Echinacea Supplementation Research Articles

Echinacea Supplementation Does Not Impact Aerobic Capacity and Erythropoiesis in Athletes: A Meta-Analysis.

Athletes are increasingly relying on natural supplements to improve athletic performance. Echinacea, a common herbal supplement, has been studied for its potential erythropoietin-enhancing effects, with mixed results in the literature. The purpose of this meta-analysis is to determine whether echinacea supplementation has erythropoietic or ergogenic effects in athletes. A search strategy was developed to identify trials studying the impact of echinacea supplementation on erythropoiesis and maximal oxygen uptake. The database search yielded 502 studies, 496 of which were excluded in the two-reviewer screening process. Six studies with a total of 107 athletes were included in the analysis. For hemoglobin and hematocrit levels, there were small, positive effect sizes when comparing the difference in pre- and post-intervention levels between the echinacea and placebo groups, at 0.38 (p = 0.02, 95% CI -0.04-0.80, I2 = 70%) and 0.34 (p < 0.01, 95% CI -0.10-0.78, I2 = 86%), respectively, though they did not reach statistical significance. There was also no statistically significant change in erythropoietin (effect size -0.29, p = 0.05, 95% CI -0.75-0.17, I2 = 67%) or maximal oxygen uptake (effect size -0.20, p = 0.95, 95% CI -0.60-0.21, I2 = 0%). Echinacea supplementation did not influence erythropoietin, hemoglobin, hematocrit, or maximal oxygen uptake in athletes; however, the evidence base is limited.

Field production of purple coneflower for beneficial phytochemicals

ABSTRACT Purple coneflower (Echinacea purpurea Moench [L.]) is widely used as a health supplement and is cultivated for its production of bioactive phytochemicals. However, there is a lack of information on how agronomic planting designs and environment affect the phytochemical content of different coneflower tissues. Experimental plots were established at two locations in Minnesota to evaluate the effect of environment and agronomic planting design on the phytochemical profile of purple coneflower, as well as the relative content of several provisionally identified compounds. Root, stem, leaf, flower, and seed tissues were harvested, and extracts were analysed using liquid chromatography-mass spectrometry. The growing environment affected the levels of several caffeic acid derivatives in leaf, stem, and root tissue, but agronomic design had little to no effect on phytochemical content. Although all tissue types contained phytochemicals of medicinal interest, no single tissue contained the highest amount of all compounds with known bioactive properties, indicating that the most beneficial purple coneflower supplements may be the combination of several tissue types. Additionally, the phytochemical content of purple coneflower seed, which is uncommon in Echinacea supplements, was chemically similar to root tissue. Seed tissue, after additional evaluations, may be a suitable alternative for root in supplement mixtures.

Echinacea angustifolia and Echinacea purpurea Supplementation Combined with Vaginal Hyaluronic Acid to Boost the Remission of Cervical Low-Grade Squamous Intraepithelial Lesions (L-SILs): A Randomized Controlled Trial.

Background and Objectives: Echinacea angustifolia and purpurea have known immunomodulatory effects which boost viral clearance, including HPV infection. However, evidence regarding the improvement due to Echinacea-based supplements of cervical HPV-related pathologies is still lacking. The aim of this study is to evaluate the efficacy of Echinacea supplementation on the remission of cervical low-grade squamous intraepithelial lesions (L-SIL). Materials and Methods: A single-blind 1:1:1 parallel randomized controlled trial was conducted at the Colposcopy Unit of a tertiary care referral center. Reproductive-aged women were allocated either to (a) an oral supplement based on Echinacea extracts plus vaginal hyaluronic acid-based soft gel capsules, (b) the Echinacea supplement alone, or (c) vaginal hyaluronic acid-based soft gel capsules alone for 3 months. The primary outcome was the regression of cervical intraepithelial neoplasia (CIN)-1 for each treatment arm at 3, 6 and 12 months after the diagnosis. Secondary outcomes included changes in the epithelialization, pap smear, colposcopic parameters, histological reports, and vaginal health indexes (VHI) in the study groups. Results: 153 women (52 for arm A, 50 for arm B and 51 for arm C) completed the follow-up and were included in the analysis. There were no significant differences in both primary and secondary outcomes for the three groups after 3 months. At the 6-month follow-up, the number of persistent CIN-1 diagnoses was significantly lower in arm A (15/51), rather than in arm B (23/48, p = 0.03) and C (27/49, p = 0.03). Similarly, the same effect was seen after 12 months for treatment A (5/51) relative to B (15/48, p = 0.03) and C (14/48, p = 0.03). Colposcopic, histological and vaginal parameters were all significantly improved at 6 and 12 months for arm A relative to B and C, while no beneficial effects were seen after 3 months. Conclusions: Echinacea extracts supplementation in women with L-SIL/CIN-1 significantly boosts HPV lesion clearance, reducing the overall amount of diagnosis, histological, colposcopic and vaginal parameters after 6 and 12 months. However, a limited sample size reduces the quality of evaluated evidence, emphasizing the need for additional studies to validate these findings.

A systematic review on the effects of Echinacea supplementation on cytokine levels: Is there a role in COVID-19?

COVID-19 is the respiratory illness caused by the novel coronavirus, SARS-CoV-2. Cytokine storm appears to be a factor in COVID-19 mortality. Echinacea species have been used historically for immune modulation. A previous rapid review suggested that Echinacea supplementation may decrease the levels of pro-inflammatory cytokines involved in cytokine storm. The objective of the present systematic review was to identify all research that has assessed changes in levels of cytokines relevant to cytokine storm in response to administration of Echinacea supplementation. The following databases were searched: Medline (Ovid), AMED (Ovid), CINAHL (EBSCO), EMBASE (Ovid). Title and abstract screening, full text screening, and data extraction were completed in duplicate using a piloted extraction template. Risk of bias assessment was completed. Qualitative analysis was used to assess for trends in cytokine level changes. The search identified 279 unique publications. After full text screening, 105 studies met criteria for inclusion including 13 human studies, 24 animal studies, and 71 in vitro or ex vivo studies. The data suggest that Echinacea supplementation may be associated with a decrease in the pro-inflammatory cytokines IL-6, IL-8, and TNF, as well as an increase in the anti-inflammatory cytokine IL-10. The risk of bias in the included studies was generally high. While there is currently no substantive research on the therapeutic effects of Echinacea in the management of either cytokine storm or COVID-19, the present evidence related to the herb's impact on cytokine levels suggests that further research may be warranted in the form of a clinical trial involving patients with COVID-19.

S2421 Drug Induced Liver Injury Secondary to Echinacea Supplements

INTRODUCTION: Drug induced liver injury (DILI) is a common cause of hepatotoxicity and around 15-20% of cases are attributed to herbal and drug supplements (HDS). Echinacea is a commonly used herbal supplement for treatment and prevention of common colds. We present a case of acute hepatitis secondary to Echinacea. CASE DESCRIPTION/METHODS: A 28-year-old Hispanic male with history of alcohol abuse. He was enrolled in an AA program and his last drink was about 18 months prior to presentation. He came to the ED complaining of weakness, nausea, postprandial vomiting, epigastric pain, and jaundice for 10 days. He denied taking medications, however, he started to take Echinacea supplements 1 month ago. Physical exam was only notable for jaundice and mild epigastric tenderness. Initial labs showed elevated AST at 1893 U/L, ALT 2763 U/L, ALP 191 U/L, T. Bili 10.4 mg/dL, D. Bili 8.32 mg/dL, GGT 141 U/L, and LDH 435 U/L. INR 1.07. UDS, Ethanol, acetaminophen, RPR, viral panel (including hepatitis A, B, C, E, CMV, EBV, HSV and HIV), autoimmune panel (including ANA, ASMA, AMA, LKM, SLA, P-ANCA), Ceruloplasmin, alpha-1-antitrypsin and HFE gene were all negative. Ultrasound of Abdomen revealed mild splenomegaly as well as thickening and edema of the gallbladder wall. CT abdomen showed periportal edema and thickening of the gallbladder wall. Vascular duplex of the abdomen was negative for thrombus. He was started on NAC infusion. His mental status and INR remained intact. Liver enzymes and bilirubin continued to rise. Liver biopsy showed panacinar cholestatic hepatitis consistent with adverse drug reaction. The patient was then transferred to a transplant center where he improved with supportive care. DISCUSSION: HDS are commonly used and often not disclosed to healthcare professionals resulting in diagnostic dilemmas. These supplements can lead to idiosyncratic liver injury with unexpected outcomes. Since it’s a diagnosis of exclusion, a comprehensive workup must be performed. There are only a few cases of echinacea induced hepatitis described in the literature. In some reports, autoimmune markers were positive suggesting drug induced autoimmune hepatitis but this does not apply to our patient. For non-paracetamol DILI, there is no strong evidence regarding benefit of NAC. However, due minimal side effect profile, it is widely used. Clinicians must maintain a high level of suspicion when encountering acute hepatitis with unclear etiology. A detailed history of medication and HDS use may hold the answer.

The effect of Echinacea spp. on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review

Brief overviewCurrent evidence suggests that Echinacea supplementation may decrease the duration and severity of acute respiratory tract infections; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Few adverse events were reported, suggesting that this herbal therapy is reasonably safe. Because Echinacea can increase immune function, there is a concern that it could worsen over-activation of the immune system in cytokine storm; however, clinical trials show that Echinacea decreases levels of immune molecules involved in cytokine storm. VerdictEchinacea supplementation may assist with the symptoms of acute respiratory infections (ARI) and the common cold, particularly when administered at the first sign of infection; however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified. Previous studies have reported that Echinacea may decrease the severity and/or duration of ARI when taken at the onset of symptoms. The studies reporting benefit used E. purpurea or a combination of E. purpurea and E. angustifolia containing standardized amounts of active constituents.Few adverse events from the use of Echinacea were reported, suggesting that this herbal therapy is reasonably safe. No human trials could be located reporting evidence of cytokine storm when Echinacea was used for up to 4 months.When assessing all human trials which reported changes in cytokine levels in response to Echinacea supplementation, the results were largely consistent with a decrease in the pro-inflammatory cytokines that play a role in the progression of cytokine storm and Acute Respiratory Distress Syndrome (ARDS), factors that play a significant role in the death of COVID-19 patients. While there is currently no research on the therapeutic effects of Echinacea in the management of cytokine storm, this evidence suggests that further research is warranted.

Effect of some herbal extracts on growth performance and liver enzymes in broilers

Objective: After the ban in 2006 of the use of antibiotic growth promoters, the search for an alternative led to the utilization of plants like Moringa oleifera Lam. The present study was carried out to determine the effect of Moringa and Echinacea supplementation on drinking water on growth performance and liver function. Methods: One hundred and fifty one-day-old chicks (Cobb strain) were randomly allotted to three experimental groups G1 (basic diet, control group), G2 (basic diet + watering of Echinacea herbal extract), and G3 (basic diet + watering of Moringa herbal extract). The liver function test was performed through the detection of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in plasma. Results: The herbal mixture groups (G2 and G3) significantly (P<0.05) improved the growth performance while no significant difference in serum levels of liver function enzymes AST and ALT as compared to the control group. Conclusion: With these results, we could conclude that replacing antibiotic growth promoters with herbal supplements is safe and improve the growth performance of broilers.

A Comparison of Commercially-Available Echinacea Supplements based off Product Label Information

A Comparison of Commercially-Available Echinacea Supplements based off Product Label Information

Herbal Prevention of Pneumonia Epidemics in Multinational Refugee Camps: Echinacea for Refugees

Considering the huge number of war refugees all over the world, taking care of their health-related problems is a critical issue for humanitarian organizations. Respiratory tract infections are one the most life-threatening hazards among these populations. Therefore, any measure to control them with acceptable safety and efficacy will be valuable. According to recent studies, Echinacea supplements are potential candidates for this indication.

Echinacea Supplementation: Does it Really Improve Aerobic Fitness?

[Purpose]Echinacea is an herbal supplement used by endurance athletes for its performance boosting properties. It is thought that Echinacea improves the blood’s oxygen carrying capacity by increasing production of erythropoietin (EPO), a glycoprotein that regulates red blood cell formation. Subsequently, these changes would lead to an overall improvement in maximal oxygen uptake (VO2max) and running economy (RE), two markers of aerobic fitness. The purpose of this review is to briefly discuss the physiological variables associated with distance running performance and how these variables are influenced by Echinacea supplementation.[Methods]To determine Echinacea’s ergogenic potential, human studies that used Echinacea in conjunction to analyzing the blood’s oxygen carrying capacity and/or aerobic fitness were assessed.[Results]Taken together, the majority of the published literature does not support the claim that Echinacea is a beneficial ergogenic aid. With the exception of one study, several independent groups have reported Echinacea supplementation does not increase EPO production, blood markers of oxygen transport, VO2max or RE in healthy untrained or trained subjects.[Conclusion]To date, the published literature does not support the use of Echinacea as an ergogenic aid to improve aerobic fitness in healthy untrained or trained subjects.

Immunomodulatory effects ofEchinacea laevigataethanol tinctures produced from different organs

Echinacea supplements may prevent or reduce symptoms of upper respiratory infections by immunomodulation, possibly by altering the cytokine profile. Compared with other species in the genus, the immunomodulatory properties of Echinacea laeviagata are poorly characterized. The purposes of this study were to compare the diversity and quantity of known bioactive compounds from aboveground organs of E. laevigata, and to characterize the in vitro immumodulatory properties of ethanol tinctures produced from those structures. High-performance liquid chromatography (HPLC) was used to determine the levels of alkamides and caffeic acid derivatives. Peripheral blood mononuclear cells (PBMCs) were obtained from 16 adults and challenged in vitro with extracts. PBMC proliferation and production of the cytokines interleukin-2 (IL-2), IL-10 and tumour necrosis factor-α (TNF-α) were measured. Fresh flower, leaf and root extracts were able to augment TNF and IL-10 and prolif eration, whereas fresh stem extract was only able to augment TNF. Extracts produced from flowers contained the greatest bioactive compound quantities and diversity. Caftaric acid was the most abundant compound and correlated with some (but not all) observed immune effects. These results suggest that of all aboveground parts, flowers have the greatest abundance and diversity of known bioactive compounds, and both flower and leaf extracts were immunomodulators.

Running Economy and Maximal Oxygen Consumption After 4 Weeks of Oral Echinacea Supplementation

The purpose of this investigation was to determine the effects of 4 weeks of oral Echinacea (ECH) supplementation on erythropoietin (EPO), red blood cell (RBC) count, running economy (RE), and VO2max. Twenty-four men aged 24.9 ± 4.2 years, height 178.9 ± 7.9 cm, weight 87.9 ± 14.6 kg, body fat 19.3 ± 6.5% were grouped using a double-blind design and self-administered an 8,000-mg·d(-1) dosage of either ECH or placebo (PLA) in 5 × 400 mg × 4 times per day for 28 days. Blood samples were collected and analyzed for RBCs and EPO using automated flow cytometery and enzyme-linked immunosorbent assay. Maximal graded exercise tests (GXTs) were administered to measure VO2max, RE, and heart-rate responses. Analysis of variance was used to determine statistically significant differences (P ≤ 0.05). The EPO increased significantly in ECH at 7 days (ECH: 15.75 ± 0.64, PLA: 10.01 ± 0.73 mU·ml(-1)), 14 days (ECH: 18.88 ± 0.71, PLA: 11.02 ± 0.69 mU·ml(-1)), and 21 days (ECH: 16.06 ± 0.55, PLA: 9.20 ± 0.55 mU·ml(-1)). VO2max increased significantly in ECH (ECH: 1.47 ± 1.28, PLA: -0.13 ± 0.52%). Running economy improved significantly in ECH as indicated by a decrease in submaximal VO2max during the first 2 stages of the GXT (stage 1: ECH -1.50 ± 1.21, PLA 0.60 ± 1.95%; stage 2: ECH -1.67 ± 1.43, PLA 0.01 ± 1.03%). These data suggest that ECH supplementation results in significant increases in EPO, VO2max, and running economy.

The effectiveness of Echinacea extract or composite glucosamine, chondroitin and methyl sulfonyl methane supplements on acute and chronic rheumatoid arthritis rat model

The study aimed to investigate the effect of the oral administration for 15 days of either Echinacea (E) or genuphil (a composite of chondroitin sulphate, glucosamine and methyl sulfonyl methane [GCM]) nutraceutical supplements on female rat model of acute or chronic arthritis induced by bacterial outer membrane protein (OMP) from faecal flora of healthy and rheumatic humans. Anti-cyclic citrullinated peptide (anti-CCP2), C-reactive protein (CRP) and rheumatoid factor (RF) values increased (p < 0.05) in both arthritic groups as compared to normal values. The rheumatic markers anti-CCP2, CRP and RF values decreased significantly in E- and GCM-treated groups compared to arthritic none-treated acute or chronic groups. The results of RF values of GCM-treated groups in acute and chronic models decreased exhibiting no statistical difference compared with the normal value. Histological examinations of the hind paw sections revealed moderate inflammation, oedema and mild proliferation of synovial cells in acute arthritic rats and more damage to cartilage and bone with severe inflammation in chronic ones. Echinacea acute treated group showed edema with proliferated synovial membrane and partial damage in cartilage and bone. While in the E-chronic treated group, rough edge with destructed cartilage and bone existed. However, the acute GCM group revealed mild cartilage damage. But the chronic GCM group showed mild synovial cells proliferation and revealed no inflammation with mild cartilage damage edge. Results demonstrated the OMP arthropathic property and through promising light on arthritis treatment using E- or GCM, with the advantage of GMC results over that of E-. The composite GCM is needed for further studies over the dose and duration to assess its preventive effects against the bacterial OMP arthrogenicity.

The Use of Echinacea to Improve Oxygen Transport Capacity

It is well established that an increase in circulating EPO can result in an increase in oxygen transport capacity and that an increase in oxygen transport capacity may result in an increase in the ability to perform endurance exercise. Echinacea has been used therapeutically in both oral and injected forms and is purported to enhance immune status through an increase in the activity of and/or the circulating concentration of components of the immune system.There is evidence that suggests Echinacea may stimulate the production of EPO and influence erythropoiesis through two separate mechanisms: 1) the activation of macrophages and subsequent production and release of PGE2 and 2) by increasing the activity level of T cells and subsequent production and release of erythroid progenitor growth factors. An increase in the circulating concentration of PGE2 is postulated to result in and increase in EPO production directly and indirectly through stimulation of CD4 and CD8 production from T cells. Evidence also exists to support the role of direct stimulation of T cells by Echinacea that may result in production and release of GM-CSF and IL-3. Thus, if Echinacea supplementation were shown to stimulate EPO production then an increase in [RBC] and oxygen transport capacity might also result. Finally, an increase in oxygen transport capacity with Echinacea supplementation may provide a therapeutic means by which to diminish the adverse effects caused by a decrease in oxygen availability and enhance endurance exercise performance through the same mechanism.

Echinacea induced hsp70 alterations in leukocytes

Heat shock proteins (hsp) are expressed constitutively as well as induced in response to mild stress. These stress factors include inflammation, viral and bacterial infection, oxidative stress and cytotoxins. Altered hsp expression has been found in a number of disease states [1]. Echinacea is used as a prophylactic to boost the immune system and has been previously shown to enhance hsp70 expression in leucocytes after mild heat shock [2]. In this study, the effects of echinacea supplementation on hsp70 expression in the different leucocyte subpopulations has been examined. Twenty four healthy volunteers aged between 20 and 66 years with a body mass index ranging from 20.2 to 30.7 participated in the study. They consumed 2 echinacea tablets (4.42mg total alkylamides per tablet) twice a day for 14 days. Blood samples were taken on days 1 and 15 and hsp70 expression was determined by flow cytometry in whole blood with and without in vitro heat shock. Significant differences were observed in the percentage of several white cell subsets that expressed hsp70. CD4 and CD8 lymphocytes expressed significantly more hsp70 in both males and females after supplementation but in natural killer cells and B lymphocytes, expression of hsp70 were only significantly increased in the male participant cohort. These results indicate that Echinacea may play a role in activating the immune system when the body encounters a challenge such as a virus.

Hypericum in infection: Identification of anti-viral and anti-inflammatory constituents

The Iowa Center for Research on Botanical Dietary Supplements seeks to optimize Echinacea, Hypericum, and Prunella botanical supplements for human-health benefit, emphasizing anti-viral, anti-inflammatory, and anti-pain activities. This mini-review reports on ongoing studies on Hypericum. The Center uses the genetically diverse, well-documented Hypericum populations collected and maintained at the USDA-ARS North Central Regional Plant Introduction Station (NCRPIS), and the strength of research in synthetic chemistry at Iowa State University to tap natural diversity, to help discover key constituents and interactions among constituents that impact bioactivity and toxicity. The NCRPIS has acquired more than 180 distinct populations of Hypericum, with a focus on Hypericum perforatum L. (Hypericaceae), representing about 13% of currently recognized taxa. Center chemists have developed novel synthetic pathways for key flavones, acyl phloroglucinols, hyperolactones, and a tetralin that have been found in Hypericum, and these compounds are used as standards and for bioactivity studies. Both light-dependent and light-independent anti-viral activities have been identified by using bioactivity-guided fractionation of H. perforatum and a HIV-1 infection test system. Our Center has focused on light-independent activity, potentially due to novel chemicals, and polar fractions are undergoing further fractionation. Anti-inflammatory activity has been found to be light-independent, and fractionation of a flavonoid-rich extract revealed four compounds (amentoflavone, chlorogenic acid, pseudohypericin, and quercetin) that interacted in the light to inhibit lipopolysaccharide-induced prostaglandin E2 activity. The Center continues to explore novel populations of H. perforatum and related species to identify constituents and interactions of constituents that contribute to potential health benefits related to infection.

Effects of Ground Echinacea (Echinacea purpurea) Supplementation Quail Diets on Growth Performance and Carcass Traits

Summary This research was conducted to determine effects of echinacea supplementation quail diets on growth performance and carcass traits. A total of 207 Japanese quail (Coturnix coturnix japonica) were used in the study. They were divided into one control and two experimental groups each containing 69 Japanese quail chicks. Each group was divided into three subgroups of 23 chicks. The study lasted 35 days. The control group (C), was fed basic rations without supplement. The rations of experimental groups were supplemented with 1 g/kg (GI) and 5 g/kg (GII) of echinacea, respectively. At the end of the study, there were no statistically significant differences in terms of live weight gain, feed consumption, feed efficiency or carcass yield (P>0.05). Nevertheless, live weight increased in the second week in Group II (P<0.05). There were statistically significant differences in the weight of heart, liver and wing (P<0.05). In conclusion, echinacea supplementation had no additional effect on quail performance.

Gauging the clinical significance of P‐glycoprotein‐mediated herb‐drug interactions: Comparative effects of St. John's wort, Echinacea, clarithromycin, and rifampin on digoxin pharmacokinetics

Concomitant administration of botanical supplements with drugs that are P-glycoprotein (P-gp) substrates may produce clinically significant herb-drug interactions. This study evaluated the effects of St. John's wort and Echinacea on the pharmacokinetics of digoxin, a recognized P-gp substrate. Eighteen healthy volunteers were randomly assigned to receive a standardized St. John's wort (300 mg three times daily) or Echinacea (267 mg three times daily) supplement for 14 days, followed by a 30-day washout period. Subjects were also randomized to receive rifampin (300 mg twice daily, 7 days) and clarithromycin (500 mg twice daily, 7 days) as positive controls for P-gp induction and inhibition, respectively. Digoxin (Lanoxin 0.25 mg) was administered orally before and after each supplementation and control period. Serial digoxin plasma concentrations were obtained over 24 h and analyzed by chemiluminescent immunoassay. Comparisons of area under the curve (AUC)((0-3)), AUC((0-24)), elimination half-life, and maximum serum concentration were used to assess the effects of St. John's wort, Echinacea, rifampin, and clarithromycin on digoxin disposition. St. John's wort and rifampin both produced significant reductions (p < 0.05) in AUC((0-3)), AUC((0-24)), and C(max), while clarithromycin increased these parameters significantly (p < 0.05). Echinacea supplementation did not affect digoxin pharmacokinetics. Clinically significant P-gp-mediated herb-drug interactions are more likely to occur with St. John's wort than with Echinacea.

Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK

Little data is available on complementary and alternative medicine (CAM) use in children attending otolaryngology services. We investigated the prevalence and pattern of CAM use among children attending the pediatric otolaryngology department in a tertiary pediatric teaching hospital in Scotland. A cross-sectional survey conducted by administering an anonymous questionnaire to the parents accompanying patients attending the pediatric otolaryngology department. Elective admissions and clinic attendees were included over a 3-month period in 2005/2006. Academic tertiary care referral centre in North-East Scotland. Five hundred and fifty-four consecutive patients aged less than 16 years were eligible. The response rate was 59% (n=327). Prevalence of CAM use in children. Secondary measures include types of CAM used, indications for use and communication with family physicians. Based on 327 responses, 93 patients (29%) had ever used CAM, 20% within the last year. Commonly used CAM preparations were cod-liver oil, echinacea, aloe vera, cranberry, primrose oil and herbal vitamin supplements. The popular non-herbal CAM included homeopathy, massage, aromatherapy, chiropractic, yoga and reiki. Nineteen percent used CAM for their admission illness. Sixty-one percent of parents thought that CAM was effective and 65% would recommend it to others. Fifty-one percent of parents stated that the family physician was unaware of CAM use by the child. Despite concerns regarding the efficacy, safety and cost effectiveness of complementary and alternative medicine, its use among the pediatric otolaryngology population is more common than many providers may realize. This has implications for all healthcare workers involved in their care.

The Effect of 4 Wk of Oral Echinacea Supplementation on Serum Erythropoietin and Indices of Erythropoietic Status

The purpose of this investigation was to determine whether echinacea supplementation results in alterations of erythroid growth factors and erythropoietic status. Twenty-four men age 24.9 +/- 4.2 y, height 1.7 +/- 0.8 m, weight 87.9 +/- 14.6 kg, and 19.3% +/- 6.5% body fat were grouped using a double-blind design and self- administered an 8000-mg/d dose of either echinacea (ECH) or placebo (PLA) in 5 x 400 mg x 4 times/d for 28 d. Blood samples were collected and analyzed for red blood cells (RBCs), hematocrit (Hct), hemoglobin (Hb), mean corpuscular volume, mean corpuscular hemoglobin content, prostaglandin E2, ferritin, erythropoietin (EPO), interleukin 3 (IL-3), and granulocyte-macrophage-colony-stimulating factor using automated flow cytometry and ELISA. ANOVA was used to determine significant differences (P ? 0.05). EPO was greater (P < 0.001) in ECH at Days 7, 14, and 21 and reflected a 44%, 63%, and 36% increase, respectively. IL-3 was greater (P = 0.011) in ECH at Days 14 and 21, which indicated a 65% and 73% increase, respectively. These data indicate that ECH supplementation resulted in an increase in EPO and IL-3 but did not significantly alter RBCs, Hb, or Hct.