Echinacea

Echinacea /ˌɛkɪˈneɪʃiə/[1] is a genus, or group of herbaceous flowering plants in the daisy family. The genus Echinacea has ten species, which are commonly called coneflowers. They are found only in eastern and central North America, where they grow in moist to dry prairies and open wooded areas. They have large, showy heads of composite flowers, blooming the entire summer. The generic name is derived from the Greek word ἐχῖνος (ekhinos), meaning "sea urchin", due to the spiny central disk. These flowering plants and their parts have different uses. Some species are cultivated in gardens for their showy flowers. Echinacea purpurea is used in folk medicine.[2] Two of the species, E. tennesseensis and E. laevigata, are listed in the United States as endangered species.[3]

This article is about the flowering plant. For the sea urchins, see Echinacea (animal).

Echinacea
Echinacea purpurea 'Maxima'
Scientific classification
Kingdom: Plantae
Clade: Tracheophytes
Clade: Angiosperms
Clade: Eudicots
Clade: Asterids
Order: Asterales
Family: Asteraceae
Subfamily: Asteroideae
Supertribe: Helianthodae
Tribe: Heliantheae
Genus: Echinacea
Moench, 1794
Synonyms

Brauneria Necker ex T.C.Porter & Britton
Helichroa Raf.

Description
The spiny center of the head showing the paleae, from which the name derives
A bee on an Echinacea paradoxa head (inflorescence)
A bee on an Echinacea purpurea head

Echinacea species are herbaceous, drought-tolerant perennial plants growing up to 140 cm or 4 feet,[4] in height. They grow from taproots, except E. purpurea, which grows from a short caudex with fibrous roots. They have erect stems that in most species are unbranched. Both the basal and cauline (stem) leaves are arranged alternately. The leaves are normally hairy with a rough texture, having uniseriate trichomes (1–4 rings of cells) but sometimes they lack hairs. The basal leaves and the lower stem leaves have petioles, and as the leaves progress up the stem the petioles often decrease in length. The leaf blades in different species may have one, three or five nerves. Some species have linear to lanceolate leaves, and others have elliptic- to ovate-shaped leaves; often the leaves decrease in size as they progress up the stems. Leaf bases gradually increase in width away from the petioles or the bases are rounded to heart shaped. Most species have leaf margins that are entire, but sometimes they are dentate or serrate.

The flowers are collected together into single rounded heads at the ends of long peduncles. The inflorescences have crateriform to hemispheric shaped involucres which are 12–40 mm wide. The phyllaries, or bracts below the flower head, are persistent and number 15–50. The phyllaries are produced in a 2–4 series. The receptacles are hemispheric to conic. The paleae (chaffs on the receptacles of many Asteraceae) have orange to reddish purple ends, and are longer than the disc corollas. The paleae bases partially surrounding the cypselae, and are keeled with the apices abruptly constricted to awn-like tips. The ray florets number 8–21 and the corollas are dark purple to pale pink, white, or yellow. The tubes of the corolla are hairless or sparsely hairy, and the laminae are spreading, reflexed, or drooping in habit and linear to elliptic or obovate in shape. The abaxial faces of the laminae are glabrous or moderately hairy. The flower heads have typically 200–300 fertile, bisexual disc florets but some have more. The corollas are pinkish, greenish, reddish-purple or yellow and have tubes shorter than the throats. The pollen is normally yellow in most species, but usually white in E. pallida. The three or four-angled fruits (cypselae), are tan or bicolored with a dark brown band distally. The pappi are persistent and variously crown-shaped with 0 to 4 or more prominent teeth. x = 11.[5]

Like all members of the sunflower family, the flowering structure is a composite inflorescence, with rose-colored (rarely yellow or white) florets arranged in a prominent, somewhat cone-shaped head – "cone-shaped" because the petals of the outer ray florets tend to point downward (are reflexed) once the flower head opens, thus forming a cone. Plants are generally long lived, with distinctive flowers. The common name "cone flower" comes from the characteristic center "cone" at the center of the flower head. The generic name Echinacea is rooted in the Greek word ἐχῖνος (echinos), meaning hedgehog,[6] in reference to the spiky appearance and feel of the flower heads.

Species

DNA analysis is applied to determine the number of Echinacea species, allowing clear distinctions among species based on chemical differences in root metabolites.[7] The research concluded that of the 40 genetically diverse populations of Echinacea studied, there were ten distinct species.

Species:[8]

Research

Echinacea products vary widely in composition.[9] They contain different species (E. purpurea, E. angustifolia, E. pallida), different plant segments (roots, flowers, extracts), different preparations (extracts and expressed juice), and different chemical compositions which complicate understanding of a potential effect.[10][11]

Well-controlled clinical trials are limited and low in quality.[11][12] Although there are multiple scientific reviews and meta-analyses published on the supposed immunological effects of Echinacea, there are significant variability of products used among studies leading to limited conclusions about effects and safety. Consequently, regulatory authorities such as the United States Food and Drug Administration have not approved echinacea safe and effective for any health or medical purposes.[2][11]

Common cold

While one 2014 systematic review found that Echinacea products are not effective to treat or prevent the common cold,[12] a 2016 meta-analysis found tentative evidence that use of Echinacea extracts reduced the risk of repeated respiratory infections.[13] A 2015 monograph by the European Medicines Agency stated that oral consumption of "expressed juice" or dried expressed juice of Echinacea could prevent or reduce symptoms of a common cold at its onset.[14] As of 2017, the benefit, if any, appears to be small and thus of little utility.[15]

Cancer

According to Cancer Research UK, "There is no scientific evidence to show that echinacea can help treat, prevent or cure cancer in any way. Some therapists have claimed that echinacea can help relieve side effects from cancer treatments such as chemotherapy and radiotherapy, but this has not been proven either."[16]

Side effects

When taken by mouth, Echinacea does not usually cause side effects,[2] but may have undesirable interactions with various drugs prescribed for diseases, such as heart disease, bleeding, and autoimmune diseases, such as rheumatoid arthritis, lupus, or psoriasis.[17][18] Although there are no specific case reports of drug interactions with Echinacea,[19] safety about taking Echinacea supplements is not well-understood, with possibilities that it may cause side effects, such as nausea, stomach upset or diarrhea, and that it may have adverse reactions with other medications.[17] One of the most extensive and systematic studies to review the safety of Echinacea products concluded that overall, "adverse events are rare, mild and reversible," with the most common symptoms being "gastrointestinal and skin-related."[20] Such side effects include nausea, abdominal pain, diarrhea, itch, and rash.[18] Echinacea has also been linked to allergic reactions, including asthma, shortness of breath, and one case of anaphylaxis.[20][21][22] Muscle and joint pain has been associated with Echinacea, but it may have been caused by cold or flu symptoms for which the Echinacea products were administered.[20] There are isolated case reports of rare and idiosyncratic reactions including thrombocytopenic purpura, leucopenia, hepatitis, kidney failure, and atrial fibrillation, although it is not clear that these were due to Echinacea itself.[17] Up to 58 drugs or supplements may interact with Echinacea.[18]

As a matter of manufacturing safety, one investigation by an independent-consumer testing laboratory found that five of eleven selected retail Echinacea products failed quality testing. Four of the failing products contained levels of phenols below the potency level stated on the labels. One failing product was contaminated with lead.[23]

Children under 12 years old

The European Herbal Medicinal Products Committee (HMPC) and the UK Herbal Medicines Advisory Committee (HMAC) recommended against the use of Echinacea-containing products in children under the age of 12. Manufacturers re-labelled all oral Echinacea products that had product licenses for children with a warning that they should not be given to children under 12 as a precautionary measure.[24]

Pregnancy

Although research has not found increased risk of birth defects associated with use of Echinacea during the first trimester, it is recommended that pregnant women should avoid Echinacea products until stronger safety supporting evidence becomes available.[17]

Lactation

It is recommended that women breastfeeding should use caution with Echinacea products due to insufficient safety information available.[17]

General precaution

The U.S. Food and Drug Administration recommends precaution about using dietary supplements because some products may not be risk free under certain circumstances or may interact with prescription and over-the-counter medicines.[25]

As with any herbal preparation, individual doses of Echinacea may vary significantly in chemical composition.[2] Inconsistent process control in manufactured echinacea products may involve poor inter- and intra-batch homogeneity, species or plant part differences, variable extraction methods, and contamination or adulteration with other products, leading to potential for substantial product variability.[12][23]

Other uses

Some species of Echinacea, notably E. purpurea, E. angustifolia, and E. pallida, are grown as ornamental plants in gardens.[26] Many cultivars exist, and many of them are asexually propagated to keep them true to type.

Echinacea extracts inhibited growth of three species of trypanosomatids: Leishmania donovani, Leishmania major, and Trypanosoma brucei.[27]

History

Echinacea angustifolia was widely used by the North American indigenous peoples as folk medicine.[28] According to Wallace Sampson, its modern use for the common cold began when a Swiss herbal supplement maker was told that Echinacea was used for cold prevention by Native American tribes who lived in the area of South Dakota.[29] Some Plains tribes did use echinacea for cold symptoms. The Kiowa used it for coughs and sore throats, the Cheyenne for sore throats, the Pawnee for headaches, and many tribes including the Lakota used it as a pain medication.[30]

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See also
  • List of ineffective cancer treatments

References
  1. Sunset Western Garden Book, 1995:606–607
  2. "Echinacea: NCCIH Herbs at a Glance". National Center for Complementary and Integrative Health, US National Institutes of Health. September 2015.
  3. Kelly K. "The Conservation Status of Echinacea Species" (PDF). USDA. Retrieved 29 October 2014.
  4. 32
  5. "Echinacea in Flora of North America @". Efloras.org. Retrieved 2010-02-01.
  6. Plowden C (1972). A manual of plant names. London, Allen and Unwin, 1972. p. 47. ISBN 978-0-04-580008-7.
  7. Perry, Ann. 2010. Exploring Echinacea’s Enigmatic Origins. United States Department of Agriculture, Agricultural Research Service
  8. The Plant List search for Echinacea
  9. "The Common Cold and Complementary Health Approaches: What the Science Says". U.S. Department of Health and Human Services. 2011-11-17. Retrieved 1 November 2014.
  10. Barnes J, Anderson LA, Gibbons S, Phillipson JD (August 2005). "Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties". The Journal of Pharmacy and Pharmacology. 57 (8): 929–54. doi:10.1211/0022357056127. PMID 16102249.
  11. Hart A, Dey P (2009). "Echinacea for prevention of the common cold: an illustrative overview of how information from different systematic reviews is summarised on the internet". Preventive Medicine. 49 (2–3): 78–82. doi:10.1016/j.ypmed.2009.04.006. PMID 19389422.
  12. Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K (February 2014). "Echinacea for preventing and treating the common cold". The Cochrane Database of Systematic Reviews (Systematic review). 2 (2): CD000530. doi:10.1002/14651858.CD000530.pub3. PMC 4068831. PMID 24554461.
  13. Schapowal A, Klein P, Johnston SL (March 2015). "Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials". Advances in Therapy. 32 (3): 187–200. doi:10.1007/s12325-015-0194-4. PMID 25784510.
  14. "European Union herbal monograph on Echinacea purpurea (L.) Moench, herba recens" (PDF). Committee on Herbal Medicinal Products, European Medicines Agency. 24 November 2015. Retrieved 16 March 2018.
  15. "The Common Cold and Complementary Health Approaches". NCCIH. August 2017. Retrieved 3 November 2017.
  16. "Echinacea". Cancer Research UK. Archived from the original on September 30, 2012. Retrieved October 22, 2012.
  17. "Echinacea (Echinacea angustifolia DC, Echinacea pallida, Echinacea purpurea): Safety". Mayo Clinic. Retrieved 2011-09-05.
  18. "Echinacea". Drugs.com. 2017. Retrieved 2 November 2017.
  19. Izzo AA, Ernst E (2009). "Interactions between herbal medicines and prescribed drugs: an updated systematic review". Drugs. 69 (13): 1777–98. doi:10.2165/11317010-000000000-00000. PMID 19719333.
  20. Huntley AL, Thompson Coon J, Ernst E (2005). "The safety of herbal medicinal products derived from Echinacea species: a systematic review". Drug Safety. 28 (5): 387–400. doi:10.2165/00002018-200528050-00003. PMID 15853441.
  21. Mullins RJ (February 1998). "Echinacea-associated anaphylaxis". The Medical Journal of Australia. 168 (4): 170–1. doi:10.5694/j.1326-5377.1998.tb126773.x. PMID 9507713.
  22. Ang-Lee MK, Moss J, Yuan CS (July 2001). "Herbal medicines and perioperative care". JAMA. 286 (2): 208–16. doi:10.1001/jama.286.2.208. PMID 11448284.
  23. "Product Review: Echinacea". ConsumerLab.com, LLC. 18 March 2004. Retrieved 2 August 2007.
  24. "Press release: Echinacea herbal products should not be used in children under 12 years old". MHRA. Archived from the original on 2014-12-06.
  25. "Tips for Dietary Supplement Users". U.S. Food and Drug Administration. Retrieved 1 November 2014.
  26. "A Comprehensive Echinacea Germplasm Collection Located at the North Central Regional Plant Introduction Station", USDA
  27. Canlas J, Hudson JB, Sharma M, Nandan D (September 2010). "Echinacea and trypanasomatid parasite interactions: growth-inhibitory and anti-inflammatory effects of Echinacea". Pharmaceutical Biology. 48 (9): 1047–52. doi:10.3109/13880200903483468. PMID 20731557.
  28. Wishart DJ (2007). Encyclopedia of the Great Plains Indians. U of Nebraska Press. p. 156. ISBN 978-0-8032-9862-0.
  29. Study: Echinacea Cuts Colds by Half WebMD Health News, June 26, 2007
  30. Moerman DE (1998). Native American Ethnobotany. Timber Press. p. 205. ISBN 978-0-88192-453-4.

Further reading
  • Mowrey D (1998). Echinacea. McGraw-Hill Professional. ISBN 978-0-87983-610-8.
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