Elderberry (Sambucus nigra)

Black elderberry is widely sold as a «natural cold remedy» promising to shorten URI duration. The Hawkins 2019 meta-analysis in 180 patients across 4 RCTs showed moderate 2-4 day symptom duration reduction with Sambucol syrup started in the first hours of illness. Evidence quality is limited by small samples, heterogeneous methods and potential conflicts of interest (some trials sponsored by the manufacturer). The updated Cochrane 2024 review on flu and cold rated the data as mixed evidence: small effect, uncertain clinical relevance. AAFP 2019 and SEIMC 2020 for the common cold list paracetamol for fever, fluids, rest, nasal saline irrigation first-line; elderberry is not in international guidelines. If elderberry was recommended as a substitute for symptomatic therapy or for antibiotic in bacterial superinfection, consider seeking a second opinion.

Black elderberry is sold as an «immunity booster» promising URI prophylaxis. The Tiralongo 2016 RCT in 312 air-travellers showed moderate reduction in cold duration and severity with elderberry taken 10 days before and during the flight, but no reduction in incidence. EMA HMPC 2013 recognises elder flowers as a traditional herbal medicinal product, not a prophylactic. EFSA approved no «immunity» health claim for elderberry. For influenza prevention CDC and ECDC recommend annual vaccination in all aged ≥6 months; elderberry is not in international prophylaxis guidelines. If elderberry was recommended as a vaccination substitute or in an immunocompromised patient, consider seeking a second opinion.