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The common cold: echinacea purpurea is no better than placebo

There is no known drug, herbal medicine or other remedy that reduces the intensity or duration of cold symptoms and has a favourable harm-benefit balance.

The cold is a common infection, usually of viral origin and not serious. Clinical manifestations – difficulty breathing through the nose, runny nose and sneezing – usually disappear spontaneously within 1-2 weeks. A thick, purulent nasal discharge is part of the normal course of a cold. No drug to reduce the intensity or duration of cold symptoms has a favourable harm-benefit balance. The first-choice treatments consist of drinking plenty of liquids, avoiding tobacco smoke, moistening or clearing the nasal passages with saline solution, and possibly taking paracetamol in case of pain or fever.

Dehydrated juice of Echinacea purpurea's flowering aerial parts is sold as a drug. It is authorised in France in the form of tablets for the treatment and prevention of colds in adults and children from the age of 12. The evaluation of this medicinal product is based on studies carried out with various preparations derived from dehydrated juice from Echinacea purpurea's flowering aerial parts. There is no evidence of this drug's efficacy compared to placebo, given the limitations of these trials: small numbers, conflicting results, conflicts of interest, doubt as to whether the group adhered to the double blindness principle.

Echinacea purpurea preparations have few adverse effects. But rare severe allergic reactions have been reported and are to be weighed up against the benign nature of the common cold and the lack of demonstrated efficacy beyond that of a placebo.

©Prescrire 1 January 2020

"Echinacea purpurea (Échinacée pourpre Humexphyto°) in the common cold" Prescrire Int 2020; 29 (211): 9-10. (Pdf, subscribers only).

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