Echinacea
Pooled prevention trials report 10% to 35% fewer colds or respiratory infections, with heterogeneous products. Cold duration did not differ from placebo in two reviews and a 719-person trial. In children, a 2025 meta-analysis found slightly shorter illness, fewer antibiotics and more adverse events, mostly mild. Allergic reactions, sometimes severe, appear in case reports.
Add to Bio HackChecked 2026-11-09
- Status
- Dietary supplement in the US. Not approved as a drug for any use.
- Also called
- Echinacea purpurea, Echinacea angustifolia, Echinacea pallida, purple coneflower, Echinaforce, Echinilin
- Taken for
- colds, flu, immunity, upper respiratory infections, cold prevention, sore throat
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help0
No benefit shown in research yet.
Reported risks2
- ModerateShown to raise mild adverse events in children, with rash in 7.1% of treated infections against 2.7% on placebo in one trial.How often is not known
- LimitedCase reports: rare allergic reactions, which may be severe. Gastrointestinal upset and rash were the most frequent adverse events reported.How often is not known
What people take it for, and what was found
Mixed results2
Preventing colds and respiratory infections
Mixed results: a Cochrane review found no single prevention comparison significant, while pooled analyses suggested about 10% to 35% fewer infections.
The numbers and sources
- Effect
- A Cochrane review of 24 trials (4,631 participants) found none of 12 prevention comparisons reached significance alone, and a post hoc pooling suggested a 10% to 20% relative risk reduction [1]. A 2019 meta-analysis found a risk ratio of 0.78 (95% CI 0.68 to 0.88) for infection [2]. A third meta-analysis of 6 studies (2,458 participants) reported a risk ratio of 0.649 (95% CI 0.545 to 0.774) for recurrent infections and 0.503 for complications such as pneumonia and ear infections [3].
- Population
- Otherwise healthy children and adults [1][2][3].
- Sources
- [1], [2], [3]
- Caveats
- Products differed widely in species, plant part and extraction [1]. The Cochrane authors call potential effects of questionable clinical relevance [1]. Review [2] lists selective reporting and protocol deviations. Review [3] used a fixed-effect model and its abstract does not report funding.
Respiratory infections in children
Mixed results: a meta-analysis found fewer infections and less antibiotic use in children, while the largest single trial found no difference in duration or severity.
The numbers and sources
- Effect
- A 2025 meta-analysis of 9 RCTs (1,518 children on Echinacea purpurea, 1,651 on placebo) found shorter treatment duration for upper respiratory infections (SMD -0.19, 95% CI -0.30 to -0.09), fewer episodes (RR 0.81, 95% CI 0.75 to 0.87) and less antibiotic use (RR 0.18, 95% CI 0.13 to 0.25). Ear infection episodes fell (RR 0.56, 95% CI 0.44 to 0.73), and ear infection treatment duration did not change (p 0.10) [5]. A 2025 systematic review of 5 RCTs rated the evidence high certainty for shorter symptoms and fewer antibiotics and moderate certainty for preventing infection [6]. In one trial of 407 children aged 2 to 11 with 707 upper respiratory infections, duration, severity, peak severity and days of fever did not differ between Echinacea purpurea and placebo [7].
- Population
- Children in 9 RCTs [5] and 5 RCTs [6]; 407 healthy children in one trial [7].
- Sources
- [5], [6], [7]
- Caveats
- The duration effect is small (SMD -0.19). Products varied in plant part and dosage form, and the funnel plot showed bias linked to heterogeneity [5]. The 5-trial review found some concerns of bias in randomization, allocation concealment, blinding and selective reporting, and did not pool results [6]. The largest single trial found no difference [7].
Not shown to help1
How long a cold lasts
Not shown to shorten colds in people with new colds. Only 1 of 7 treatment trials found echinacea better than placebo.
The numbers and sources
- Effect
- Of 7 treatment trials reporting cold duration, only 1 found echinacea better than placebo [1]. A 2019 meta-analysis found a mean difference of -0.45 days, with a confidence interval crossing zero [2]. In 719 patients aged 12 to 80, blinded echinacea shortened colds by a nonsignificant 0.53 days (95% CI -1.25 to 0.19) and lowered global severity by a nonsignificant 28 points [4].
- Population
- People with new-onset colds [1][2][4].
- Sources
- [1], [2], [4]
- Caveats
- The 719-person trial had more variability than expected, which limited power to detect small effects. It was funded by the NIH's National Center for Complementary and Alternative Medicine [4].
Doses studied
The 719-person treatment trial gave the equivalent of 10.2 g of dried echinacea root in the first 24 hours and 5.1 g a day for the next 4 days [4]. The children's trial started the product at symptom onset for up to 10 days per infection [7]. A 4-month prevention trial in 755 adults used an alcohol extract of fresh Echinacea purpurea, 95% aerial parts and 5% root [8].
Risks
Reported risks2
Rash and adverse events in children
Shown to raise mild adverse events in children, with rash in 7.1% of treated infections against 2.7% on placebo in one trial.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In the 9-trial pediatric meta-analysis, adverse events were more frequent on Echinacea purpurea (RR 1.38, 95% CI 1.08 to 1.78) and were generally mild [5]. In one trial, rash occurred during 7.1% of infections treated with echinacea and 2.7% on placebo (p 0.008), and the overall adverse event rate did not differ [7]. The 5-trial review reported mild gastrointestinal discomfort and skin rashes [6].
- Population
- Children in 9 RCTs [5] and 5 RCTs [6]; 407 children aged 2 to 11 [7].
- Sources
- [5], [6], [7]
- Caveats
- The meta-analysis authors call the pediatric safety profile unclear [5].
Allergic reactions
Case reports: rare allergic reactions, which may be severe. Gastrointestinal upset and rash were the most frequent adverse events reported.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- A systematic review of trials, spontaneous reporting programs, WHO data and manufacturer files found gastrointestinal upset and rash to be the most frequent adverse events. In rare cases, echinacea was associated with allergic reactions that may be severe [9].
- Population
- Clinical studies and spontaneous reports [9].
- Sources
- [9]
- Caveats
- Spontaneous reports cannot give a rate. The review found little data on use in pregnancy and lactation [9].
Checked, no increase found1
Adverse events in trials
Adverse events were about as common as on placebo across trials, and slightly less common in a 48-trial review. Serious events were rare.
The numbers and sources
- How common
- How often is not known: the sources give no rate.
- Effect
- In the Cochrane review, dropouts and adverse effects did not differ significantly from placebo, with a trend toward more dropouts for adverse events in prevention trials [1]. A 2019 meta-analysis found a risk ratio of 1.09 (95% CI 0.95 to 1.25) for adverse events [2]. In a 4-month trial of 755 adults, there were 293 adverse events on echinacea and 306 on placebo [8]. A 2026 meta-analysis of 48 trials (10,115 participants) found adverse events in 22.7% on echinacea and 24.8% on any control (p 0.014), and 29.1% against 32.3% when the control was placebo (p 0.005). Serious adverse events made up 0.09% of events on echinacea and 0.08% on control, with none fatal. In European spontaneous reports, the most common categories were gastrointestinal (17.7%), skin (16.1%), general (13.1%) and nervous system (10.3%, such as headache) [10].
- Population
- Trial participants [1][2][8][10]; EudraVigilance case reports [10].
- Sources
- [1], [2], [8], [10]
- Caveats
- Most trials were short. The 755-person trial tested Echinaforce, made by A. Vogel Bioforce AG, and its corresponding author's address is at bioforce.ch [8]. The 2026 meta-analysis mostly covered pharmaceutical-grade extracts, and its abstract does not report funding [10].
Claims tested and not found
Sources
- Karsch-Völk M, Barrett B, Kiefer D, et al. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.CD000530.pub3
- David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complementary Therapies in Medicine. 2019. https://doi.org/10.1016/j.ctim.2019.03.011
- Schapowal A, Klein P, Johnston SL. Echinacea Reduces the Risk of Recurrent Respiratory Tract Infections and Complications: A Meta-Analysis of Randomized Controlled Trials. Advances in Therapy. 2015. https://doi.org/10.1007/s12325-015-0194-4
- Barrett B, Brown R, Rakel D, et al. Echinacea for Treating the Common Cold: A Randomized Trial. Annals of Internal Medicine. 2010. https://doi.org/10.7326/0003-4819-153-12-201012210-00003
- Pham TP, Vu TM, Doan PM, et al. Efficacy and safety of Echinacea purpurea in treating upper respiratory infections and complications of otitis media in children: Systematic review and meta-analysis. Clinical Nutrition ESPEN. 2025. https://doi.org/10.1016/j.clnesp.2025.04.025
- Mazi A, Alqahtani RM. Role of Echinacea in the management and prevention of acute respiratory tract infections in children: A systematic review of the evidence. Journal of Family and Community Medicine. 2025. https://doi.org/10.4103/jfcm.jfcm_144_25
- 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. https://doi.org/10.1001/jama.290.21.2824
- Jawad M, Schoop R, Suter A, et al. Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial. Evidence-Based Complementary and Alternative Medicine. 2012. https://doi.org/10.1155/2012/841315
- Huntley AL, Thompson Coon J, Ernst E. The Safety of Herbal Medicinal Products Derived from Echinacea Species: A Systematic Review. Drug Safety. 2005. https://doi.org/10.2165/00002018-200528050-00003
- Ogal M, Willcox M, Bauer R, et al. Safety of Oral Echinacea Preparations: Systematic Review and Meta-Analysis in the Context of Therapeutic Benefit. Planta Medica. 2026. https://doi.org/10.1055/a-2992-1199