Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated February 8, 2017

Echinacea spp

What is it?

Description

Echinacea species are flowering plants that belong to the Aster (Asteraceae or Compositae) family.

Names

The species most commonly used as medicinal herbs are E. purpurea, E. angustifolia and E.pallida. Common names include American coneflower, coneflower, purple coneflower, pale coneflower. Brand names include Echinagard, Echinacin, Echinaforce, Echinaid.1,2

Ingredients

Several groups of active constituents have been identified: Glycoproteins, alkylamides (also known as alkamides), polysaccharides including arabinogalactan and heteroxylan, and phenolic substances – caffeic acid and related compounds such as cynarine, echinacosides, chlorogenic acid, chicoric acid.1,2,3 The amount of each of the constituents found in the three species in medicinal use varies.3,4

Administration and dosage

Echinacea is most frequently taken orally. It may also be applied topically for treatment of small superficial wounds.5 Injectable preparations have been used in research studies but are not generally available and have been associated with severe reactions.2 For oral administration, echinacea may be given as a tablet or capsule, as herb juice or tea, or as a tincture. Various dosages have been used depending on the formulation but these generally relate to use for the prevention or treatment of the common cold or influenza.1,2 Recommended doses tend to be based on historical practice.2 Use in children less than 12 is not recommended and echinacea is contra-indicated in those less than 1 year.5 Preparations (extracts and whole-plant products) are produced from the roots or above ground parts of E. purpurea, E. angustifolia and E.pallida. Products available as echinacea vary in composition depending on the species, parts of the plant used and the extraction method used in production.6

History/provider(s)

Echinacea species are native to North America and were originally used as traditional herbal remedies by indigenous American populations for many different conditions.2,7 European settlers learned of their medicinal use and subsequently adopted them for their own use.7 Echinacea preparations continued to be used in Europe, particularly Germany.7 Interest in herbs such as echinacea has increased in recent years due to increased antibiotic resistance and the limitations of anti-viral agents for common infections such as colds and flu. Echinacea preparations are prescribed by herbal practitioners but are also widely available to purchase for self-treatment. Use of echinacea for cancer is documented in texts reporting traditional use data related to the Eclectics, a group of practitioners in the United States in the late 19th and early 20th centuries.8

Claims of efficacy/Alleged indication(s)

The main claim related to echinacea is that it boosts the body’s immune system by stimulating the activity of macrophages and natural killer cells. It is promoted mainly for the treatment of infections or other conditions where stimulation of the immune system is considered to be beneficial.1 These include colds, influenza, other respiratory infections, urinary tract infections, vaginal candidiasis (‘thrush’) and treatment of superficial wounds. It is also promoted as a general ‘immune-stimulant’.2 Some therapists have also claimed that echinacea can help relieve adverse effects of chemotherapy and radiotherapy used in the treatment of cancer.9 It has also been used in an effort to prolong survival time in patients with advanced hepatocellular carcinoma and colorectal cancer.1

Mechanism(s) of action

The exact mechanism of action for the effects of echinacea preparations on the immune system is unclear. The main action of Echinacea purpurea is considered to be stimulation of the non-specific immune system, particularly phagocytosis by macrophages and the activity of natural killer cells.5 Commercial preparations of echinacea juice have been shown to increase cytokine production by macrophages.10 A series of in-vitro studies have demonstrated that Echinacea purpurea stimulates various immune cells including macrophages, polymorphnuclear granulocytes and natural killer cells.7 Effects on T-cell and B-cell activation and proliferation are less clear. Several constituents of echinacea are considered to play a role in its effects on the immune system.6,11,12,13 However, the findings from in-vitro and ex-vivo studies have not always been reflected in clinical studies.14,15 Recent research suggests that the action of Echinacea purpurea varies depending on the portion of the plant used and the extraction method.16

Prevalence of use

Echinacea is one of the most widely used herbs in USA and European countries. In 2002, it was the most frequently used herb in the USA being used by over 40% of the population in the previous year.17 By 2007 use had declined to approximately 20% of the population.18 Use is primarily for the prevention or treatment of viral upper respiratory tract infections. A large European survey confirmed that echinacea was among the herbs used by cancer patients but the extent of use or specific reason for use was not reported.19 Other surveys suggested that the main reason for use by cancer patients is to boost the immune system.20,21

Legal issues

Echinacea products are widely available in pharmacies, health food and grocery stores and on the internet. Echinacea purpurea (l.) moench, and herba recens have been adopted by the European Medicines Agency’s Committee on Herbal Medicinal Products (HMPC).5 The use of Echinacea purpurea for the short-term prevention and treatment of the common cold is classed as well-established use and the treatment of small superficial wounds as traditional use.5

Cost(s) and expenditures

Typical costs are £10 (12 Euros, US prices $12-16) for a 50ml bottle of liquid extract and £10 (12 Euros, US prices $12-16) for 60 tablets. Doses are not well-established except for use in upper respiratory tract infections.

Citation Karen Pilkington, CAM-Cancer Consortium. Echinacea spp [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Echinacea-spp. February 8, 2017.

References

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