If you’ve been looking for ways to boost your immune system — whether to prevent the spread of COVID-19 or to ward off the common cold — you’re not alone. More than half of Americans are looking for ways to improve their immunity for health and longevity, according to the 2022 U.S. Mindbody Wellness Index. As a result, interest in alternative and complementary therapies such as supplements is on the rise. One supplement with a longstanding reputation for aiding immune function is echinacea.

Echinacea, a native North American plant, is also known as coneflower or purple coneflower, and has long been used medicinally by Native Americans, according to the National Center for Complementary and Integrative Health (NCCIH). Three of echinacea’s nine species are considered therapeutic: Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida.

A flowering plant with pink-purple petals, echinacea was named for its large, spiky seed pod, which resembles the scales of a hedgehog, or echinos in Greek, according to Mount Sinai. Despite the prominence of the seed pod, research has found that most of the plant’s health benefits are derived from the roots, leaves, and flower, which can be made into supplements or brewed as tea.

While Native Americans used echinacea as a cure-all, research has only borne out its benefits for certain applications. In Europe, echinacea is approved to help with wound care. The European Medicines Agency has noted that while there are limited studies proving the herb’s efficacy, there is enough traditional use of echinacea to suggest that it is safe and may be effective.

Echinacea has a promising reputation: Studies have shown that it can stimulate the immune system, and some studies have suggested that it can have anti-inflammatory, antiviral, and antimicrobial effects, too, according to a review published in Molecules in 2018.

Other studies, however, have found that echinacea has little to no effect on immunity, nor any other benefits. Researchers have noted that this could be attributed to inconsistency in the species, parts of the plant, or dosages measured in the research. Even the plant’s growing conditions may have an impact on its efficacy, according to a study published in Scientific Reports in 2019. And despite its reputation as a treatment for the common cold, an article published in American Family Physician in 2019 stated that high-quality studies did not prove echinacea could reduce the length of a cold or the severity of its symptoms.

While evidence of echinacea’s effect on COVID-19 is still very limited, a study published in April 2022 in Frontiers in Pharmacology showed that a specific dosage of Echinacea purpurea can have an effect in preventing respiratory tract infections, including COVID-19. The study also suggested that echinacea might reduce viral load. More research is needed, but it could help as part of COVID-19 prevention, along with vaccination, social distancing, and mask-wearing.

Very limited studies show a potential for higher doses of echinacea to reduce anxiey. In the United States, some echinacea supplements claim to have calming properties, but the results of a recent study led by one brand have not been published.

Echinacea is popular among cancer patients, with mixed results. A review of available research published in Medicines in 2020 showed that in some studies the use of echinacea and other supplements was related to worse health outcomes and pain in breast cancer patients. In some studies, certain doses of specific extracts of the plant were effective in inhibiting cancer cells, but further research showed that echinacea can also make anticancer drugs less effective.

“I don’t think anyone needs to take echinacea. There are more tried-and-true ways to bolster one’s immunity,” says Susan Levin, a registered dietitian, certified specialist in sports dietetics, and director of nutrition education at the Physicians Committee for Responsible Medicine in Washington, DC. Past research has shown that handwashing is a much more effective way to stop the spread of illness and prevent infection, for instance. Eating a healthy diet with a colorful mix of fruits and vegetables, whole grains, and legumes can help your gut microbiome, boosting immunity as well.

If you’re really interested in the supplement, talk with your doctor or pharmacist before taking it. They can give you recommendations about brands, types, and how much to take and for how long. “There is no official dosage recommendation for echinacea because there is no consistent amount used in research,” Levin adds.

It’s also important to note that while using echinacea as a short-term measure to prevent or lessen cold symptoms has been studied, long-term use of the plant, especially at high doses, has not been sufficiently studied. “With any substance that impacts the immune system, we also have to be concerned about whether this product can negatively impact how our bodies work,” says Julie Stefanski, registered dietitian nutritionist, certified specialist in sports dietetics, and spokesperson for the Academy of Nutrition and Dietetics in Baltimore. “An immune system that works too aggressively can act against our own bodies, as in the case of autoimmune disease.”

Counterintuitively, echinacea may be risky for people with autoimmune issues, according to the limited research done in this area. In 2018, the National Multiple Sclerosis Society recommended that people with multiple sclerosis avoid echinacea, as its potential to boost immunity may cause problems for an already overstimulated immune system. And a study published in the Journal of the American Academy of Dermatology in 2021 showed that echinacea could worsen some autoimmune diseases that affect the skin, or cause flares after a long dormant period. There’s evidence that the immunosuppressant effects of some of the medications prescribed for those conditions may be affected by echinacea’s potential immune-stimulating activity, says Alexander Ford, DO, RD, a second-year physician resident at the Cleveland Clinic.

“If someone is going to a rheumatologist, for example, and being prescribed first-line medications, echinacea could possibly interfere with the effects and metabolism of those medications,” Dr. Ford says. “A lot of times people aren’t sharing what dietary supplements they take, because they don’t think of them as medication, but some may cause serious adverse effects.”

Echinacea may also interact with caffeine, prolonging the stimulant’s effects on the body, according to a small study published in Clinical Pharmacology and Therapeutics.

Echinacea is not recommended during pregnancy or breastfeeding, as there is not enough research to prove whether it’s safe, according to the NCCIH.

People who are allergic to echinacea should not take it. If you’re allergic to related plants, such as daisies, ragweed, marigolds, or chrysanthemums, you may have a higher risk of an echinacea allergy, according to a past article published in American Family Physician. An allergic reaction can also make asthma symptoms worse.

Echinacea can be found in a variety of forms: Pills, drops, and teas are all available over the counter. But it can be hard to decipher supplement labels and tell which are quality products. In fact, independent research from ConsumerLab.com in 2021 showed that one-third of the echinacea products tested contained less echinacea than their labels claimed.

Ford recommends looking for high marks from certifying bodies such as NSF International, U.S. Pharmacopeia, or ConsumerLab.com. “This is like the stamp of approval that these are high-quality supplements,” he says.

In the United States, however, the Food and Drug Administration does not regulate supplements’ efficacy. “Herbs can be as powerful as pharmaceuticals,” Levin notes. “Labels can be difficult to decipher on your own.” Talk with your doctor, pharmacist, or a registered dietitian to decide if you should take echinacea, and if so, which supplement you should take.

Echinacea has a reputation for being an immunity-boosting herbal supplement, and there is some evidence to support those claims. But, because the research is inconsistent, it’s hard to know how much of it to take and how effective it can be. Talk to your healthcare provider or pharmacist to discuss whether you should start taking echinacea — and if so, what kind, how much, and for how long.

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