Elder is sometimes referred to as black elder, black elderberry, or by its Latin binomial, Sambucus nigra. Elderberry has several historical applications; among them are uses as a laxative, diuretic, diaphoretic (induces opening of the pores and sweating), nerve pain (sciatica and neuralgia), and treatments for rhinitis and sinusitis|sinusitis]]. A more modern application of elderberry is use for viral influenza.
In addition to its use as a medicinal plant, elderberry is also used in wine production and as a flavoring agent. Persons often confuse elder with another plant known as American elder (Sambucus canadensis). The Non-American elder has a long history of use, dating as far back as the Stone Age. Interestingly, Egyptians used the flowers for improving complexion and for applications of soft tissue trauma (i.e. burns). American Indian tribes used elderberry in teas; while 17th century Englishmen made wine and cordials from the fruit, which was a popular remedy for the common cold. 
Elder is associated with a rich history of superstition as well. In the middle ages, it was believed that elder trees were home to witches, and by cutting them down, one would incur the wrath of these “evil doers.” However, the English and Russians thought of elder tress as good luck, and planting one near home could ward off evil spirits. Sicilians even believed that sticks made of elder could kill serpents and drive away thieves.
The most widely utilized part of the plant is its fruit. Elderberries contain chemicals known as flavonoids. Among the primary flavonoids are a sub grouping known as anthocyanidins. Other constituents include, rutin, isoquertin, and hyperoside. [2, 3]
Elderberry also contains many essential oils and a 3% concentration of tannins; these constituents add to the pleasing taste of elderberry wine.  If consumed raw, and in large quantities, elderberries have been reported to cause nausea. The unripe berries are considered toxic. However, when ripened and cooked, the berries have no adverse effects. Historically, the leaves, flowers, bark, and berries have all been used for medicinal purposes. It is important to note that all parts of the plant (with the exception of the berries) contain poisonous alkaloid chemicals and cannot be used internally. 
Historic uses of elder flowers include application as a mild skin astringent and wash. This was thought to improve the complexion and to relieve skin conditions such as eczema, acne, and psoriasis. Flowers were also soaked in water and used as a gargle in sore throats. When strained, the flower/water remnant was used as an eyewash for conjunctivitis. Additionally, the flowers and leaves were often pulverized and combined as main ingredients for a variety of ointments and poultices. These topically applied delivery forms were populare in reating burns, cuts, scrapes, and occasional swelling. Its historical uses offer a prelude to modern scientific validation for its effectiveness in treating the common cold and flu.
The immune-boosting and anti-inflammatory effects of elderberry are thought to be derived from its anthocyanidin constituents; elder was shown to be a “cost effective and safe influenza treatment” in a recent study.  Elderberry extract has specific effects on viruses, inhibiting viral replication in multiple strains of influenza A and B. One particular study has demonstrated significant improvements in persons taking an elderberry preparation in comparison to those receiving placebo. 
Elderberry appears to be most effective when taken within 48 hours of symptom onset (e.g. cold and flu symptoms). Overall, elderberry appears to reduce flu symptoms by roughly 56% in those using it for a standard treatment option. 
Approximate dosing for treatment of influenza is typically 1 tablespoon of elderberry extract, 4 times per day, for a minimal duration of 3 - 5 days. In children, one tablespoon extract, twice per day is often recommended.
Elder Side effects
When taken during the onset of flu symptoms, elderberry appears to be well tolerated. There have been no adverse effects reported in adults or children taking the extract.  However, this is not to say that side effects have not occurred. As mentioned previously, raw or unripend fruit may cause nausea, vomiting, and/or diarrhea.  Elderberry juice has been known to cause weakness, dizziness, stupor, and numbness following its ingestion. 
No interactions with other herbs or supplements are known, nor with foods or clinical lab tests.
Elder Drug interactions
Due to the status of elderberry as an immunostimulant, taking this herb may disrupt any type of pharmaceutical immunosuppressive therapy; such as in people with organ transplants. There are numerous immunosuppressant drugs that may have interactions with supplemental forms of this plant. The more commonly prescribed forms of immunosuppressive drugs include the corticosteroid variety. If using such medications, consult with a knowledgeable physician.
Elder Disease Conditions
There are no known interactions with this herb concerning disease or specific condition.
1 Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
2 Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm GmbH Scientific Publishers, 1994.
3 Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.
4 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
5 Online document at: http://www.allsands.com/Health/Alternative/elderberrymedic
6 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. J Int Med Res 2004;32:132-40.
7 Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1:361-9.
9 Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
10 McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association’s Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
11 The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.