Elderberry
In short
Summary of findings for quick reference
Elderberry is not a footnote of botany; it is one of the historically most significant medicinal plants of Europe and beyond. The plant group appears across many centuries in medical, household, and folk-medical sources. Depending on the source base, the references span from ancient Mediterranean traditions through European household pharmacies to North American and East Asian Sambucus traditions.
Modern clinical research applies a markedly narrower standard of proof. That is important because it makes scientific claims testable. At the same time, this standard captures only a small slice of what has been documented, passed on, and practically used over a long history.
For elderberry both levels point in the same direction: an exceptionally strong historical significance and a modern research picture that is not yet settled, but already clear enough to place elderberry as a serious plant group in everyday use and in the history of phytotherapy. For concrete therapeutic claims, however, the clinical and legal bar stays narrower.
Clinical evidence ↔ Historical significanceWe display two separate evidence categories: clinical evidence from modern trials and historical significance from documented healing tradition. Both are valuable, but they answer different questions.Read more
In every encyclopedia entry we evaluate two distinct categories of evidence. Clinical evidence as used in trials meets a narrower but scientifically essential bar. At the same time, the hundreds of thousands of plant species worldwide have only partially been captured and tested in modern studies.
Alongside the trial picture our researchers compile a comprehensive overview of where and since when a plant has been used across different traditions of natural medicine. When a plant has been used as a medicinal plant in many cultures across many generations, that historical significance deserves to be visible too.
Our position: a truly informative overview emerges only when both categories sit side by side. We communicate transparently what counts as what.
Overview
Black elderberry, Sambucus nigra, is a European native shrub that has held a central place in the household herbal cabinet of German speaking Europe for centuries. In an Austrian Bauerngarten you often find it growing along the farmyard hedge. Two distinct plant parts carry their own tradition: the fragrant elderflower (Sambuci flos) and the ripe cooked berries (Sambuci fructus). Both are traditionally taken at the early onset of a cold, the flower as a sweat inducing tea, the berries usually as a syrup or cordial.
Modern research has focused on the anthocyanins of the dark berry, in particular cyanidin-3-glucoside and cyanidin-3-sambubioside. Small clinical trials such as Tiralongo et al. 2016 in air travellers, the meta-analysis by Hawkins et al. 2019 and the earlier study by Zakay-Rones et al. 2004 sketch a cautiously positive but modest picture for cold onset and duration. There is no approved EFSA health claim for elderberry; the EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) traditional use monograph covers the elderflower (Sambuci flos) at the early onset of a cold, while the EMA declined to establish a monograph for the berry (Sambuci fructus) in 2014. Elderberry is the plant Christiane began making recipes from in 1968 for friends and family, and so it stands at the beginning of our family tradition.
Elderflower (Sambuci flos) is the flowering part of the plant covered within this umbrella elderberry entry. It is distinct from the berry, traditionally taken as a sweat inducing tea at the onset of a cold, and carries its own EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) traditional use monograph. A dedicated elderflower page is planned.
History
Elderberry is one of the oldest medicinal plants of German speaking Europe. In the farmhouse garden and the monastery gardens of the early middle ages it was a matter of course; the Carolingian monk Walahfrid Strabo named sambucus among the plants of his monastery garden in the Hortulus around 840 CE. In folk medicine the household elder at the farmyard fence was regarded as a protective plant and as a reliable home remedy for the first cold days of the year. The flowers are usually harvested in June, the ripe berries in late August or early September.
In the nineteenth century German language Naturheilkunde documented elderflower and elderberry as a sweat inducing remedy at the early onset of a cold; the tradition continues in the Commission E monograph from 1986 and is now formally covered by the EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) monograph for the traditional use of the flower at the early symptoms of a cold. Christianes Naturkraft sources elderberry from Steiermark, Burgenland and Niederösterreich, the Alpenvorland regions rather than the high Alps. Christiane began making elderberry syrup and small extracts for friends and family in 1968, and that Holundersirup stands at the beginning of our family tradition.
Mechanism
The dark berry of Sambucus nigra contains a characteristic group of anthocyanins, in particular cyanidin-3-glucoside and cyanidin-3-sambubioside; these compounds give elderberry juice its deep colour and are the most studied chemical class of the plant. Flavonoids such as rutin and quercetin and other plant polyphenols are also present. Laboratory work such as Roschek et al. 2009 has described elderberry flavonoids binding to influenza virus surfaces in vitro. Observations of this kind explain why the plant has been studied in the context of cold and influenza symptoms, but they are not a demonstration of a clinical effect.
A second pharmacologically important compound is sambunigrin, a cyanogenic glycoside found mainly in the raw berries, the unripe berry parts and the bark and leaves. In the stomach sambunigrin can release small amounts of hydrocyanic acid, and even a small portion of raw berries can cause nausea and vomiting. Heating reliably destroys sambunigrin, which is why traditional preparations of elderberry always cook the berries. In dried or freshly infused elderflower, sambunigrin plays no comparable role. How much anthocyanin actually reaches the bloodstream from a spoon of syrup or a cup of tea is modest; the everyday dose is not the dose used in the clinical trials.
A second class of active compounds has come into focus in more recent laboratory work: the pectic polysaccharides released from the berry pulp into water based preparations. Their backbone of galacturonic acid, galactose, arabinose and rhamnose was the active fraction in a 2022 dendritic cell study by Stich and colleagues (PMID 35409309); the water extract activated immune cell maturation while an ethanolic extract with more than twice the anthocyanin density did nothing. The polysaccharides do not partition into ethanol, which means an alcoholic tincture loses them whatever the bottle's anthocyanin density. A briefly cooked, water extracted syrup carries both classes. This is one piece of laboratory evidence behind the long staying power of the European Hausholunder preparation.
Modern research on elderberry has focused on the duration and severity of cold and influenza symptoms. The current systematic review by Wieland and colleagues from 2021 (PMID 33827515), conducted with Cochrane methodology, gives the picture in plain terms: elderberry may reduce cold and flu duration, but the evidence is uncertain. The synthesis covers Tiralongo and colleagues 2016 (PMID 27023596), a randomised trial in 312 international air travellers in which the elderberry arm reported shorter and milder colds; the older Zakay-Rones and colleagues 2004 (PMID 15080016) randomised study in influenza, which reported earlier symptom resolution; and the meta-analysis by Hawkins and colleagues from 2019 (PMID 30670267), which pooled four trials with 180 participants and reported a direction consistent but modest signal.
The most rigorous independent confirmatory trial is Macknin and colleagues 2020 (PMID 32929634), a randomised controlled trial in 87 emergency department patients with PCR confirmed influenza A or B. The primary endpoint was null at 5.3 versus 4.9 days of symptoms. A post hoc subgroup that took elderberry without oseltamivir trended about two days worse, not better. Honest reading: the positive trials are real, the most independent confirmatory trial was not. The encyclopedia therefore stops short of saying elderberry shortens a cold or flu.
Beyond cold and flu the public picture of elderberry is much broader than the evidence supports. Two human trials on cardiovascular biomarkers (Curtis and colleagues 2009, PMID 19793846; Murkovic and colleagues 2004) found no chronic effect on cholesterol, blood pressure, or fasting glucose; the class level signal for anthocyanin rich berries comes from blueberry, chokeberry and cranberry, not from elderberry. Two cousin species pilot trials in mild cognitive impairment (Curtis 2024, PMID 38673938; Musich 2025, PMID 40002317) used American elderberry, Sambucus canadensis, not the European elder; we name them here as cousin context, not as direct evidence. There is no approved EFSA health claim for elderberry; the EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC) monograph covers the flower, Sambuci flos, as a traditional herbal medicinal product for the early onset of a cold, and a 2014 Public Statement declined to establish an equivalent monograph for the berry.
Evidence
| Outcome | Class | Grade | Effect | Studies | Refs |
|---|---|---|---|---|---|
| Cold and flu durationElderberry may shorten the duration of a cold or flu, but the overall evidence is still uncertain. The Cochrane method systematic review by Wieland 2021 reaches this cautious conclusion. The Hawkins 2019 meta-analysis (n=180 across 4 RCTs) points in the same direction with a modest signal; it predates the independent null Macknin 2020 trial, which is why current reviews keep the verdict tentative.Adults during the cold and flu season | EmergingEmerging research. Early small trials suggest an effect but await replication. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | May shorten, evidence uncertain | [1][4] | |
| Cold symptoms in air travellersIn air travellers, colds were shorter and milder in the elderberry arm. This comes from a single trial, Tiralongo 2016 (n=312), using a water extracted standardised dry extract at roughly 90 to 135 mg anthocyanin per day. One trial only, so the signal needs replication.International air travellers | EmergingEmerging research. Early small trials suggest an effect but await replication. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | Shorter, milder in one trial | [2] | |
| Influenza symptom durationThe picture for influenza is mixed. An early trial, Zakay-Rones 2004 (n=60), reported faster symptom resolution on a Sambucol syrup. The later, independent Macknin 2020 trial (n=87, PCR confirmed influenza, FDA IND) was null on its primary endpoint (5.3 vs 4.9 days). Because a well run recent trial found no effect, current systematic reviews treat the evidence as uncertain.Patients with influenza like or PCR confirmed influenza | EmergingEmerging research. Early small trials suggest an effect but await replication. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | Mixed, recent null trial | [3][5] | |
| Immune cell activity in cell cultureIn cell culture, the water extracted polysaccharide fraction activates dendritic cell maturation and downstream T cell responses, while an ethanolic extract with 2.3 times more anthocyanin does not. This is a laboratory signal only (in vitro). Stich 2022 ran the head to head, supported by Ho 2015 and 2016 and Krawitz 2011 mechanism papers. The reading for the reader is that the active sits in water based preparations, not in tinctures, but this has not been shown in people.Human dendritic cells, in vitro | EmergingEmerging research. Early small trials suggest an effect but await replication. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | Lab signal only (in vitro) | [8][9][7] | |
| Gut microbiome compositionElderberry shifts gut microbiome markers in a direction often read as favourable, raising Faecalibacterium, Bifidobacterium and Akkermansia. This is a biomarker shift only, with no symptom or health endpoint measured. The data come from two small human studies, Reider 2022 (small open intervention) and Teets 2024 (n=18, one week crossover), so this stays emerging research.Healthy adults | EmergingEmerging research. Early small trials suggest an effect but await replication. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | Biomarker shift only | [21][22] | |
| Early cold relief, elderflower (Sambuci flos)For the flower (Sambuci flos), there is a traditional use registration. The EMA HMPC monograph covers elderflower for the relief of early symptoms of the common cold. This applies to the flower, not the berry. The EMA declined a corresponding monograph for the fruit in 2014, so there is no equivalent EU level indication for the berry (Sambuci fructus). Flower and berry are kept distinct here.Adults at the early onset of a cold | TraditionalTraditional use. Long-standing folk practice or EMA HMPC traditional-use monograph. | IEvidence quality grade I (Insufficient). Not enough evidence to draw a conclusion. More research needed. This is an evidence rating, not a product endorsement. | Traditional use (EMA, flower) | [10][11] |
Usage
Forms and preparation
For a classic elderflower tea, place one to two teaspoons of dried elderflowers in about one hundred and fifty millilitres of hot water, cover the cup and let it steep for around ten minutes, then strain. Drink the tea warm, traditionally one to three cups a day in the early days of a cold. For simple household use of the berries, fully ripe fresh elderberries are slowly cooked with roughly the same weight of sugar, strained and filled hot as elderberry syrup into clean bottles; once opened, store in the refrigerator and use within a few weeks. Important: elderberries are never processed or eaten raw. Only cooking reliably destroys the sambunigrin in the berries. If you forage the berries yourself, check that the cluster hangs downward from a woody shrub; upright berry clusters on a herbaceous stem are a warning sign for dwarf elder. Standardised elderberry extracts from the pharmacy are a practical alternative to home preparation and are the form typically used in clinical research.
Dosage
The EMA HMPC monograph gives a usage period of up to about a week for the traditional use of the elderberry at the early onset of cold symptoms; the precise dose depends on the preparation and its standardisation. In household use elderberry syrup is often taken as one to two tablespoons two to three times a day in hot water, again for a few days at the start of a cold. Elderflower tea is traditionally drunk at one to three cups a day. For standardised pharmacy preparations follow the dosing instruction on the pack. Two practical notes: elderberry syrup contains sugar. If you have diabetes or you are watching your blood sugar, count this amount in. And elderberry is intended as short help in the acute phase, not as a daily long term supplement. If symptoms last for more than a few days, high fever develops, or you feel distinctly worse, that is a reason to see a doctor, not a reason to take more syrup.
Safety
Drug interactions
Documented or flagged interactions are limited. Warfarin: a single WHO-UMC case in the EMA fructus assessment report reported an INR shift; inform your prescriber if you start or stop a regular elderberry preparation. Immunosuppressants and biologics (azathioprine, mycophenolate, cyclosporin, tacrolimus, infliximab, adalimumab, rituximab, systemic corticosteroids): a theoretical interaction from cytokine stimulation in vitro; default is to avoid elderberry in this group unless the treating physician explicitly clears it. No documented signal for antihypertensives, theophylline, or CYP3A4 substrates such as statins, calcium channel blockers or oral contraceptives; the in vitro CYP3A4 work on elderberry alone is null (Schroeder-Aasen 2012). For antidiabetics there is no clinical hypoglycaemia signal, but watch your blood sugar when starting a new sugar containing preparation.
Contraindications
Hypersensitivity to elderberry, including known Type I allergy to Sam n 1. Pregnancy and breastfeeding for concentrated medicinal preparations, per EMA HMPCEuropean Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Children under 12 years for elderflower as a medicinal product and under 18 years for elderberry fruit as a medicinal product, both per EMA; cooked Hollersaft as a household food is treated separately by tradition. Active dermatomyositis or cutaneous lupus, per the Faden 2024 flare rate signal. Transplant recipients or patients on systemic immunosuppression.
Side effects
Generally well tolerated in traditional amounts. Occasional mild gastrointestinal upset has been described, particularly with larger amounts of unfamiliar syrup, and rare allergic reactions are on record. If signs of an allergic reaction develop (rash, swelling, breathing difficulties) stop use immediately and seek medical advice.
Look-alikes
Toxic look-alikes
Sambucus ebulus (Zwergholunder, dwarf elder)
Dwarf elder is a herbaceous plant, not a woody shrub; it usually grows only one to two metres tall. The berries stand upright in flat clusters rather than hanging down as in black elderberry, and rubbing the leaves releases an unpleasant herbaceous smell. The berries of dwarf elder are toxic.
Sambucus racemosa (Roter Holunder, red berried elder)
Red berried elder bears red berries rather than black and flowers earlier in the year (April to May) than black elderberry (May to June). The raw berries are problematic and are not used in household preparations.
FAQs
Can I eat elderberries raw?
No. Raw elderberries contain sambunigrin, a cyanogenic glycoside that can release hydrocyanic acid in the stomach, and even a small portion can cause nausea and vomiting. Cooking reliably destroys sambunigrin. For this reason traditional preparations of elderberry always cook the berries, as syrup, juice, cordial or stewed fruit. Elderflowers can be infused fresh or dried as a tea; sambunigrin plays no comparable role there.
How do I tell black elderberry apart from dwarf elder?
Three cues are the most useful. Black elderberry (Sambucus nigra) is a woody shrub that grows three to eight metres tall, with drooping berry clusters. Dwarf elder (Sambucus ebulus) is a herbaceous plant, usually only one to two metres tall, and its berries stand upright in flat clusters rather than hanging down. Rubbing the leaves of dwarf elder also releases an unpleasant herbaceous smell. If in doubt, leave the berries.
Is elderberry safe during pregnancy and breastfeeding?
The data are thin. The EMA HMPC monograph recommends, out of caution, that concentrated elderberry preparations are avoided in pregnancy and breastfeeding. A moderate culinary amount of elderberry syrup or an infusion of elderflowers is traditionally treated differently; if in doubt talk with your doctor or midwife.
When in the course of a cold should I take elderberry?
The EMA HMPC monograph names traditional use at the early onset of cold symptoms, in other words early rather than at the peak. The small clinical trials of elderberry in colds were carried out in a similarly early window. Elderberry is meant as short help in the acute phase, not as a daily long term supplement and not as a curative treatment. If symptoms last for more than a few days, high fever develops, or you feel distinctly worse, that belongs in the hands of a doctor.
Can children have elderberries or elderberry syrup?
Cooked elderberry syrup in small age appropriate amounts and elderflower tea in a light concentration are part of the Austrian household tradition for older children. Raw berries are off limits, including for snacking during the harvest. Do not give syrup that has been sweetened with honey to infants under one year; for this age group talk with the paediatrician in general. For standardised pharmacy preparations follow the age related dosing instruction on the pack.
What is the Macknin 2020 study, and why does it matter?
Macknin and colleagues 2020 (PMID 32929634) is the most rigorous independent randomised controlled trial of elderberry in PCR confirmed influenza A or B. 87 patients seen in an emergency department were randomised to Sambucol or matched placebo. The primary endpoint, symptom duration, was null at 5.3 versus 4.9 days. A post hoc subgroup analysis suggested that participants who took elderberry without oseltamivir had symptoms about two days worse, not better. This is the inconvenient trial, and the encyclopedia cites it because honest grading includes inconvenient findings.
Why is there no EU 'immune support' health claim on elderberry?
The European Food Safety Authority opined on the relevant claim in 2011 and judged it not supported by pertinent human data; the elderberry respiratory health claim under ID 2137 received a negative opinion (EFSA Journal 2011;9(6):2248). Three other elderberry claims remain on the EU 'botanicals on hold' list, none yet authorised. The only legally authorised 'immune system' claim that an elderberry containing supplement can carry today is the vitamin C claim ('Vitamin C contributes to the normal function of the immune system'), and it requires that the product deliver at least 12 milligrams of vitamin C per portion and that the claim be worded as a vitamin C attribute, not an elderberry attribute.
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About this entry
This encyclopedia is published by Christianes Naturkraft. Christianes elderberry syrups are made from Haschberg cultivar berries grown in the Steiermark Alpenvorland, briefly cooked and water extracted in the traditional Hausholunder way, and supplemented with ElderCraft, a standardised water extracted black elderberry concentrate of the kind studied in the Tiralongo 2016 trial in international air travellers. We try to write this entry the way a researcher would read the evidence, with our grading kept honest where the trials are mixed or absent; this disclosure is here so you can read the entry knowing where it comes from.
Legal notice: The depiction of historical significance and traditional use is context within our encyclopedia and not a health claim for any product, not a treatment promise, and not a substitute for medical advice. What may be stated on product labels, product pages, or in advertising is governed by the applicable legal requirements.