When the clinical and in vivo studies of Echinacea are carefully examined, most conclude that the herb increases phagocytic activity. Even the polysaccharides only enhance macrophage activity and killing (Bauer and Wagner, 1991). Phagocytic cells are part of nonspecific immunity. What is often not appreciated is that the activities of phagocytic cells, especially macrophages, are a key element of immune surveillance. The macrophage secretes several immune-enhancing cytokines and pro cesses antigenic material and then presents this to the helper T-cell. Helper T-cells can only effectively respond to antigen presented in this way. Hence, if an herb such as Echinacea significantly increases phagocytic activity, the end result will be enhanced immune surveillance. For infections in general, the fact that Echinacea increases phagocytic activity emphasizes that it works best as a prophylactic or in the very early stages of an infection. This is because enhanced phagocytosis gives better direct clearance and inactivation of pathogenic organisms by phagocytes, which is one of the first lines of immune defense, and better immune surveillance, which accelerates the response of the immune system to the new pathogen or to other opportunistic pathogens.
That Echinacea works best as a preventative is consistent with the clinical experience of many phytotherapists, although this activity has not been borne out by recent studies (Melchart and Linde, 1999). In fact, it may be more accurate to describe Echinacea as an immunomodulator. While it stimulates phagocytic activity, this may have the end result of modulating immune function overall. For example, the chronic presence of a microorganism may cause a state of immune dysregulation that results in autoimmune disease or a chronic inflammatory condition such as asthma. Such theories have been proposed in the mainstream scientific literature (Bone, 1999). A substance that enhances immune surveillance may help the body to eliminate the organism or neutralize its imbalancing effect on the immune system, thereby toning down an inappropriate immune response. Similarly, the body's response to an allergen may be reduced if a more appropriate response results from enhanced phagocytic activity and immune recognition.
Limitations on the oral use of Echinacea have resulted from preconceived and simplistic concepts of the immune system and Echinacea's influence on it. Misinterpretations or overinterpretations in the scientific literature have confounded the problem. Confounding this issue further are the observations that the term Echinacea is used to describe many different preparations and the phytochemical content of Echinacea products varies considerably. However, the weight of evidence, including traditional, observational, and scientific, is that limitations on the use of Echinacea are ill advised.
Perhaps if the understanding of Echinacea's activity after oral doses were shifted toward the concept of an immunomodulator rather than an immunostimulant, concerns about its use would abate. Echinacea is undoubtedly one of the most valuable herbs in use in the world today. Misconceptions about its use can only devalue its role in modern health care and needlessly restrict the efficacy of herbal therapy.
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