Chem Toxicol 1985;23(2):317-319.
50. Tubaro A, Tragni E, Del Negro P, et al. Anti-inflammatory activity of a polysaccharidic fraction of Echinacea angustifolia. J Pharm Pharmacol 1987;39(7): 567-569.
51. Tunnerhoff FK, Schwabe HK. Studies in human beings and animals on the influence of echinacea extracts on the formation of connective tissue following the implantation of fibrin. Arzneim Forsch 1956;6:330-334.
52. Rehman J, Dillow JM, Carter SM, et al. Increased production of antigen-specific immunoglobulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett 1999;68(2-3): 391-395.
53. Steinmuller C, Roesler J, Grottrup E, et al. Polysaccharides isolated from plant cell cultures of Echinacea purpurea enhance the resistance of immunosuppressed mice against systemic infections with Candida albicans and Listeria monocytogenes. Int J Immunopharmacol 1993;15(5):605-614.
54. Wacker A, Hilbig W. [Virus-inhibition by echinacea purpurea (author's transl)]. Planta Med 1978;33(1):89-102.
55. Thompson KD. Antiviral activity of Viracea against acyclovir susceptible and acyclovir resistant strains of herpes simplex virus. Antiviral Res 1998;39(1):55-61.
56. Voaden DJ, Jacobson M. Tumor inhibitors. 3. Identification and synthesis of an oncolytic hydrocarbon from American coneflower roots. J Med Chem 1972;15(6): 619-623.
57. Melchart D, Linde K, Worku F, et al. Immunomodulation with echinacea - a systematic review of controlled clinical trials. Phytomed 1994;1:245-254.
58. Dorn M. Milderung grippaler Infekte durch ein pflanzliches Immunstimulans [Treatment of influenza-like syndromes with a phytotherapeutic immunostimulatory preparation]. Natur-und-Ganzheitsmedizin 1990:2:314-319.
59. Bräunig B, Knick E. [Therapeutic experiences with Echinacea pallida in upper respiratory tract infections]. Naturheilpraxis 1993;1:72-75.
60. Vorberg G, Schneider B. Pflanzliches Immunstimulans verkürzt grippalen Infekt. Doppelblindstudie belegt die Steigerung der unspezifischen Infektabwehr [Phytotherapeutic immunostimulator decreases the duration of influenza-like syndromes. Double-blind trial proves the enhancement of unspecific immune defense]. Ärztliche Forschung 1989;36:3-8.
61. Reitz HD. Immunodulatoren mit pflanzlichen Wirkstoffen: eine wissenschaftliche Studie am Beispiel Esberitox N [Immunomodulation with phytotherapeutic agents: a scientific study on the example of Esberitox]. Notabene medici 1990;20:362-366.
62. Vorberg G. Bei Erkältung unspezifische Immunabwehr stimulieren. [Stimulation of the immune defense in common colds]. Ärztliche Praxis 1984;36:97-98.
63. Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory tract infection. J Fam Pract 1999;48(8):628-635.
64. Brinkeborn R, Shah D, Geissbuhler S, et al. Echinaforce in the treatment of acute colds. Results of a placebo-controlled double-blind study carried out in Sweden. Schweiz Zschr Ganzheits Medizin 1998;10:26-29.
65. Hoheisel O, Sandberg M, Bertram S, et al. Echinacea treatment shortens the course of the common cold: a double blind, placebo-controlled clinical trial. European J Clin Research 1997;9:261-269.
66. Giles JT, Palat CT, III, Chien SH, et al. Evaluation of echinacea for treatment of the common cold. Pharmacotherapy 2000;20(6):690-697.
67. Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1998;7(6):541-545.
68. Grimm W, Muller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Am J Med 1999;106(2):138-143.
69. Melchart D, Linde K, Fischer P, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2000;(2):CD000530.
70. Henneicke-von Zepelin H, Hentschel C, Schnitker J, et al. Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double blind, placebo controlled, multicentre study. Curr Med Res Opin 1999;15(3):214-227.
71. Thom E, Wollan T. A controlled clinical study of Kanjang mixture in the treatment of uncomplicated upper respiratory tract infections. Phytother Research 1997; 11:207-210.
72. Scaglione F, Lund B. Efficacy in the treatment of the common cold of a preparation containing an echinacea extract. International J Immunother 1995;11(4):163-166.
73. Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002;137(12):939-946.
74. Millea PJ. Echinacea for the common cold. Ann Intern Med 2003;139(7):601.
75. Shober S. Echinacea for the common cold. Ann Intern Med 2003;139(7):600.
76. Mittman P, Wollner D, Kim L. Echinacea for the common cold. Ann Intern Med 2003;139(7):600-601.
77. Russo EB. Echinacea for the common cold. Ann Intern Med 2003;139(7):599.
78. Applequist WL. Echinacea for the common cold. Ann Intern Med 2003; 139(7):599-600.
79. Abrahams SG. Echinacea for the common cold. Ann Intern Med 2003;139(7): 599.
80. Schmidt U, Albrecht M, Schenk N. Immunstimulas senkt Häufigkeit grippaler Infekte. Plazebokontrollierte Doppelblindstudie mit einem kombinierten Echinacea-Präparat mit 646 Studenten der Kölner Universität. [Immunstimulator decreases the frequency of influenza-like syndromes. Double-blind placebo-controlled trial on 646 students of the University of Cologne]. Natur- und Ganzheitsmedizin 1990;3:277-281.
81. Schoneberger D. [The influence of immune-stimulating effects of pressed juice from Echinacea purpurea on the course and severity of colds. Results of a double-blind study]. Forum Immunologie 1992;8(18):2-12.
82. Forth H, Beuscher N. [Effect on the frequency of banal cold infections by esberitox]. ZFA (Stuttgart) 1981;57(32):2272-2275.
83. Turner RB, Riker DK, Gangemi JD. Ineffectiveness of echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother 2000;44(6): 1708-1709.
84. Freyer HU. [Incidence of banal infections in childhood and possibilities of their prevention]. Fortschr Med 1974;92(4):165-168.
85. Kleinschmidt H. Versuche zur herabsetzung der infektneigung bei kleinkindern mit esberitox. Therapie ger Gegenwart 1965;104:1258-1262.
86. Helbig G. Unspezifische Reizkörpertherapie zur Infektprophylaxe. Medizinische Klinik 1961;35:1512-1514.
87. Berg A, Northoff H, Konig D, et al. Influence of Echinacin (EC31) treatment on exercise-induced immune response in athletes. J Clin Res 1998;1:367-380.
88. Bendel R, Bendel V, Renner K, et al. [Supplementary treatment with Esberitox of female patients undergoing curative adjuvant irradiation following breast cancer]. Strahlenther Onkol 1988;164(5):278-283.
89. Sartor KJ. [Efficacy of Esberitox in the treatment of radiation-induced leukopenia]. Ther Ggw 1972;111(8):1147-1150.
90. Pohl P. [Treatment of radiation-induced leukopenia with Esberitox]. Ther Ggw 1970;109(6):902-906.
91. Bendel R, Bendel V, Renner K, et al. [Additional treatment with Esberitox N in patients with chemo- radiotherapy treatment of advanced breast cancer]. Onkologie. 1989;12 Suppl 3:32-38.
92. Elsasser-Beile U, Willenbacher W, Bartsch HH, et al. Cytokine production in leukocyte cultures during therapy with Echinacea extract. J Clin Lab Anal 1996; 10(6):441-445.
93. Firenzuoli F, Gori L. Echinacea for treating colds in children. JAMA 2004; 291(11):1323-1324.
94. Kim L, Wollner D, Anderson P, et al. Echinacea for treating colds in children. JAMA 2004;291(11):1323.
95. Vonau B, Chard S, Mandalia S, et al. Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? Int J STD AIDS 2001;12(3):154-158.