L Susan Wieland1, Vanessa Piechotta2, Termeh Feinberg3,4,5, Emilie Ludeman6, Brian Hutton7,8, Salmaan Kanji7,9, Dugald Seely9,10,11, Chantelle Garritty7. 1. Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. swieland@som.umaryland.edu. 2. Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 3. Kelly Government Solutions, Rockville, MD, USA. 4. Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA. 5. Yale Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, USA. 6. University of Maryland, Health Sciences and Human Services Library, Baltimore, MD, USA. 7. The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada. 8. University of Ottawa, School of Epidemiology and Public Health, Ottawa, Ontario, Canada. 9. The Ottawa Hospital, Ottawa, Ontario, Canada. 10. The Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada. 11. The Centre for Health Innovation, The Canadian College of Naturopathic Medicine, Ottawa, Ontario, Canada.
Abstract
BACKGROUND: Elderberry has traditionally been used to prevent and treat respiratory problems. During the COVID-19 pandemic, there has been interest in elderberry supplements to treat or prevent illness, but also concern that elderberry might overstimulate the immune system and increase the risk of 'cytokine storm'. We aimed to determine benefits and harms of elderberry for the prevention and treatment of viral respiratory infections, and to assess the relationship between elderberry supplements and negative health impacts associated with overproduction of pro-inflammatory cytokines. METHODS: We conducted a systematic review and searched six databases, four research registers, and two preprint sites for studies. Two reviewers independently assessed studies for inclusion, extracted data from studies, assessed risk of bias using Cochrane tools, and evaluated certainty of estimates using GRADE. Outcomes included new illnesses and the severity and duration of illness. RESULTS: We screened 1187 records and included five randomized trials on elderberry for the treatment or prevention of viral respiratory illness. We did not find any studies linking elderberry to clinical inflammatory outcomes. However, we found three studies measuring production of cytokines ex vivo after ingestion of elderberry. Elderberry may not reduce the risk of developing the common cold; it may reduce the duration and severity of colds, but the evidence is uncertain. Elderberry may reduce the duration of influenza but the evidence is uncertain. Compared to oseltamivir, an elderberry-containing product may be associated with a lower risk of influenza complications and adverse events. We did not find evidence on elderberry and clinical outcomes related to inflammation. However, we found evidence that elderberry has some effect on inflammatory markers, although this effect may decline with ongoing supplementation. One small study compared elderberry to diclofenac (a nonsteroidal anti-inflammatory drug) and provided some evidence that elderberry is as effective or less effective than diclofenac in cytokine reduction over time. CONCLUSIONS: Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system. However, the evidence on both benefits and harms is uncertain and information from recent and ongoing studies is necessary to make firm conclusions.
BACKGROUND: Elderberry has traditionally been used to prevent and treat respiratory problems. During the COVID-19 pandemic, there has been interest in elderberry supplements to treat or prevent illness, but also concern that elderberry might overstimulate the immune system and increase the risk of 'cytokine storm'. We aimed to determine benefits and harms of elderberry for the prevention and treatment of viral respiratory infections, and to assess the relationship between elderberry supplements and negative health impacts associated with overproduction of pro-inflammatory cytokines. METHODS: We conducted a systematic review and searched six databases, four research registers, and two preprint sites for studies. Two reviewers independently assessed studies for inclusion, extracted data from studies, assessed risk of bias using Cochrane tools, and evaluated certainty of estimates using GRADE. Outcomes included new illnesses and the severity and duration of illness. RESULTS: We screened 1187 records and included five randomized trials on elderberry for the treatment or prevention of viral respiratory illness. We did not find any studies linking elderberry to clinical inflammatory outcomes. However, we found three studies measuring production of cytokines ex vivo after ingestion of elderberry. Elderberry may not reduce the risk of developing the common cold; it may reduce the duration and severity of colds, but the evidence is uncertain. Elderberry may reduce the duration of influenza but the evidence is uncertain. Compared to oseltamivir, an elderberry-containing product may be associated with a lower risk of influenza complications and adverse events. We did not find evidence on elderberry and clinical outcomes related to inflammation. However, we found evidence that elderberry has some effect on inflammatory markers, although this effect may decline with ongoing supplementation. One small study compared elderberry to diclofenac (a nonsteroidal anti-inflammatory drug) and provided some evidence that elderberry is as effective or less effective than diclofenac in cytokine reduction over time. CONCLUSIONS: Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system. However, the evidence on both benefits and harms is uncertain and information from recent and ongoing studies is necessary to make firm conclusions.
Authors: Jennifer R Tisoncik; Marcus J Korth; Cameron P Simmons; Jeremy Farrar; Thomas R Martin; Michael G Katze Journal: Microbiol Mol Biol Rev Date: 2012-03 Impact factor: 11.056
Authors: Tatiana V Kirichenko; Igor A Sobenin; Dragana Nikolic; Manfredi Rizzo; Alexander N Orekhov Journal: Phytomedicine Date: 2015-12-19 Impact factor: 5.340
Authors: Christian Krawitz; Mobarak Abu Mraheil; Michael Stein; Can Imirzalioglu; Eugen Domann; Stephan Pleschka; Torsten Hain Journal: BMC Complement Altern Med Date: 2011-02-25 Impact factor: 3.659
Authors: Carina Pedrosa Costa; Samuel Patinha; Alisa Rudnitskaya; Sónia A O Santos; Armando J D Silvestre; Sílvia M Rocha Journal: Foods Date: 2021-12-31
Authors: Jia Yao; Yuan Zhang; Xian-Zhe Wang; Jia Zhao; Zhao-Jun Yang; Yu-Ping Lin; Lu Sun; Qi-Yun Lu; Guan-Jie Fan Journal: Front Public Health Date: 2022-02-16