Elderberry has been used in folk medicine for centuries to treat influenza, colds and sinusitis, and has been reported to have antiviral activity against influenza and herpes simplex. We investigated the efficacy and safety of oral elderberry syrup for treating influenza A and B infections. Sixty patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less were enrolled in this randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000 in Norway. Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study.

1. Centers for Disease Control and Prevention: Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998; 47 (RR-6): 121 Google Scholar
2. Long, JK, Mossad, SB, Goldman, MP: Antiviral agents for treating influenza. Cleve Clin J Med 2000; 67: 9295 Google Scholar, Crossref, Medline
3. British Herbal Medicine Association: British Herbal Pharmacopoeia. Bournemouth: BHMA Publications 1983; pp 186187 Google Scholar
4. Serkedjieva, J, Manolova, N, Zgorniak-Nowosielka, I, Zawilinska, B, Grybek, J: Antiviral activity of the infusion (SHS-174) from flowers of Sambucus nigra L., aerial parts of Hypericum perforatum L., and roots of Saponaria officinalis L. against influenza and herpes simplex viruses. Phytother Res 1990; 4: 97100 Google Scholar, Crossref
5. Brønnum-Hansen, K, Hansen, SH: High-performance liquid chromatographic separation of anthocyanins of Sambucus nigra L. J Chromatogr 1983; 262: 385392 Google Scholar, Crossref
6. Amoros, M, Simoes, CM, Girre, L, Sauvage, F, Cormier, M: Synergistic effect of flavones and flavonols against herpes simplex virus type 1 in cell cultures. Comparison with the antiviral activity of propolis. J Nat Prod 1992; 55: 17321740 Google Scholar, Crossref, Medline
7. Hemingway, RW, Laks, PE (eds): Plant Polyphenols-Synthesis, Properties and Significance. New York: Plenum Press 1992; pp 705715 Google Scholar
8. Nagai, T, Miyaichi, Y, Tomimori, T, Suzuki, Y, Yamada, H: Inhibition of influenza virus sialidase and anti-influenza virus activity by plant flavonoids. Chem Pharm Bull (Tokyo) 1990; 38: 13291332 Google Scholar, Crossref, Medline
9. Mahmood, N, Pizza, C, Aquino, R, De Tommasi, N, Piacente, S, Colman, S: Inhibition of HIV infection by flavonoids. Antiviral Res 1993; 22: 189199 Google Scholar, Crossref, Medline
10. Abuja, PM, Murkovic, M, Pfannhauser, W: Antioxidant and prooxidant activities of elderberry (Sambucus nigra) extract in low-density lipoprotein oxidation. J Agric Food Chem 1998; 46: 40914096 Google Scholar, Crossref
11. Kaack, K, Austed, T: Interaction of vitamin C and flavonoids in elderberry (Sambucus nigra L.) during juice processing. Plant Foods Hum Nutr 1998; 3: 187198 Google Scholar, Crossref
12. Cao, G, Prior, RL: Anthocyanins are detected in human plasma after oral administration of an elderberry extract. Clin Chem 1999; 45: 574576 Google Scholar, Medline
13. Zakay-Rones, Z, Varsano, N, Zlotnik, M, Manor, O, Regev, L, Schlesinger, M: Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995; 1: 361369 Google Scholar, Crossref, Medline
14. Burge, E, Mumcuoglu, M, Simmons, T: The effect of Sambucol on flu-like symptoms in chimpanzees: prophylactic and symptom-dependent treatment. Int Zoo News 1999; 46: 1619 Google Scholar
15. Kalin, M, Grandien, M: Rapid diagnostic methods in respiratory infections. Curr Opin Infect Dis 1993; 6: 150157 Google Scholar, Crossref
16. Døller, G, Schuy, W, Tjhen, KY, Stekeler, B, Gerth, HJ Direct detection of influenza virus antigen in nasopharyngeal specimens by direct enzyme immunoassay in comparison with quantitating virus shedding. J Clin Microbiol 1992; 30: 866869 Google Scholar, Medline
17. National Institute of Public Health: Influenza surveillance 1999/2000, No. 20. Oslo: National Institute of Public Health, 2000 Google Scholar
18. Barak, V, Halperin, T, Kalickman, I: The effect of Sambucol, a black elderberry-based natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw 2001; 12: 290296 Google Scholar, Medline
19. Wang, H, Nair, MG, Strasburg, GM, Chang, YC, Booren, AM, Gray, JI: Antioxidant and antiinflammatory activities of anthocyanins and their aglycon, cyanidin, from tart cherries. J Nat Prod 1999; 62: 294296 Google Scholar, Crossref, Medline
20. Matsumoto, K, Ogawa, N, Nerome, K, Numazaki, Y, Kawakami, Y, Shirato, K: Safety and efficacy of the neuraminidase inhibitor zanamivir in treating influenza virus infection in adults: results from Japan. Antivir Ther 1999; 4: 6168 Google Scholar, Medline
21. Mäkelä, MJ, Pauksens, K, Rostila, T, Fleming, DM, Man, CY, Keene, ON: Clinical efficacy and safety of the orally inhaled neuraminidase inhibitor zanamivir in the treatment of influenza: a randomized, double-blind, placebo-controlled European study. J Infect 2000; 40: 4248 Google Scholar, Crossref, Medline
22. Nicholson, KG, Aoki, FY, Osterhaus, AD, Trottier, S, Carewicz, O, Mercier, CH: Efficacy and safety of oseltamivir in treatment of acute influenza: a randomised controlled trial. Neuraminidase Inhibitor Flu Treatment Investigator Group. Lancet 2000; 355: 18451850 Google Scholar, Crossref, Medline

Vol 32, Issue 2, 2004