Common English ivy is a significant, if lesser known in the UK, aid to respiratory health – an antiviral and respiratory supporting medicinal plant.
In our heritage of medicinal plants, there are key plant medicines for respiratory health that have been used by humans for centuries that now have modern scientific research to verify this use. Only a select few of these plant medicines have been studied in gold standard controlled clinical studies. For example in patients with bronchial asthma there are plant medicines that safely decrease airway resistance and improve forced expiratory volume. These plant medicines include dried Common Ivy Leaf Extract, a plant medicine used clinically and available in pharmacies across Europe for a wide range of respiratory disorders, and one we include in our Respiratory Tincture.
The Plant Hedera helix L.
Although a haven for wildlife, ivy is regarded by some gardeners and home owners as a menace and perhaps only valued at Christmas time. However ivy has surprising health benefits, and some surprising relatives. It belongs to the Apiaceae (Umbelliferae) plant family that contains vegetables like carrot and celery, and herbs like parsley and fennel.
Native to most of Europe and western Asia, common (English or European) ivy is a rampant evergreen vine, clinging to walls and tree trunks and covering ground in wild spaces. The leaves are of two types – lobed juvenile leaves and unlobed adult leaves on flowering stems. Flowering late summer to late autumn, small clusters of greenish-yellow blooms, rich in nectar, are an important food source for bees. Fruits are orange-yellow to purple-black to berries ripening in late winter and while attractive to many birds are poisonous to humans. It is the leaves, gathered from non-flowering stems, that are used in plant medicine.
Another surprising fact about this neglected plant is that perfumes were made from the flowers – though we have yet to find a source of ivy essential oil to check this out!
History & Folklore
Ivy’s use as a cough medicine across Europe today was said to have been discovered by an early 20th century doctor in the south of France who noticed children from the region did not suffer from bronchitis and that they drank from cups made from the wood of the ivy plant.
Ivy was associated with the Roman god of revelry. According to Mrs Grieve (A Modern Herbal, 1931):
“Ivy was in high esteem among the ancients. Its leaves formed the poet’s crown, as well as the wreath of Bacchus, to whom the plant was dedicated, probably because of the practice of binding the brow with ivy leaves to prevent intoxication, a quality formerly attributed to the plant.
We are told by old writers that the effects of intoxication by wine are removed if a handful of ivy leaves are bruised and gently boiled in wine and drunk.”
Grieve also says that Greek priests presented ivy wreaths to newly-married couples and ivy has long been regarded as the emblem of fidelity, and adds that “the custom of decorating houses and churches with ivy at Christmas was forbidden by one of the early councils of the church, on account of its pagan associations.”
The plant was in fact sacred to the druids and considered the female counterpart to the masculine holly.
Traditional Use
Ivy is used in plant medicine for the symptomatic treatment of chronic inflammatory bronchial conditions and as an effective anti-inflammatory for bronchial conditions such as asthma and bronchitis, and also as an anti-viral.
Ivy extracts are widely used in cough medicines in Europe, as an expectorant to treat cough and for bronchitis. The leaf extract is approved by the German Commission E and European Medicines Agency for use against chronic inflammatory bronchial conditions and productive coughs, due to its actions as an expectorant.
Science – Human Studies
A research paper that turned the spotlight on common ivy (Hedera helix) leaf for respiratory health was an analysis of the controlled trials of a specific extract of leaf used in Germany for the treatment of acute and chronic respiratory diseases (Lang et al, 2015).
This ivy leaf dry extract was shown efficacious and safe in the treatment of a range of respiratory diseases from acute bronchitis to bronchial asthma in clinical trials in adults and in children over 2 years (from 8 clinical trials and observational studies in a total of 65,383 patients suffering from acute and chronic respiratory diseases).
In a further study, this ivy leaf extract also contributed to a reduction in the number of inappropriate antibiotic prescriptions for respiratory infection with cough symptoms – in 7034 patients treated with this extract, and matched with 7034 patients receiving an antibiotic, ivy leaf extract prescription was associated with a significantly lower incidence antibiotic prescription, as well as with lower odds of a new cough diagnosis when compared to antibiotic prescription.
In a separate study, children with mild uncontrolled asthma regularly using inhaled corticosteroid benefitted further from ivy leaf dry extract. Overall ivy is a key respiratory medicine with a range of clinical benefits, and future studies will confirm the efficacy of the different extracts’ chemical components.
Science – Laboratory Studies
Laboratory studies show how a plant medicine or drug works to produce their effects. Common ivy leaf works to alleviate respiratory disease, and potentially support against microbial infections, by a number of mechanisms.
The extract and its main chemicals are expectorant and lower cough via lowering muscle spasms in the airways (bronchus), improving bronchodilation, and aiding secretolysis, the break up of mucus secretions.
In addition, common ivy leaf has been shown to significantly reduce serum oxidative stress biomarkers, and inflammatory cytokines in acute lung inflammation.
There are numerous research studies on common ivy’s antiviral action. For example, it’s effective against influenza A virus and against enterovirus. Ivy leaf is also antibacterial, antifungal, antiparasitic and anticancer.
Bioactive Compounds
Ivy contains tannins, flavonoids like quercetin and kaempferol, vitamins, minerals and terpenoid saponins like hederacosides (B-I), which act with hederasaponin C, its main bioactive chemical, to reduce the surface tension of bronchial mucus.
Ivy also contains an essential oil containing germacrene, β-caryophyllene, sabinene, α+β-pinene and limonene.
Dose and Formulation
CAUTION: Do not stop taking medication you have been prescribed. In order to treat a condition plant medicine must be taken at the correct dose and prescription for individual needs – always consult a NIMH registered medical herbalist first in order to treat a child, if you are pregnant, taking any medication, or have any medical condition or allergy.
To treat a cough, common ivy leaf collected from non-flowering stems, can be taken as a tea (finely chopped or ground, dried) using 0.5g of dried leaf (one teaspoon is 0.8g) per cup 1-3 times daily. The tea actually tastes quite pleasant but it’s often taken as a tincture (the plant extracted in 45% alcohol), 1-3ml daily, and is commercially available in capsule or syrup form. To treat a chronic condition the specific prescription depends on the degree of breathing impairment, age and other factors. Ivy is not for long term use without consultation. Do not exceed recommended dose.
SAFETY
Not to be confused with the toxic plant, poison ivy (Toxicodendron radicans). Always be sure of the identify of your plant. Do not exceed the recommended dose. Ivy leaf medicines are not given to children under two years of age because of the risk of worsening respiratory symptoms. No contraindications are reported for medical conditions or medication (though CYP enzyme inhibition is shown in lab studies and contraindications may be possible). One study reports safety of leaf syrup in pregnancy. Leaf may cause contact dermatitis in some due to a chemical called falcarinol (these people will also likely react to carrots and other members of Apiaceae). Side effects such as nausea, vomiting or diarrhoea have been reported at higher doses. Further information on ivy leaf medicines, including the appropriate precautions for their safe use, can be found on the European Medicines Agency website: https://www.ema.europa.eu/en/medicines/herbal/hederae-helicis-folium.
Selected References
Hong EH, Song JH, Shim A, et al. Coadministration of Hedera helix L. Extract Enabled Mice to Overcome Insufficient Protection against Influenza A/PR/8 Virus Infection under Suboptimal Treatment with Oseltamivir. PLoS One. 2015;10(6):e0131089. Published 2015 Jun 22. doi:10.1371/journal.pone.0131089
Lang C, Röttger-Lüer P, Staiger C. A Valuable Option for the Treatment of Respiratory Diseases: Review on the Clinical Evidence of the Ivy Leaves Dry Extract EA 575®. Planta Med. 2015;81(12-13):968‐974. doi:10.1055/s-0035-1545879
Maidannik V, Duka E, Kachalova O, Efanova A, Svoykina S, Sosnovskaja T. Efficacy of Prospan application in childrenʼs disease of respiratory tract. Pediatr Tocol Gyn 2003; 4: 1-7
Rai A. The Antiinflammatory and Antiarthritic Properties of Ethanol Extract of Hedera helix. Indian J Pharm Sci. 2013;75(1):99‐102. doi:10.4103/0250-474X.113537
Rehman SU, Kim IS, Choi MS, Kim SH, Zhang Y, Yoo HH. Time-dependent Inhibition of CYP2C8 and CYP2C19 by Hedera helix Extracts, A Traditional Respiratory Herbal Medicine. Molecules. 2017;22(7):1241. Published 2017 Jul 24. doi:10.3390/molecules22071241
Schmidt M, Thomsen M, Schmidt U. Suitability of ivy extract for the treatment of paediatric cough. Phytother Res. 2012;26(12):1942‐1947. doi:10.1002/ptr.4671
Song J, Yeo SG, Hong EH, et al. Antiviral Activity of Hederasaponin B from Hedera helix against Enterovirus 71 Subgenotypes C3 and C4a. Biomol Ther (Seoul). 2014;22(1):41‐46. doi:10.4062/biomolther.2013.108
Grieve, M. A Modern Herbal, 1931.
Schmidt M, Thomsen M, Schmidt U. Suitability of ivy extract for the treatment of paediatric cough. Phytother Res. 2012;26(12):1942‐1947. doi:10.1002/ptr.4671
