Elderberry for Upper Respiratory Infections
Elderberry is not recommended as a treatment for upper respiratory infections due to insufficient high-quality evidence supporting its efficacy. 1
Evidence Assessment
- Current clinical guidelines do not recommend homeopathic substances, including elderberry, for the prevention or treatment of lower or upper respiratory tract infections (C4 level recommendation) 1
- The European Respiratory Journal guidelines specifically state that "the use of homeopathic substances is not recommended as a preventive approach against LRTI" 1
- While some research suggests potential benefits, the evidence is inconsistent and of limited quality 2, 3, 4
Research Findings on Elderberry
- A 2019 meta-analysis suggested elderberry supplementation might reduce upper respiratory symptoms, but included only 180 participants across all studies, limiting the strength of conclusions 2
- A 2020 randomized, double-blind, placebo-controlled trial (the most recent high-quality study) found no evidence that elderberry benefits the duration or severity of influenza, contradicting earlier smaller studies 3
- Post-hoc analysis from this trial suggested primary outcomes with elderberry taken alone (without oseltamivir) were actually 2 days worse than with placebo 3
- A 2021 systematic review concluded that evidence regarding elderberry's efficacy for viral respiratory infections remains uncertain 5
Safety Considerations
- There are theoretical concerns about elderberry potentially overstimulating the immune system, although current evidence is insufficient to confirm this risk 5, 6
- One study found elderberry has effects on inflammatory markers, though these effects may diminish with ongoing supplementation 5
- Elderberry may be less effective than conventional anti-inflammatory medications in cytokine reduction 5
Recommended Approaches for Upper Respiratory Infections
- For upper respiratory tract infections, antibiotics are not recommended as they will not prevent progression to lower respiratory tract infections (A1 level recommendation) 1
- Symptomatic treatment with analgesics for pain and antipyretics for fever is appropriate for most uncomplicated upper respiratory infections 1
- For specific conditions like acute rhinosinusitis, antibiotics should be reserved for patients with:
- Persistent symptoms for more than 10 days
- Severe symptoms including high fever (>39°C) with purulent nasal discharge or facial pain for at least 3 consecutive days
- Worsening symptoms following initial improvement of a typical viral illness (double sickening) 1
Bottom Line
Based on the most recent high-quality evidence, elderberry cannot be recommended for the treatment or prevention of upper respiratory infections. The 2020 randomized controlled trial showed no benefit and possible harm when used alone 3. Patients should be advised to use evidence-based symptomatic treatments and to consult healthcare providers if symptoms are severe or persistent.