Elderberry vs echinacea for colds: what the trials found

The early elderberry trials were small. In a Norwegian flu-season trial, 60 adults with flu-like symptoms took 15 ml of elderberry syrup or placebo four times a day for five days; symptoms were relieved about four days earlier with elderberry Zakay 2004. A 2019 meta-analysis reported a large effect on upper respiratory symptoms, but pooled only 180 participants Hawkins 2019.

For colds specifically, the largest trial followed 312 economy-class passengers flying from Australia. Colds were a little less common with elderberry (12 versus 17), but that difference was not significant. The colds that did happen were shorter (57 versus 117 cold days in total) and had lower symptom scores than in the placebo group Tiralongo 2016.

Then came a stricter test. A 2020 US trial of 87 emergency-room patients with lab-confirmed flu found no benefit on how long symptoms lasted or how bad they were; the authors said their results contradict the earlier studies Macknin 2020. NCCIH sums up the evidence as preliminary: elderberry may relieve symptoms of flu, colds or other upper respiratory infections NCCIH. That is a limited grade.

Echinacea has many more trials. The Cochrane review included 24 double-blind trials with 4,631 participants, testing a wide variety of products made from different species and parts of the plantKarsch 2014.

• Once you have a cold: of seven treatment trials that reported how long colds lasted, only one found a significant benefit over placebo. The reviewers concluded echinacea products have not been shown to provide benefits for colds once started Karsch 2014.
• Catching one in the first place: none of 12 prevention comparisons was significant on its own, but a pooling of their results done after the fact suggested a 10 to 20% lower relative risk, an effect the authors called of questionable clinical relevance Karsch 2014.

NCCIH reads it the same way: echinacea may slightly reduce your chances of catching a cold, and it is still unclear whether it can shorten one NCCIH. So on this page's question, shorter and milder colds, echinacea is graded not supported, and elderberry edges it only because one trial points the right way.

Little is known about whether elderberry is safe for health purposes in pregnancy or while breastfeedingNCCIH. The FDA and FTC have acted against companies marketing elderberry with unsupported COVID-19 claims, and there is no good evidence for that use NCCIH.

Echinacea is a relative of sunflowers, daisies and ragweed. Some people have allergic reactions to it, which may be severe, and the most common side effects are stomach symptoms such as abdominal pain and nausea. Some children in a trial developed rashes, so talk with a child's clinician first. There are theoretical reasons to suspect echinacea might interact with immunosuppressants or caffeine. Some extracts may be safe for up to 7 days in the first trimester of pregnancy, but ask your provider NCCIH. See echinacea and immunosuppressants.

Most colds get better on their own. For a child over one year old with a night cough, honey has better evidence than either herb; see honey vs cough medicine. The colds page covers the rest of the kitchen options and the signs that mean a call to your clinician.

If you want to try one anyway, buy a single-ingredient product so you know what you are taking. iHerb elderberry syrups and iHerb echinacea teas list options; check the label for species and plant part on echinacea, since the trials used many different ones.