Echinacea - Get the Facts on Herbal Supplements

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  • Studies have reported mixed results, and it is not clear whether echinacea has benefits for this use.<a href="#hdng0">(More...)</a>

  • Studies have come to conflicting conclusions as to whether the herb is truly effective.<a href="#hdng1">(More...)</a>

<a name="hdng0"></a>Studies have reported mixed results, and it is not clear whether echinacea has benefits for this use. <a href="" TARGET="_blank" [1]</a> Liver transplant patients who consume large amounts of echinacea may have increased liver enzyme activity, which often indicates liver damage. Although the relevance of this is not clear, liver transplant patients should use echinacea cautiously due to its potential hazards. At this time, echinacea cannot be recommended during pregnancy or breastfeeding. Although early studies show no effect of echinacea on pregnancy, there is not enough research in this area.<a href="" TARGET="_blank" [1]</a> Natural medicine practitioners sometimes caution that echinacea may lead to liver inflammation. Although there is no clear information from laboratory or human studies, in theory echinacea may add to liver toxicity caused by other agents, such as kava.<a href="" TARGET="_blank" [1]</a> Echinacea may affect the way certain drugs are broken down by the liver. In theory, echinacea's ability to stimulate the immune system may interfere with drugs that suppress the immune system (including azathioprine, cyclosporine, and steroids such as prednisone). Because clear human studies are lacking, people taking these drugs should consult a healthcare professional or pharmacist before using echinacea.<a href="" TARGET="_blank" [1]</a> Few side effects from echinacea are reported when it is used at the recommended doses. Reported complaints include stomach discomfort, nausea, sore throat, rash (allergic, hives, or painful lumps called "erythema nodosum"), drowsiness, headache, dizziness, and muscle aches. Rare cases of hepatitis (liver inflammation), kidney failure, or irregular heart rate (atrial fibrillation) have been reported in people taking echinacea, although it is not clear that these were due to echinacea itself.<a href="" TARGET="_blank" [1]</a> Caution should be used when combining echinacea by mouth with other medications that can harm the liver. Examples of such agents include anabolic steroids, amiodarone, methotrexate, acetaminophen (Tylenol®), and antifungal medications taken by mouth (such as ketoconazole).<a href="" TARGET="_blank" [1]</a> When applied on the skin, echinacea 15% pressed herb (non-root) juice semisolid preparation has been used daily for wounds and skin ulcers.<a href="" TARGET="_blank" [1]</a> Echinacea may be combined with goldenseal or other herbs in some cold relief preparations. There is a lack of high-quality human studies that have shown added benefits or interactions of these combinations.<a href="" TARGET="_blank" [1]</a> Echinacea has been studied alone and in combination preparations for immune system stimulation (including in patients receiving cancer chemotherapy). It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.<a href="" TARGET="_blank" [1]</a> Echinacea is sometimes used in combination products that are thought to stimulate the immune system.<a href="" TARGET="_blank" [1]</a>

In children, a combination of echinacea, propolis, and vitamin C has been reported to reduce the number and duration of cold episodes.<a href="" TARGET="_blank" [1]</a> There are fundamental differences in causes of upper respiratory tract infection symptoms in children versus adults (bacterial versus viral causes, different viruses, different sites of infection, etc). Until additional research is available, echinacea cannot be considered effective in children for this use. Development of rash has been associated with echinacea use, and therefore the risks may outweigh the potential benefits in this population.<a href="" TARGET="_blank" [1]</a> Echinacea has been associated with an increased incidence of rash in children. Therefore, the risks may outweigh potential benefits, and use in children is not recommended.<a href="" TARGET="_blank" [1]</a>

Initial research suggests that echinacea may not be helpful in children for alleviation of cold symptoms, possibly because parents are not able to recognize the onset of common cold symptoms soon enough to begin treatment, or because the dose of echinacea for use in children is not clear.<a href="" TARGET="_blank" [1]</a> Early information suggests that the use of echinacea with econazole nitrate cream (Spectazole®) on the skin may lower the frequency of vaginal yeast infections after treatment.<a href="" TARGET="_blank" [1]</a> Gillespie EL, Coleman CI. The effect of Echinacea on upper respiratory infection symptom severity and quality of life.<a href="" TARGET="_blank" [1]</a> Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study.<a href="" TARGET="_blank" [1]</a> Cohen HA, Varsano I, Kahan E, et al. Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study.<a href="" TARGET="_blank" [1]</a> 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.<a href="" TARGET="_blank" [1]</a> A common dosing range studied in trials is 500 to 1,000 milligrams of echinacea in capsule form taken by mouth three times daily for five to seven days.<a href="" TARGET="_blank" [1]</a> For URI prevention (prophylaxis), daily echinacea has not been shown effective in human trials.<a href="" TARGET="_blank" [1]</a> For URI treatment, numerous human trials have found echinacea to reduce duration and severity, particularly when initiated at the earliest onset of symptoms.<a href="" TARGET="_blank" [1]</a>

A 2006 meta-analysis investigating the efficacy of echinacea found that the likelihood of experiencing a clinical cold was 55% higher with placebo than with Echinacea (based on three trials).<a href="" TARGET="_blank" [1]</a> Schoop R, Klein P, Suter A, et al. Echinacea in the prevention of induced rhinovirus colds: a meta-analysis.<a href="" TARGET="_blank" [1]</a> Le Tourneau M. Echinacea fails to show efficacy in treating colds in a pediatric population.<a href="" TARGET="_blank" [1]</a>

Echinacea may affect the way certain herbs and supplements are broken down by the liver.<a href="" TARGET="_blank" [1]</a> Echinacea is sometimes sold in combination with goldenseal ( Hydrastis canadensis ), an herb that may reduce the body's ability to absorb vitamin B.<a href="" TARGET="_blank" [1]</a>

When echinacea is used at the same time as the prescription cream econazole nitrate (Spectazole®), vaginal yeast infections ( Candida ) may occur less frequently. Further research is needed to confirm this.<a href="" TARGET="_blank" [1]</a> Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections.<a href="" TARGET="_blank" [1]</a> Linde K, Barrett B, Wolkart K, et al. Echinacea for preventing and treating the common cold.<a href="" TARGET="_blank" [1]</a> Preliminary studies suggest that echinacea is not helpful for preventing the common cold in adults.<a href="" TARGET="_blank" [1]</a>

In children, echinacea cannot be recommended due to reports of rash and apparent lack of benefits in the available literature.<a href="" TARGET="_blank" [1]</a> The dosing and safety of echinacea have not been studied thoroughly in children. Parents considering echinacea for their children should discuss this decision with the child's healthcare provider before starting therapy.<a href="" TARGET="_blank" [1]</a> Based on one vague case report, taking echinacea along with amoxicillin may cause life-threatening reactions. The details of this case are not very clear.<a href="" TARGET="_blank" [1]</a> Severe reactions to injected echinacea have been reported, and echinacea injections are not recommended.<a href="" TARGET="_blank" [1]</a> Multiple cases of anaphylactic shock (severe allergic reactions) and allergic rash have been reported with echinacea taken by mouth.<a href="" TARGET="_blank" [1]</a> People with allergies to plants in the Asteraceae or Compositae family (ragweed, chrysanthemums, marigolds, daisies) are theoretically more likely to have allergic reactions to echinacea.<a href="" TARGET="_blank" [1]</a>

There is a lack of clear human evidence that echinacea affects any type of cancer.<a href="" TARGET="_blank" [1]</a> As an extract, 300 to 800 milligrams of echinacea has been taken by mouth two to three times daily for up to six months.<a href="" TARGET="_blank" [1]</a> Echinacea is commercially available as capsules, expressed juice, extract, tincture and tea.<a href="" TARGET="_blank" [1]</a> Echinacea may also interact with anesthetics, antineoplastics, and caffeine. These potential interactions are not fully understood.<a href="" TARGET="_blank" [1]</a> Kemp DE, Franco KN. Possible leukopenia associated with long-term use of echinacea.<a href="" TARGET="_blank" [1]</a> Initial human studies suggest that echinacea is not helpful in the treatment of genital herpes.<a href="" TARGET="_blank" [1]</a> Injected echinacea may alter blood sugar levels and cause severe reactions and should be avoided.<a href="" TARGET="_blank" [1]</a> In the United States, sales of echinacea are believed to represent approximately 10% of the dietary supplement market.<a href="" TARGET="_blank" [1]</a> Traditionally used for a range of infections and malignancies, the roots and herb (above ground parts) of echinacea species have attracted recent scientific interest due to purported "immune stimulant" properties. Oral preparations are popular in Europe and the United States for prevention and treatment of upper respiratory tract infections (URI), and Echinacea purpurea herb is believed to be the most potent echinacea species for this indication.<a href="" TARGET="_blank" [1]</a> Koenig K, Roehr CC. Does treatment with Echinacea purpurea effectively shorten the course of upper respiratory tract infections in children? Arch Dis Child 2006 June; 91(6):535-7.<a href="" TARGET="_blank" [1]</a> Narimanian M, Badalyan M, Panosyan V, et al. Randomized trial of a fixed combination (KanJang) of herbal extracts containing Adhatoda vasica, Echinacea purpurea and Eleutherococcus senticosus in patients with upper respiratory tract infections.<a href="" TARGET="_blank" [1]</a> The majority of trials, largely conducted in Europe, have been small or of weak design. Negative results exist of a U.S. trial in adults, which used a whole-plant echinacea preparation containing both Echinacea purpurea and Echinacea angustifolia. Another clinical trial reported in July 2005 also did not demonstrate any clinical benefit.<a href="" TARGET="_blank" [1]</a> Vonau B, Chard S, Mandalia S, et al. Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? Int J STD AIDS 2001;12(3):154-158.<a href="" TARGET="_blank" [1]</a>

Preliminary studies of echinacea taken by mouth for genital herpes and radiation-associated toxicity remain inconclusive. Topical Echinacea purpurea juice has been suggested for skin and oral wound healing, and oral/injectable echinacea for vaginal Candida albicans infections, but evidence is lacking in these areas. The German Commission E discourages the use of echinacea in patients with autoimmune diseases, but this warning is based on theoretical considerations rather than human data.<a href="" TARGET="_blank" [1]</a> Esberitox® (PhytoPharmica, Germany) contains Echinacea purpurea, Echinacea pallida, wild indigo root ( Baptisia tinctoria ), and thuja (white cedar).<a href="" TARGET="_blank" [1]</a>

Oral Echinacea purpurea may offer some benefits in people with low-grade uveitis. Further research is needed to confirm these findings.<a href="" TARGET="_blank" [1]</a>

Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial.<a href="" TARGET="_blank" [1]</a>

Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea: a randomized, double-blind, placebo-controlled trial.<a href="" TARGET="_blank" [2]</a> NCCAM is continuing to support the study of echinacea for the treatment of upper respiratory infections. NCCAM is also studying echinacea for its potential effects on the immune system.<a href="" TARGET="_blank" [2]</a> Fugh-Berman A. Echinacea for the prevention and treatment of upper respiratory infections.<a href="" TARGET="_blank" [2]</a>

Echinacea has traditionally been used to treat or prevent colds, flu, and other infections.<a href="" TARGET="_blank" [2]</a> Most studies to date indicate that echinacea does not appear to prevent colds or other infections.<a href="" TARGET="_blank" [2]</a> Two NCCAM-funded studies did not find a benefit from echinacea, either as Echinacea purpurea fresh-pressed juice for treating colds in children, or as an unrefined mixture of Echinacea angustifolia root and Echinacea purpurea root and herb in adults. Other studies have shown that echinacea may be beneficial in treating upper respiratory infections.<a href="" TARGET="_blank" [2]</a> 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.<a href="" TARGET="_blank" [2]</a> In clinical trials, gastrointestinal side effects were most common. People are more likely to experience allergic reactions to echinacea if they are allergic to related plants in the daisy family, which includes ragweed, chrysanthemums, marigolds, and daisies.<a href="" TARGET="_blank" [2]</a> People with asthma or atopy (a genetic tendency toward allergic reactions) may be more likely to have an allergic reaction when taking echinacea.<a href="" TARGET="_blank" [2]</a>

The aboveground parts of the plant and roots of echinacea are used fresh or dried to make teas, squeezed (expressed) juice, extracts, or preparations for external use.<a href="" TARGET="_blank" [2]</a> Echinacea is believed to stimulate the immune system to help fight infections. Less commonly, echinacea has been used for wounds and skin problems, such as acne or boils.<a href="" TARGET="_blank" [2]</a>

Study results are mixed on whether echinacea effectively treats colds or flu.<a href="" TARGET="_blank" [2]</a> There are nine known species of echinacea, all of which are native to the United States and southern Canada.<a href="" TARGET="_blank" [2]</a>

The most commonly used, Echinacea purpurea, is believed to be the most potent.<a href="" TARGET="_blank" [2]</a>

NCCAM-funded researchers at the University of Washington and Bastyr University have found that echinacea ( Echinacea purpurea ), an herb often used to treat colds (upper respiratory infections), is not effective in young children.<a href="" TARGET="_blank" [3]</a> Echinacea is often used by consumers for the treatment and prevention of upper respiratory infections. It is one of the most commonly used herbs in the United States.<a href="" TARGET="_blank" [3]</a> The researchers concluded that the "results do not support the use of echinacea for treatment of upper respiratory infections in children 2 to 11 years old."<a href="" TARGET="_blank" [3]</a> Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children.<a href="" TARGET="_blank" [3]</a> The children were randomly assigned to receive either echinacea or a placebo at the onset of cold symptoms and twice a day for as long as the cold lasted, up to a maximum of 10 days.<a href="" TARGET="_blank" [3]</a> The researchers reported that use of echinacea from the onset of symptoms did not lessen the number of days the colds lasted or the severity of symptoms.<a href="" TARGET="_blank" [3]</a>

Data were analyzed for 707 colds (337 treated with echinacea and 370 treated with placebo) experienced by 407 children.<a href="" TARGET="_blank" [3]</a> No overall difference in side effects (adverse events); however, children taking echinacea were more likely to develop rashes than those taking placebo.<a href="" TARGET="_blank" [3]</a>

The researchers recommend more studies to look at other echinacea preparations or different doses or dosing schedules to determine if there is any possible role for echinacea in treating colds in children. They also suggest further research to determine whether echinacea has any role in preventing colds.<a href="" TARGET="_blank" [3]</a> The echinacea preparation was a dried-pressed juice of the herb that had been used previously in a number of encouraging preliminary studies in Europe.<a href="" TARGET="_blank" [3]</a>

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<a name="hdng1"></a>Studies have come to conflicting conclusions as to whether the herb is truly effective. This latest study, published in the Annals of Allergy, Asthma and Immunology, adds to doubts about echinacea's ability to prevent colds. Researchers at the University of California San Francisco found no clear evidence that echinacea prevented nasal congestion, sore throats or other cold-season woes among 58 volunteers they followed for eight weeks. <a href="" TARGET="_blank" [4]</a> Study participants were randomly assigned to take either three echinacea capsules or three parsley-containing placebo capsules twice a day for the entire study period. Once a week, the researchers asked the volunteers whether they had suffered a sore throat, runny nose, headache or other cold symptoms over the previous week.<a href="" TARGET="_blank" [4]</a> The study did not address whether echinacea is useful for lessening the severity of cold symptoms, or speeding people's recovery, O'Neil noted.<a href="" TARGET="_blank" [4]</a>

NEW YORK (Reuters Health) - The popular herbal cold-fighter echinacea may not work as advertised, a new clinical trial shows.<a href="" TARGET="_blank" [4]</a> Overall, the echinacea group reported nine "sick days" per person, while the placebo group reported 14.<a href="" TARGET="_blank" [4]</a> Echinacea, which is derived from the coneflower, has long been touted as a way to bolster immunity and prevent or ease the common cold.<a href="" TARGET="_blank" [4]</a> In a subsequent study ( 35 35 ), we injected arabinogalactan intraperitoneally daily for 7 days or 14 days into elderly mice. Since this complex polysaccharide is contained in whole Echinacea, it was hypothesized that this component might have as good an effect on NK cells as did the extract of whole herb. We found that in contrast to whole product, this component was not effective in stimulating NK cell numbers in the elderly mouse bone marrow or spleen.<a href="" TARGET="_blank" [5]</a> Three months after leukemia onset—long after all control (untreated chow) leukemic mice had died—NK cells were recorded at more than twice the numbers present in normal mice of identical age, strain and gender. All the other hemopoietic and immune cell lineages in both bone marrow and spleen in these long-term, Echinacea -consuming, originally leukemic mice were indistinguishable from the corresponding populations of cells in normal mice.<a href="" TARGET="_blank" [5]</a> Life span analysis indicated that not only had Echinacea extended life span ( 43 ) but also the survival advantage provided to leukemic mice by consuming Echinacea daily was statistically significant ( P < 0.022).<a href="" TARGET="_blank" [5]</a> When we gave the combination of Echinacea and melatonin ( 43 ), via the diet, daily to leukemic mice (leukemia induced as above), not only did we find the usual significant elevation in NK cells but also the long-term survival increased to 40%, compared with the one-third of the leukemic mice when Echinacea alone was given (above). At least for this tumor, the two NK stimulants together were indeed better than one.<a href="" TARGET="_blank" [5]</a> In another type of combination therapy, we immunized mice 5 weeks beforehand, with killed leukemia cells ( 49 49 ) before injecting live cells and daily dietary Echinacea.<a href="" TARGET="_blank" [5]</a> Brousseau M, Miller SC. Enhancement of natural killer cells and increased survival of aging mice fed daily Echinacea root extract from youth.<a href="" TARGET="_blank" [5]</a> Spontaneous neoplasms, clinically undetectable, are well known to increase with advancing age in humans and mice. The logical corollary from this study indicates that chronic daily intake of Echinacea, is clearly not detrimental to the immune system, but rather prophylactic.<a href="" TARGET="_blank" [5]</a> We elected next to study the influence of daily consumption of Echinacea throughout life beginning in youth, i.e. 7 week of age (puberty), until early ‘old age’ (13 months) in inbred mice ( 37 37 37 37 ).<a href="" TARGET="_blank" [5]</a> The early (7 days) elevation in absolute numbers of NK cells in the bone marrow necessarily indicated that actual generation of new NK cells was underway in that organ under the influence of Echinacea.<a href="" TARGET="_blank" [5]</a> We believe that further manipulation of Echinacea dose/frequency/duration regimens could allow many more if not the other full two-thirds to go on to live a full life. The mechanism by which Echinacea mediates its antineoplastic activity is well known (see Introduction). It acts exclusively via the immune system and has no influence on the tumor cells themselves, the latter being highly unstable and continuously cloning out their most virulent cells to produce frank neoplasm.<a href="" TARGET="_blank" [5]</a> There is very little available information concerning the potential for detrimental interactions of Echinacea with either other herbs or pharmaceuticals ( 22 22 22 ). Another problem pertains to the choice of the most effective source of Echinacea as NK stimulant—not an insignificant problem since there is extremely wide variation in the quality of Echinaceas from assorted commercial sources.<a href="" TARGET="_blank" [5]</a> Some of the contents of Echinacea are natural killer (NK) cell stimulants while others (the alkylamides) inhibit the endogenous suppressors of NK cells, i.e. the prostaglandins. NK cells are the first line of defense in cancer immunosurveillance, and consequently any agent that will either stimulate these fundamental cells or remove any negative influence on them would be clearly of medicinal value.<a href="" TARGET="_blank" [5]</a> Figure 1 Contained within Echinacea root extract is a family of complex polysaccharides known as arabinogalactans. These sugars directly stimulate macrophages to produce three cytokines that, in turn, directly stimulate NK cells.<a href="" TARGET="_blank" [5]</a>

In our analysis of the effect of Echinacea on the above-mentioned cells, everything was standardized.<a href="" TARGET="_blank" [5]</a> One-third of all Echinacea -consuming mice that survived until 3 months after leukemia onset went on to live a full-life.<a href="" TARGET="_blank" [5]</a> Melchart D, Linde K, Worku F, Sarkady L, Horzmann M, Jurcic K, et al. Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea.<a href="" TARGET="_blank" [5]</a> There is considerable evidence suggesting that other phytochemicals in Echinacea might have the capacity to reduce tumors and virus infections ( 5 5 5 – 10 10 ).<a href="" TARGET="_blank" [5]</a> There is considerable controversy concerning the duration/frequency with respect to human consumption of Echinacea.<a href="" TARGET="_blank" [5]</a> The common label advice when purchasing Echinacea over the counter indicates that Echinacea should be taken for short spurts of time and then terminated for several days/weeks before resuming intake.<a href="" TARGET="_blank" [5]</a> Immunization alone produced a survival rate and life span increment similar to that achieved by giving leukemic mice dietary Echinacea alone.<a href="" TARGET="_blank" [5]</a> Mullins RJ, Heddle R. Adverse reactions associated with Echinacea: the Australian experience.<a href="" TARGET="_blank" [5]</a> We observed that the combination of immunization and dietary Echinacea was substantially more therapeutic than either alone.<a href="" TARGET="_blank" [5]</a>

Steinmuller C, Roesler J, Grottrup E, Franke G, Wagner H, Lohmann-Matthes ML. Polysaccharides isolated from plant cell cultures of Echinacea purpurea enhance the resistance of immunosuppressed mice against systemic infections with Candida albicans and Listeria monocytogenes.<a href="" TARGET="_blank" [5]</a> Roesler J, Steinmuller C, Kiderlen A, Emmendorffer A, Wagner H, Lohmann-Matthes ML. Application of purified polysaccharides from cell cultures of the plant Echinacea purpurea to mice mediates protection against systemic infections with Listeria monocytogenes and Candida albicans.<a href="" TARGET="_blank" [5]</a>

Currier NL, Miller SC. Natural killer cells from aging mice treated with extracts from Echinacea purpurea are quantitatively and functionally rejuvenated.<a href="" TARGET="_blank" [5]</a> Currier NL, Miller SC. The effect of immunization with killer tumor cells, with/without feeding of Echinacea purpurea in an erythroleukemic mouse model.<a href="" TARGET="_blank" [5]</a> Currier NL, Miller SC. Echinacea purpurea and melatonin augment natural killer cells in leukemic mice and prolong life span.<a href="" TARGET="_blank" [5]</a> Leuttig B, Steinmuller C, Gifford GE, Wagner H, Lohmann-Matthes ML. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpurea.<a href="" TARGET="_blank" [5]</a> Roesler J, Emmendorffer A, Steinmuller C, Leuttig B, Wagner H, Lohmann-Matthes ML. Application of purified polysaccharides from cell cultures of the plant Echinacea purpurea to test subjects mediating activation of the phagocyte system.<a href="" TARGET="_blank" [5]</a>

Rininger JA, Kickner S, Chigurupati P, McLean A, Franck Z. Immunopharmacological activity of Echinacea preparations following stimulated digestion of murine macrophages and human peripheral blood mononuclear cells.<a href="" TARGET="_blank" [5]</a>

Mengs U, Clare CB, Poiley JA. Toxicity of Echinacea purpurea : acute, subacute and genotoxicity studies.<a href="" TARGET="_blank" [5]</a> Lersch C, Zeuner M, Bauer A, Siements M, Hart R, Drescher M, et al. Nonspecific immunostimulation with low doses of cyclophosphamide (LDCY), thymostimulin, and Echinacea purpurea extracts (Echinacin) in patients with far advanced colorectal cancers: preliminary results.<a href="" TARGET="_blank" [5]</a>

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SELECTED SOURCES<image src="apx4.jpg" alt="Most Informative Documents, used in preparation of this report."></a>

1. <a href="" TARGET="_blank">MedlinePlus Herbs and Supplements: Echinacea (Echinacea angustifolia DC, Echinacea pallida, Echinacea purpurea)</a>
<a href="" TARGET="_blank"></a>

2. <a href="" TARGET="_blank">Echinacea (Echinacea purpurea, Echinacea angustifolia, Echinacea pallida) [NCCAM Herbs at a Glance]</a>
<a href="" TARGET="_blank"></a>

3. <a href="" TARGET="_blank">Echinacea Not Effective in Treating Children's Colds: Consumer Advisory [NCCAM Research Results]</a>
<a href="" TARGET="_blank"></a>

4. <a href="" TARGET="_blank">MedlinePlus: More doubts about echinacea for preventing colds</a>
<a href="" TARGET="_blank"></a>

5. <a href="" TARGET="_blank">Echinacea: a Miracle Herb against Aging and Cancer? Evidence In vivo in Mice</a>
<a href="" TARGET="_blank"></a>

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