There is evidence that black elderberry extract (trade name: Sambucol) can reduce the risk of contracting ordinary influenza strains, or shorten the course of disease in those who contract the typical flu.

It does so by increasing the production of inflammatory cytokines like IL-1, IL-6, and TNF. PMID:12455180 (cache). PMID:11399518 (cache).

While black elderberry extract be appropriate for ordinary Type A influenza, it could make avian flu more lethal. Ordinary strains of flu do not trigger massive production of TNF, and ordinary flu viruses are generally susceptible to the action of TNF. Avian flu, by contrast, does trigger massive production of TNF (as much as a 45x increase), while the virus is relatively resistant to the anti-viral effects of TNF. If TNF is a significant cause of the illness and mortality in avian flu, anything that increases TNF would be undesirable.

It has been pointed out that black elderberry does not just increase TNF and other cytokines. It also may reduce the spread of the virus through inactivation, or exert anti-inflammatory effects as well as contributing to the cytokine storm. It may be that combining elberberry with other anti-inflammatories may allow it to check the infection without producing tissue destroying levels of cytokines. But there is insufficient evidence to make a solid conclusion, while there are significant red flags that should be raised about the mode of action of elderberry.

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