Elderberry
In short
Summary of findings for quick reference
Elder has a long history as a food and medicinal plant. European sources mainly describe black elder. Other Sambucus species are used in North America and East Asia; their traditions need to be considered separately.
Historical records describe how people used elder. Clinical studies ask whether a particular preparation helps with a particular condition. These sources answer different questions.
Early clinical studies of elderberries for colds and influenza have produced conflicting results. The traditional use of elderflower at the beginning of a cold is described in an EMA monograph. It does not establish the same effect for the berry.
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. Some small trials and the Hawkins 2019 meta-analysis report positive results for cold and flu symptoms. Macknin 2020, however, found no benefit in influenza. Overall efficacy remains uncertain. 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. Christiane began making herbal recipes for friends and family in 1968. This tradition informs our interest in elder.
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
Elder has been part of European folk medicine for centuries. It was grown near farmhouses and in household gardens and was also associated with protective properties. Flowers and berries are harvested at different times: flowers usually in June and ripe berries in Central Europe often in late August or early September.
Elderflowers have long been used in European herbal medicine as a sweat-promoting preparation at the onset of a cold. The current EMA monograph describes this traditional use of the flower. Our elderberries come from Styria, Burgenland and Lower Austria. Christiane began making herbal recipes for family and friends in 1968. This personal history marks 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. Elderberries must be cooked thoroughly to render their harmful constituents harmless. In dried or freshly infused elderflower, sambunigrin plays no comparable role. An ordinary serving of syrup or tea does not specify a reliable anthocyanin dose. Such preparations cannot therefore be directly equated with standardised study products.
Recent laboratory research has also examined pectic polysaccharides from elderberries. Stich and colleagues 2022 (PMID 35409309) identified them in a water extract and tested enriched fractions on dendritic cells. These fractions promoted immune cell maturation in vitro, whereas a different ethanolic extract did not show this effect. The comparison describes differences between the tested extracts; it does not establish the effectiveness of homemade syrup or a general superiority of water-based preparations.
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.
Macknin and colleagues 2020 (PMID 32929634) adds a negative result to this picture. Among 87 emergency department patients with PCR-confirmed influenza A or B, elderberry showed no statistically significant benefit. The mean time until all symptoms were mild or absent was 5.3 days with elderberry and 4.9 days with placebo. In a post hoc subgroup analysis without oseltamivir, symptoms lasted about two days longer with elderberry. This exploratory finding does not establish harm, but underlines uncertainty about efficacy.
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 cultureStich 2022 compared two elderberry extracts in cell culture. The water extract and its polysaccharide-rich fractions promoted dendritic cell maturation and subsequent T cell responses; the tested ethanol extract did not show this effect despite a higher anthocyanin content. This finding applies to these extracts and this laboratory experiment. It does not demonstrate a benefit in people or establish that syrups are generally superior to tinctures.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 compositionTwo small human studies reported changes in gut microbiota. Reider 2022 found increased Akkermansia in only a subset of participants. Teets 2024 studied 18 adults in a crossover trial with one week each of elderberry juice and placebo, reporting changes including Faecalibacterium and Bifidobacterium. Metabolic measures were also assessed. These findings do not establish a long-term health benefit.Healthy adults, including people with overweight or obesity | 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 monograph on traditional medicinal use. 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 elderflower tea, pour boiling water over the dried flowers, cover and steep for about ten minutes, then strain. For medicinal use, follow the guidance in the Dosage section and the package leaflet. For elderberry syrup, use only positively identified, fully ripe black elderberries. Remove stalks and unripe fruit, cook the berries thoroughly using a tested recipe, and follow its instructions for hygienic bottling, storage and shelf life. Do not eat elderberries raw. The preparations described here require positively identified, fully ripe black elderberries and a tested recipe with thorough cooking. Drooping fruit clusters on a woody shrub are a feature of black elder; upright clusters on a herbaceous plant can indicate dwarf elder. These features alone do not replace reliable identification. If unsure, use fruit or suitable prepared products from a retailer.
Dosage
There is no EMA elderberry-fruit monograph specifying a recommended dose for colds. Follow the instructions for the individual product. The elderflower monograph describes an infusion of 2 to 5 g flowers in 150 ml boiling water, three times daily, for adults and adolescents aged 12 and over. Seek medical advice if symptoms persist longer than a week or worsen. Elderberry syrup often contains substantial sugar. If you have diabetes or monitor your blood glucose, take the amount per serving into account. Seek medical advice for persistent or worsening symptoms, or if breathlessness, fever or purulent sputum occurs.
Safety
Drug interactions
Interaction data are limited. If you take warfarin, discuss starting or stopping a regularly used elderberry preparation with your prescriber. Consult your clinician before use with immunosuppressants or biologics: laboratory findings on immune cell activity justify caution but do not establish a clinical interaction. A lack of reports for other medicines does not prove that combinations are safe. If you have diabetes, account for the sugar content of syrup.
Contraindications
Do not use elder preparations if you have a known allergy to elder. Elderflower medicines are not recommended for children under 12 or during pregnancy and breastfeeding because data are insufficient. For berry preparations, follow product-specific age restrictions. Discuss use with your treating clinician if you have active dermatomyositis or cutaneous lupus, or take systemic immunosuppressants.
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
Similar plants and look-alikes
Dwarf elder (Sambucus ebulus)
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.
Red elder (Sambucus racemosa)
Red elder (Sambucus racemosa) bears red fruit in cone-shaped clusters and usually flowers earlier than black elder. Its raw fruit and especially the seeds are problematic. It is used in processed preparations, but requires its own preparation methods. Do not substitute it for black elder in the recipes described here.
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.
What should pregnant or breastfeeding readers know before using elderberry?
The safety of medicinal use during pregnancy and breastfeeding has not been adequately studied. The EMA therefore does not recommend elderflower medicines during this period, including medicinal tea. Safety data for elderberry preparations are also insufficient. Discuss regular use with your doctor or midwife.
When in the course of a cold should I take elderberry?
The EMA HMPC elderflower monograph names traditional use at the early onset of cold symptoms, in other words early rather than at the peak. Berry trials used different schedules, starting either before travel or shortly after symptom onset. The studies tested time-limited regimens; they do not establish a general recommendation for daily long-term use. 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 is also used as a food; consider age, serving size and sugar content. Medicinal use has different requirements: elderflower medicines are not recommended below age 12. For berry products, follow age restrictions and discuss treatment with a paediatrician. Children must not eat raw berries. Do not give honey-containing syrup to infants under one year.
What is the Macknin 2020 study, and why does it matter?
Macknin and colleagues 2020 (PMID 32929634) studied 87 people with PCR-confirmed influenza A or B, randomly assigning them to Sambucol or placebo. The mean time until symptoms were mild or absent was 5.3 days with elderberry and 4.9 days with placebo, a statistically non-significant difference. A post hoc subgroup analysis without oseltamivir was less favourable to elderberry, but does not establish a harmful effect. The study matters because it did not confirm earlier positive results.
Why is there no EU 'immune support' health claim on elderberry?
EFSA gave a negative opinion on the elderberry respiratory-health claim under ID 2137 in 2011 (EFSA Journal 2011;9(6):2248). In a combination product, an authorised normal immune-function claim may refer, for example, to its vitamin C content if the applicable conditions of use are met. It then describes that nutrient. Simply including elderberry or vitamin C does not by itself qualify a product for the claim.
25 sources.
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- Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers, a Randomized, Double-Blind Placebo-Controlled Clinical Trial. 2016. doi:10.3390/nu8040182
- Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections. 2004. doi:10.1177/147323000403200205
- Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms, a meta-analysis of randomized, controlled clinical trials. 2019. doi:10.1016/j.ctim.2018.12.004
- Macknin M, Wolski K, Negrey J, Mace S. Elderberry extract outpatient influenza treatment for emergency room patients ages 5 and above, a randomised controlled trial. 2020. doi:10.1007/s11606-020-06170-w
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- Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T (2011). Inhibitory activity of a standardised elderberry liquid extract against clinically relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complementary and Alternative Medicine 11:16.. 2011. doi:10.1186/1472-6882-11-16
- Stich L, Plattner S, McDougall G, Austin C, Steinkasserer A. Polysaccharides from European Black Elderberry Extract Enhance Dendritic Cell Mediated T Cell Immune Responses. 2022. doi:10.3390/ijms23073949
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- EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). Scientific opinion on the substantiation of health claims pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA Journal 2011;9(6):2248. Negative opinion for ID 2137 Sambucus nigra respiratory health.. 2011. doi:10.2903/j.efsa.2011.2248
- Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Poisoning from elderberry juice, California, August 1983. MMWR Morbidity and Mortality Weekly Report 33(11), 23 March 1984.. 1984. PMID:6708250
- Daniella F. Faden, Caroline J. Stone, Lillian Xie, Lais Lopes Almeida Gomes, Victoria P. Werth. Prevalence and Risk of Immunostimulatory Herbal Supplement Treatment Among Autoimmune Dermatology Patients. 2024. doi:10.1002/acr2.11735
- Foerster-Waldl E, Marchetti M, Schoell I, Focke M, Radauer C, Kinaciyan T, Nentwich I, Jaeger S, Schmid ER, Boltz-Nitulescu G, Scheiner O, Jensen-Jarolim E. Foerster-Waldl E, Marchetti M, Schoell I, Focke M, Radauer C, Kinaciyan T, Nentwich I, Jaeger S, Schmid ER, Boltz-Nitulescu G, Scheiner O, Jensen-Jarolim E (2003). Type I allergy to elderberry (Sambucus nigra) is elicited by a 33.2 kDa allergen with significant homology to ribosomal inactivating proteins. Clinical and Experimental Allergy 33(12):1703 to 1710.. 2003. doi:10.1111/j.1365-2222.2003.01811.x
- Vlachojannis JE, Cameron M, Chrubasik S. Vlachojannis JE, Cameron M, Chrubasik S (2015). Quantification of anthocyanins in elderberry and chokeberry dietary supplements. Phytotherapy Research.. 2015. doi:10.1002/ptr.5284
- Curtis PJ, Kroon PA, Hollands WJ, Walls R, Jenkins G, Kay CD, Cassidy A. Curtis PJ, Kroon PA, Hollands WJ, Walls R, Jenkins G, Kay CD, Cassidy A (2009). Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. Journal of Nutrition 139(12):2266 to 2271.. 2009. doi:10.3945/jn.109.113126
- Bell DR, Gochenaur K. Bell DR, Gochenaur K (2006). Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. Journal of Applied Physiology 100(4):1164 to 1170.. 2006. doi:10.1152/japplphysiol.00626.2005
- Reider S, Watschinger C, Längle J, Pachmann U, Przysiecki N, Pfister A, Zollner A, Tilg H, Plattner S, Moschen AR. Short- and Long-Term Effects of a Prebiotic Intervention with Polyphenols Extracted from European Black Elderberry-Sustained Expansion of Akkermansia spp.. 2022. doi:10.3390/jpm12091479
- Teets C, Ghanem N, Ma G, Minj J, Perkins-Veazie P, Johnson SA, Etter AJ, Carbonero FG, Solverson PM. A One-Week Elderberry Juice Intervention Augments the Fecal Microbiota and Suggests Improvement in Glucose Tolerance and Fat Oxidation in a Randomized Controlled Trial. 2024. doi:10.3390/nu16203555
- Curtis AF et al.. Curtis AF et al. (2024). American elderberry (Sambucus canadensis) anthocyanin supplementation in older adults with mild cognitive impairment, pilot RCT.. 2024. PMID:38673938
- Musich AJ et al.. Musich AJ et al. (2025). American elderberry (Sambucus canadensis) MCI pilot RCT extension.. 2025. PMID:40002317
- Jabbari M, Hashempur MH, Razavi SZ, Shahraki HR, Kamalinejad M, Emtiazy M. Jabbari M, Hashempur MH, Razavi SZ, Shahraki HR, Kamalinejad M, Emtiazy M (2016). Efficacy and short-term safety of topical Dwarf Elder (Sambucus ebulus L.) versus diclofenac for knee osteoarthritis, a randomised, double-blind, active-controlled trial.. 2016. PMID:27619828
About this entry
This encyclopedia is published by Christianes Naturkraft. We source berries for our elderberry syrups from Austria, particularly Steiermark, Burgenland and Niederösterreich. This entry describes traditional use and assesses the research, including conflicting or missing evidence. This disclosure makes our connection to the subject transparent.
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.