19 Mar 2020

Safety Discussion: Elderberry and Immune Stimulation Concerns

There has been a great deal of discussion here and elsewhere on whether or not elderberry should be used during the current outbreak of viral illness. For many of us, elderberry is already a common part of supportive care during cold and flu season. Naturally, we’re curious about whether it’s appropriate for use now, and a lot of discussions continue to circulate online. (Discussions have included both elderberry and elderflower, with some herbalists considering these interchangeable and others finding nuances.)

In this present situation, we have very little information we can rely on to tell us which herbs are helpful and which may be harmful to individuals infected or looking to prevent being infected. However, many herbalists are venturing to extrapolate and give ideas on what a useful herbal protocol might be. 

Elderberry and Immune Stimulation

Herbalists generally recommend supporting the immune system with immunomodulant herbs and perhaps even immune stimulant herbs (if these are safe for you personally) if you do not currently have symptoms of respiratory infection. Elderberry is something that many herbalists and herb-interested people turn to in order to stay healthy during cold and flu season in general, so it is reasonable that we are all thinking about it right now. The theoretical concern regarding elderberry is based on a concern that if elderberry enhances immune function it could also upregulate inflammatory cytokines, and cause what is referred to as a “cytokine storm.” Cytokine storm refers to a rare phenomenon that has led to complications in young and otherwise healthy individuals while fighting off a severe infection. The bottom line is that we don’t know whether elderberry can cause a cytokine storm in individuals infected at this time. Many herbalists state that it is unlikely. Others have taken a stance that even if this is speculative, there are many other herbs and practices to choose from for individuals caring for viral illness at home.

You can avoid elderberry altogether by using some other immune-supportive herbs, such as licorice (Glycyrrhiza glabra) root (not for individuals with high blood pressure or for long-term use), astragalus (Astragalus membranaceus) root, turkey tail (Trametes versicolor) mushroom, and/or reishi (Ganoderma spp.) mushroom. Some herbalists prefer to avoid immune-tonic herbs after symptoms begin, and it may be a good idea to move on to other herbs that fit an individual’s presentation of symptoms once infection occurs (this is not true for licorice, which may help to manage symptoms and increase comfort during an acute infection). This may be even more important with regard to elderberry; while we believe that for most individuals elderberry is safe before infection, it may be that it should be avoided if symptoms develop. Elderberry may also not be safe for some individuals with autoimmune conditions. 

While there are no exact answers to these types of questions, we must use the best information we have and our experience and share what we learn as we proceed through this together. We are keeping up with the many thoughtful articles published by experienced clinical herbalists on this topic to date and encourage you to do the same. 

For additional resources, see our blog post here.