Echinacea: Herbal medicine as part of a winter health strategy: Dr Ross Walton, Immunologist and founder of clinical research company, A-IR reviews the building scientific research for the herb Echinacea and discusses how this easily accessible licensed herbal medicine may play a useful and valid role as part of a winter health strategy.
Echinacea purpurea is a herb that can be found on the shelf in the majority of the UK’s pharmacies and health stores. Currently licensed in the UK as a traditional herbal medicine to support immune health, and relieve upper respiratory tract symptoms of the common cold and influenza (such as sore throat, cough, runny nose, blocked nose / sinuses, fever), could this herb also help reduce infection and transmission of coronavirus strains past, present and future as we learn to live with COVID, as well as shortening the duration and severity of symptoms when infected?
The evidence for Echinacea is continuing to mount. There are over 30 peer- reviewed studies that support the growing evidence for a prophylactic role of Echinacea purpurea in preventing the incidence, severity and symptom duration of common cold and influenza viruses, as well as more recent research suggesting it could be an effective prophylactic treatment for a range of human coronaviruses.
In September 2020, Switzerland’s Spiez Laboratory published a study in Virology Journali revealing that a fresh, whole plant liquid extract of Echinacea purpurea could be effective as prophylactic treatment for a spectrum of human coronaviruses. The researchers investigated the activity of the Echinacea purpurea extract (Echinaforce®) In vitro against HCoV-229E (coronavirus strain causing seasonal common cold), MERS-CoV, SARS-CoV-1, as well as SARS-CoV-2 (COVID-19).
Results showed that the Echinacea purpurea extract is virucidal against HCoV-229E, upon direct contact and in pre-treatment of an organotypic cell culture model. Furthermore, MERS-CoV and both SARS-CoV-1 and SARS-CoV-2 were deactivated upon direct contact at similar concentrations of the extract.
These results suggest that Echinacea extract could play a role in reducing human coronavirus replication in the airways if applied to the upper airways and in a manner which allowed for direct virus contact; however, the subsequent effect on disease severity and duration are not understood, and further studies are required to fully determine treatment efficacy in a real- life setting.
In addition, a further paper demonstrated that antibiotic use may be reduced as a result of the use of Echinacea purpurea in the treatment of common colds and influenza. Twenty percent of influenza infections lead to complications, particularly in older people and those suffering from chronic disease. These secondary infections often result in more time off work and, in worse case scenarios, hospitalisation. Fear of complications is the main motive for antibiotic prescription by GPs, as well as pressure exerted by patients to be prescribed antibiotics. The overuse of antibiotics, leading to increasing numbers of antibiotic-resistant bacteria, is now a major global public health problem .
A third recent paper conducted retrospective analysis from two Echinacea prophylactic studies in adults and children. Here, it was demonstrated that within the groups receiving Echinacea during cold and flu season, where reductions in frequency and severity of colds were observed, there were also significant reductions in the number of endemic coronaviruses. This displays efficacy against typical coronaviruses which it is hoped, could be extrapolated to SARS-CoV-2.
The argument in support of the use of Echinacea purpurea for upper respiratory tract infections has been substantially enhanced during the past five years. An expanding number of pre-clinical studies have aimed to determine underlying mechanisms of action of what appears clearly a complex substance, whilst clinical trials endeavour to demonstrate all important clinical efficacy.
In 2012, 755 participants took part in the longest and largest trial thus far by the Common Cold Centre (Cardiff) on the preventative use of Echinacea (Echinaforce extract) over a 4-
month period  . The development of recurrent colds was reduced by 59 per cent as well as the severity of cold symptoms. The need to use painkillers also fell by over half. The number of colds reduced as well as the number of days cold symptoms were experienced. Echinacea was particularly beneficial to those most at risk of infection such as those prone to more than two colds per year, those with high stress levels, poor sleepers, and smokers.
Research conducted by Prof. Margaret Richie  at the University of St Andrews, highlighted that Echinacea purpurea adapts to individual needs; in those with lower level production of immune mediators, Echinacea purpurea is stimulatory, whereas in those with strong production, Echinacea purpurea lowers inflammatory mediators, supporting a more moderate, modulated response.
Meta-analysis data from six clinical trials with 2,458 participants presented at the Royal Society of Medicine, showed that Echinacea purpurea extract significantly reduces recurrent respiratory tract infections and consequently the risk for pneumonia, or bronchitis .
As the nation begins to get back on its feet, government officials have warned that we must continue to live with COVID-19 at a level with which we can tolerate, in the same way, that we live with influenza, and booster vaccinations are likely to be required. Whilst virus dissemination was suppressed during summer months, it did not disappear completely, therefore it could be beneficial to support immune health year-round as well as at peak infection times
This highlights the need for additional, safe, self-administered support treatments for infection that can augment the critical and ongoing vaccination program.
So, is Echinacea purpurea the answer? Further, fully controlled, larger population-based clinical studies are required to further evidence Echinacea’s efficacy and build on the existing data that shows the extract’s efficacy in reducing severe secondary complications and antibiotic prescription. However, this action, along with the broad virucidal and anti- viral capacity of Echinacea extracts, its efficacy against a large number of respiratory pathogens including importantly a number of different SARS-CoV-2 strains, and its favourable safety profile provides a compelling rationale for its additive use alongside vaccine-generated immunity strategies.
For optimal results, OTC herbal medicines should contain all parts of the plant, such as are found in Echinaforce Echinacea extract, produced by traditional herbal medicine brand A.Vogel, containing fresh, organic Echinacea plant and root. But not all Echinacea products are equal, so look for traditional herbal medicinal products that display the THR logo on pack, as this denotes that it has been assessed by the UKs Medicines and Herbal products Regulatory Agency (MHRA), checked for quality and safety, and carries an approved medicinal claim to relieve symptoms of the common cold and influenza.
 Jawad M et al. Safety and efficacy profile of Echinacea purpurea to prevent common cold episodes: A randomised, double-blind, placebo-controlled trial. Evidence-Based Complementary and Alternative Medicine 2012; doi: 10.1155/2012/841315
 Ritchie MR, Gertsch J, Klein P, Schoop R. Effects of Echinaforce Treatment on ex vivo Stimulated Blood Cells. Phytomedicine 2011; 18: 826-831
 Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015;32(3):187-200