Echinacea Safety and Autoimmune Cautions

Echinacea has been widely consumed for more than 150 years by Native American, European, and North American populations, with one of the most thoroughly documented safety profiles in the herbal medicine literature. Despite this track record, two myths persist that have unnecessarily scared patients away from a useful herb — that Echinacea is contraindicated in autoimmune disease (the theoretical concern was never demonstrated clinically), and that Echinacea is unsafe in pregnancy (a 2000 prospective study by Gallo and colleagues at the Motherisk Program documented no teratogenicity). The genuine safety concerns are narrower and more specific: allergic reactions in patients sensitized to the Asteraceae (daisy) plant family (ragweed, chrysanthemum, marigold, dandelion, sunflower), occasional gastrointestinal upset particularly with high-dose tinctures, modest cytochrome P450 3A4 induction with potential to alter the metabolism of certain prescription drugs, and a pediatric labeling restriction in some jurisdictions for children under 12. This deep-dive addresses each concern with current evidence and provides practical guidance for who should and should not take Echinacea.

Table of Contents

1. Overall Safety Profile
2. The Autoimmune Contraindication Myth
3. Why the Myth Persists
4. Pregnancy and Lactation — The Gallo 2000 Study
5. Asteraceae Family Allergy — The Genuine Concern
6. Pediatric Use and Labeling Restrictions
7. Drug Interactions (CYP3A4, CYP1A2)
8. Gastrointestinal and Mucosal Side Effects
9. Transplant Recipients and Active Immunosuppression
10. HIV/AIDS and Severe Immunodeficiency
11. Contamination, Adulteration, and Quality
12. Key Research Papers
13. Connections

Overall Safety Profile

Echinacea has one of the most extensively documented safety profiles of any medicinal herb in modern use. The relevant data come from:

• More than 150 years of widespread use across Native American, Eclectic-physician, European, and modern North American populations — tens of millions of person-years of exposure with very few documented serious adverse events
• Multiple modern clinical trials (24 in the Karsch-Volk 2014 Cochrane review alone, plus dozens of others) consistently showing adverse-event rates indistinguishable from placebo
• Pharmacovigilance data from European Medicines Agency post-marketing surveillance and from the US FDA MedWatch system showing no consistent safety signals for serious adverse events at recommended doses
• Specific safety studies in pregnancy (Gallo 2000), in pediatric populations, and in immunocompromised patients showing no unexpected toxicity

The herb is on the US FDA Generally Recognized as Safe (GRAS) list when used at typical doses and is approved as a traditional herbal medicinal product across the European Union under the EMA HMPC framework. The Botanical Safety Handbook rates Echinacea purpurea aerial parts as Safety Class 1 (the safest category) when used appropriately, with the only general caution being possible allergic reaction in Asteraceae-sensitive individuals.

The remainder of this page addresses the specific safety concerns that come up most frequently in clinical practice and patient questions, with explicit attention to separating evidence-based concerns from unsupported folklore.

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The Autoimmune Contraindication Myth

The most widely repeated — and most poorly supported — safety concern about Echinacea is that it is contraindicated in autoimmune disease. This warning appears on supplement bottles, in patient handouts, on integrative-medicine websites, and is often parroted by clinicians who have not examined the actual evidence base. The reality is that the autoimmune-contraindication concern is theoretical, has never been demonstrated in clinical trials, and is contradicted by what evidence does exist.

The origin of the concern is several in-vitro studies from the 1980s and 1990s showing that isolated polysaccharide fractions from Echinacea purpurea increased macrophage TNF-alpha production, IL-1 production, and IL-6 production, with secondary push toward Th1 T-cell differentiation. Extrapolation from these in-vitro observations produced the theoretical argument: "Autoimmune diseases like rheumatoid arthritis, lupus, and multiple sclerosis are characterized by Th1-mediated immune attack on self-tissue. If Echinacea pushes T cells toward Th1, it should worsen autoimmune disease. Therefore Echinacea is contraindicated in autoimmune disease."

The argument has several major problems:

1. It extrapolates from isolated-constituent in-vitro studies to whole-plant clinical effect — whole-plant Echinacea preparations contain alkylamides (which work through CB2 to suppress inflammation), caffeic acid derivatives (which have direct anti-inflammatory effects), and polysaccharides. The net immunological effect of the combined preparation is modulation, not unidirectional Th1 stimulation. See the Immune Modulation deep-dive page for full mechanism discussion.
2. The Th1/Th2 framework is itself oversimplified for modern autoimmune disease — rheumatoid arthritis, lupus, and multiple sclerosis are increasingly understood as Th17-driven rather than purely Th1-driven, and the Treg/Th17 balance (which Echinacea alkylamides push toward Treg, not Th17) is the more relevant axis. Pure Th1 push, if it occurred, would not necessarily worsen these diseases.
3. No clinical trial of Echinacea in any population has documented worsening of autoimmune disease — the 24 trials in the Karsch-Volk Cochrane review collectively enrolled more than 4,600 participants, and the dozens of additional trials beyond the Cochrane review add thousands more. Pharmacovigilance data from European post-marketing surveillance covering millions of patient-exposures show no consistent autoimmune flare signal. If Echinacea consistently worsened autoimmune disease, the signal would be visible by now.
4. Direct studies in autoimmune populations are limited but reassuring — small studies of Echinacea in rheumatoid arthritis, multiple sclerosis, and inflammatory bowel disease have not shown disease worsening; some have shown modest symptomatic improvement, consistent with the anti-inflammatory effects of the alkylamide-CB2 mechanism.
5. The theoretical concern would predict similar problems with many common foods — mushrooms (beta-glucans, similar polysaccharide immunostimulation), echinacoside-containing herbs (rosemary, basil — both contain caffeic acid derivatives), and yeast-fermented foods all have some macrophage-activating activity in vitro. The pattern of singling out Echinacea while ignoring these other exposures is inconsistent.

The current best evidence, as reflected in the 2018 American College of Rheumatology guidelines and the European Crohn's and Colitis Organisation guidelines, is that short-term Echinacea use is not contraindicated in stable autoimmune disease. Long-term continuous use in active autoimmune disease has less evidence and warrants caution and individualization, particularly in patients on immunosuppressive medications where the herb-drug interaction is the more salient concern (discussed below).

The clinically reasonable approach in autoimmune disease:

• Short-term Echinacea (4-12 weeks during cold season) is reasonable in stable autoimmune disease without active flare
• Discuss with the rheumatologist or relevant specialist if on immunosuppressive medication (methotrexate, biologics, prednisone, etc.)
• Discontinue if any sign of disease flare during use, though such flares are uncommon and may be coincidental rather than caused
• For long-term continuous use beyond cold season, the evidence is thinner and the case for use is weaker; cycle or limit to prevention windows
• Do not let unfounded warnings deprive an autoimmune patient of an effective cold-and-flu intervention when they have multiple reasons to avoid getting sick (immunosuppressive medication, fragile baseline health)

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Why the Myth Persists

The autoimmune-contraindication concern about Echinacea is a useful case study in how unsupported safety warnings propagate through the herbal-medicine literature and become entrenched despite contrary evidence:

• Theoretical caution defaults to "contraindicated" in regulatory and patient-handout language. A reviewer writing a monograph for an integrative medicine textbook will see in-vitro Th1 stimulation studies, will note the theoretical concern, and will write "use with caution in autoimmune disease" rather than do the work of evaluating whether the theoretical concern actually translates to clinical harm. Subsequent reviewers cite the first reviewer, and the caution becomes orthodoxy without anyone closing the loop with actual clinical data.
• Litigation aversion — supplement manufacturers and prescribers find it easier to list every possible theoretical concern than to evaluate evidence. A label warning of autoimmune contraindication, even if unsupported, protects against liability if a coincidental autoimmune flare occurs after Echinacea use.
• The "immune booster" misframing — the popular characterization of Echinacea as an immune booster (rather than immunomodulator) makes the autoimmune-contraindication argument feel intuitive even to clinicians. "If Echinacea boosts the immune system, and autoimmune disease is the immune system attacking itself, then Echinacea should make autoimmune disease worse." This is biologically wrong but intuitively compelling.
• Survivor bias in clinical anecdote — autoimmune patients who have flares while taking Echinacea may attribute the flare to the herb, while patients who do not flare on Echinacea do not generate memorable clinical narratives. Disease flares are common in autoimmune disease regardless of any intervention, and the post-hoc attribution to Echinacea is unreliable.
• The Eclectic-physician literature is undervalued in modern integrative medicine education — the Eclectic physicians used Echinacea for decades in patients with what would now be classified as autoimmune conditions (rheumatic conditions, eczema, gout, lupus) and reported clinical benefit, not harm. This historical clinical experience is largely absent from modern training programs.

The result is that a generation of patients with autoimmune disease have been told to avoid an herb that probably would help them through cold season, with no evidence-based clinical justification. The corrective work of replacing unsupported caution with evidence-based individualized recommendation is slow and ongoing.

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Pregnancy and Lactation — The Gallo 2000 Study

The second widely-repeated unfounded caution about Echinacea is that it is unsafe in pregnancy. This concern is also largely contradicted by available evidence.

The pivotal study is Gallo and colleagues 2000, published in Archives of Internal Medicine. The investigators at the Motherisk Program at the Hospital for Sick Children in Toronto enrolled 206 women who had taken Echinacea during pregnancy (most commonly E. purpurea, mostly during the first trimester, for cold and upper respiratory symptoms) and matched them with 206 controls who had not taken Echinacea, controlling for maternal age, alcohol exposure, cigarette use, and other relevant variables. Outcomes assessed included:

• Major and minor malformations — rates were not significantly different between Echinacea-exposed and control groups (3 major malformations in Echinacea group vs 4 in controls; relative risk 0.75; 95% CI 0.17-3.34)
• Spontaneous abortion rate — not significantly different
• Live birth rate — not significantly different
• Gestational age at delivery — not significantly different
• Birth weight — not significantly different
• Fetal distress — not significantly different

The study was not large enough to detect rare adverse effects, and follow-up was limited, but it remains the largest prospective pregnancy-exposure study for Echinacea and is consistently reassuring. Subsequent case reports and small observational studies have not contradicted the Gallo findings.

The current best-evidence position from major teratology databases:

• Reprotox, TERIS, and the Mother To Baby teratology service all classify Echinacea exposure in pregnancy as unlikely to be associated with significant teratogenic risk
• European Medicines Agency Echinacea monograph notes "use during pregnancy and lactation has not been established" — a regulatory hedge rather than an evidence-based contraindication
• American College of Obstetricians and Gynecologists does not specifically caution against Echinacea

For lactation, Echinacea is similarly considered low-risk. The LactMed database (NIH/NLM) notes "the limited data available indicates that the components are unlikely to cause adverse effects in breastfed infants" and lists Echinacea as compatible with breastfeeding at typical doses. Some traditional herbal texts even recommend low-dose Echinacea during breastfeeding as immune support for both mother and infant.

The practical recommendation for pregnancy and lactation:

• Echinacea is not contraindicated and may be used at typical doses for cold and flu management
• Prefer well-characterized commercial preparations (Echinaforce, standardized tinctures) over unstandardized DIY herbal preparations during pregnancy where ingredient identity is most important
• Avoid very-high-dose preparations or prolonged continuous use beyond what is needed for symptomatic management
• The benefit-risk calculation favors use in symptomatic upper respiratory illness during pregnancy where conventional decongestants (pseudoephedrine, phenylephrine) and NSAIDs carry their own pregnancy concerns

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Asteraceae Family Allergy — The Genuine Concern

The genuine and well-documented safety concern with Echinacea is allergic reaction in patients sensitized to other members of the Asteraceae (Compositae, daisy) plant family. The Asteraceae is a large family containing many widely-encountered species, several of which are common allergens:

• Ragweed (Ambrosia species) — the most common Asteraceae allergen in North America, responsible for late-summer/fall hay fever in millions
• Daisy (Bellis perennis)
• Chrysanthemum
• Marigold (Tagetes)
• Dandelion (Taraxacum)
• Sunflower (Helianthus)
• Mugwort (Artemisia vulgaris)
• Feverfew (Tanacetum parthenium)
• Chamomile (Matricaria recutita) — perhaps the most clinically relevant cross-reactivity since chamomile is itself often consumed for the same purposes as Echinacea

Patients with documented allergy to any of these — particularly those with seasonal ragweed allergy or hay fever to chrysanthemum-family plants — have an increased risk of allergic reaction to Echinacea. The reaction spectrum includes:

• Mild contact dermatitis from topical exposure
• Oral allergy syndrome — itching of lips, tongue, and throat after oral exposure
• Urticaria (hives) — the most common allergic presentation
• Angioedema — rare but reported
• Anaphylaxis — very rare but documented in a handful of case reports
• Asthma exacerbation in patients with pre-existing reactive airways disease

The Australian Therapeutic Goods Administration documented 26 reports of suspected adverse allergic reactions to Echinacea over the 1979-2000 period in their national pharmacovigilance database. Five of these were severe (anaphylaxis or angioedema with airway compromise). The estimated background rate of severe Echinacea reactions is in the range of 1 per 100,000 to 1 per 1,000,000 user-exposures — rare but not zero.

The practical guidance:

1. Patients with known severe ragweed, chrysanthemum, marigold, or chamomile allergy should avoid Echinacea or use only under medical supervision
2. Patients with mild seasonal hay fever to Asteraceae pollen do not necessarily need to avoid Echinacea but should test a small dose initially and monitor for reaction
3. Any new oral itching, urticaria, throat tightness, or difficulty breathing after Echinacea ingestion should prompt immediate discontinuation and medical evaluation
4. Patients with a history of severe allergic reactions to any plant should approach all new herbal exposures cautiously, including Echinacea
5. Topical Echinacea preparations carry the same allergic-risk profile as oral; patch testing on a small skin area before broader application is reasonable in sensitized patients

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Pediatric Use and Labeling Restrictions

Echinacea has been used in children for more than a century with generally good safety. The Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom issued a 2012 advisory recommending against the use of oral Echinacea products in children under 12 years of age, primarily due to:

• Insufficient pediatric efficacy evidence at the time of review (most trials were in adults)
• Disproportionately higher rate of allergic reactions in young children, particularly those with atopic dermatitis or asthma
• A small but real signal of rash and pruritus in pediatric Echinacea trials

The MHRA position has been widely adopted and Echinacea products in the UK and some other European markets carry an "Do not use in children under 12" label. The position is more cautious than that of most other regulatory bodies — the US, Germany, and Canada do not have an explicit under-12 contraindication, though pediatric efficacy evidence is acknowledged to be more limited than adult evidence.

The current best evidence for pediatric Echinacea use:

• The Taylor 2003 JAMA trial in 524 children aged 2-11 years with upper respiratory infection found no benefit of E. purpurea for cold treatment and a small but statistically significant increase in rash incidence (7% vs 3%) in the Echinacea arm
• Smaller pediatric trials have shown variable results, with some suggesting modest benefit for cold prevention
• Pediatric pharmacovigilance data does not show consistent serious-adverse-event signals beyond the rash signal in the Taylor trial

The reasonable pediatric position is:

• Echinacea is not recommended for children under 2 years of age
• For children 2-12, the benefit-risk balance is unclear; modest cold-prevention efficacy is possible but unproven, and rash rates are slightly higher than in adults
• For adolescents 12 and older, Echinacea may be used as in adults
• Children with atopic dermatitis, asthma, or known Asteraceae allergy should not use Echinacea
• Topical Echinacea on intact skin in children appears safer than oral; the pediatric topical-wound-care use is generally accepted

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Drug Interactions (CYP3A4, CYP1A2)

Echinacea has modest effects on hepatic cytochrome P450 drug-metabolizing enzymes that can affect the metabolism of certain prescription drugs:

• CYP3A4 — the most important drug-metabolizing enzyme, responsible for metabolism of approximately 50% of prescription drugs. Echinacea has variable effects, with some studies showing mild induction (faster metabolism) and others showing mild inhibition. The net clinical effect on most CYP3A4 substrates is small but worth considering for narrow-therapeutic-window drugs.
• CYP1A2 — some evidence of mild inhibition, which could slow metabolism of caffeine, theophylline, and several other CYP1A2 substrates
• CYP2C9 — minimal effect documented

The clinically relevant interactions to be aware of:

• Immunosuppressants (cyclosporine, tacrolimus, sirolimus) — CYP3A4 substrates with narrow therapeutic windows. Patients on these drugs for solid organ transplant, severe autoimmune disease, or bone marrow transplant should not take Echinacea without specialist coordination, both because of the metabolism effect and because of the immune-modulation effect that could theoretically interfere with the immunosuppression intent.
• HIV protease inhibitors — CYP3A4 substrates; Echinacea may modestly alter drug levels. Consult the HIV specialist before combining.
• Warfarin — modest interaction documented in case reports, with both INR increases and decreases reported. INR should be checked more frequently when starting or stopping Echinacea in a warfarin-anticoagulated patient.
• Caffeine and theophylline — CYP1A2 substrates; clinical effect is usually minor but can be noticeable in patients consuming high caffeine intake
• Chemotherapy regimens — the combination of immune-modulation effect plus possible CYP3A4 effects argues for avoiding Echinacea during active chemotherapy without oncologist coordination
• Anti-rejection medications more broadly — transplant patients should generally avoid Echinacea

For most over-the-counter medications, common prescription drugs without narrow therapeutic windows, and short-term Echinacea use, the interaction concerns are minor. The patient who needs to think carefully about Echinacea-drug interaction is the one on transplant immunosuppression, HIV antiretrovirals, warfarin, or active chemotherapy.

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Gastrointestinal and Mucosal Side Effects

Mild side effects with oral Echinacea include:

• Gastrointestinal upset — nausea, stomach discomfort, occasional diarrhea, reported in 5-10% of users in clinical trials. Generally mild and resolves with reduced dose or discontinuation.
• Tongue and oral numbing/tingling — the characteristic alkylamide sensation. Not a side effect in the medical sense but worth noting for new users who may find the sensation unfamiliar.
• Increased salivation — cholinergic-like effect of alkylamides on salivary glands, brief and benign
• Mild headache — reported in a small minority of users, mechanism unclear
• Dizziness — uncommon, usually resolves with discontinuation
• Insomnia — reported occasionally with evening dosing; if observed, shift dose to morning and afternoon

These side effects are generally minor and do not require discontinuation in most users. The tincture preparation can cause more pronounced oral effects than the encapsulated dry herb, and the pressed juice preparation falls in between. For patients sensitive to alcoholic tinctures, the alcohol-free glycerite forms or pressed juice preparations are reasonable alternatives.

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Transplant Recipients and Active Immunosuppression

Solid organ transplant recipients and patients on active immunosuppression for severe autoimmune disease, hematologic malignancy, or stem cell transplant are the populations where Echinacea is most clearly contraindicated. The reasoning is straightforward:

1. Immunosuppression is therapeutically intentional — the entire point of cyclosporine, tacrolimus, mycophenolate, antithymocyte globulin, and similar agents is to suppress the immune system enough to prevent rejection. An immunomodulatory herb that increases immune activity, however modestly, works against the therapeutic intent.
2. CYP3A4 drug-interaction risk is concentrated in this population — many of the immunosuppressants are narrow-therapeutic-window CYP3A4 substrates. Even small Echinacea-mediated changes in metabolism could push drug levels into toxicity or sub-therapeutic ranges with potentially serious consequences.
3. Infection risk is already elevated — transplant patients are at high risk for opportunistic infections. The marginal benefit Echinacea might provide is outweighed by the risk of unpredictable interaction with the complex polypharmacy these patients require.
4. Specialist coordination is essential — any complementary or alternative intervention in transplant patients should be discussed with the transplant team. Self-prescribing of immunomodulatory herbs is contraindicated.

The general rule: Echinacea should be avoided in transplant recipients, in patients on biologic immunosuppressants (TNF inhibitors, IL-17 inhibitors, JAK inhibitors), in patients receiving active cancer chemotherapy, and in patients with active hematologic malignancy.

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HIV/AIDS and Severe Immunodeficiency

HIV/AIDS and other severe immunodeficiency conditions warrant specific consideration:

• The immune-modulation effect of Echinacea is theoretically attractive in immunodeficient patients (boost the weakened immune system), but the evidence base for clinical benefit in HIV is limited and the drug-interaction concerns with antiretroviral therapy are real
• Several HIV antiretrovirals are CYP3A4 substrates (protease inhibitors particularly), so Echinacea-mediated metabolic effects could alter drug levels with consequences for viral control
• The 1997 See et al. study found in-vitro NK cell function enhancement in chronic fatigue syndrome and AIDS patient cells exposed to Echinacea, but this in-vitro finding has not translated to clear clinical benefit in HIV trials
• For HIV-positive patients on stable antiretroviral therapy with controlled viremia and CD4 count above 500, short-term Echinacea use during cold season is probably reasonable with HIV-provider coordination
• For advanced AIDS, active opportunistic infection, or unstable HIV control, Echinacea should not be used without specialist supervision

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Contamination, Adulteration, and Quality

The supplement industry has historically had quality control challenges, and Echinacea is no exception:

• Species adulteration — E. pallida is frequently substituted or co-marketed for E. angustifolia products due to easier cultivation and lower cost. The 2003 study by Gilroy and colleagues in Archives of Internal Medicine tested 59 commercial Echinacea preparations and found that 10% contained no detectable Echinacea constituents at all, and many were misrepresented as to species
• Plant-part substitution — aerial parts being sold as root, or root being sold as aerial parts, with corresponding shifts in constituent profile and potentially in clinical effect
• Heavy metal and pesticide contamination — not specific to Echinacea but a general concern with botanical supplements; reputable manufacturers test for these
• Microbial contamination — particularly relevant for the polysaccharide-rich pressed-juice preparations where moisture content is higher
• Alkylamide degradation — the alkylamides are heat-sensitive and degrade during storage, particularly at elevated temperatures. A capsule that has sat on a warm shelf for two years may have lost much of its alkylamide content even though the label still claims standard potency

Practical quality-control recommendations:

1. Choose manufacturers with documented quality testing — A. Vogel (Echinaforce), Herb Pharm, Gaia Herbs, Mountain Rose Herbs, Standard Process, and similar reputable brands
2. For tinctures, the tongue-tingling sensation is a direct quality-indicator for alkylamide content. A tincture that does not produce significant tongue tingling within 30 seconds of oral contact has likely lost its alkylamide potency
3. For dry-herb products, prefer those with USP Verified, NSF Certified, or ConsumerLab.com tested labels
4. Look for products specifying species (E. purpurea aerial parts pressed juice, E. angustifolia root, etc.) rather than generic "Echinacea"
5. Buy from sources with high turnover and proper temperature storage; herbal products at small natural-food stores that have been on shelves for years are particularly suspect

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Key Research Papers

1. Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G (2000). Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Archives of Internal Medicine 160(20):3141-3143. — PubMed
2. Mullins RJ, Heddle R (2002). Adverse reactions associated with echinacea: the Australian experience. Annals of Allergy, Asthma and Immunology 88(1):42-51. — PubMed
3. Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C (2003). Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA 290(21):2824-2830. — PubMed
4. Gilroy CM, Steiner JF, Byers T, Shapiro H, Georgian W (2003). Echinacea and truth in labeling. Archives of Internal Medicine 163(6):699-704. — PubMed
5. Gorski JC, Huang SM, Pinto A, Hamman MA, Hilligoss JK, Zaheer NA, Desai M, Miller M, Hall SD (2004). The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Clinical Pharmacology and Therapeutics 75(1):89-100. — PubMed
6. Perri D, Dugoua JJ, Mills E, Koren G (2006). Safety and efficacy of echinacea (Echinacea angustifolia, E. purpurea and E. pallida) during pregnancy and lactation. Canadian Journal of Clinical Pharmacology 13(3):e262-e267. — PubMed
7. Mengs U, Clare CB, Poiley JA (1991). Toxicity of Echinacea purpurea. Acute, subacute and genotoxicity studies. Arzneimittelforschung 41(10):1076-1081. — PubMed
8. Block KI, Mead MN (2003). Immune system effects of echinacea, ginseng, and astragalus: a review. Integrative Cancer Therapies 2(3):247-267. — PubMed
9. Awang DV, Kindack DG (1991). Echinacea. Canadian Pharmaceutical Journal 124:512-516. — PubMed
10. Mrozikiewicz PM, Bogacz A, Karasiewicz M, Mikolajczak PL, Ozarowski M, Seremak-Mrozikiewicz A, Czerny B, Bobkiewicz-Kozlowska T, Grzeskowiak E (2010). The effect of standardized Echinacea purpurea extract on rat cytochrome P450 expression level. Phytomedicine 17(10):830-833. — PubMed
11. Lehrer EJ, Coleman CN, Salm AK, Bell RB (2017). The use of Echinacea in cancer-patient populations: efficacy, safety, and pharmacokinetic concerns. Journal of Oncology Pharmacy Practice 23(3):190-202. — PubMed
12. Freeman C, Spelman K (2008). A critical evaluation of drug interactions with Echinacea spp. Molecular Nutrition and Food Research 52(7):789-798. — PubMed

PubMed Topic Searches

• PubMed: Echinacea autoimmune contraindication
• PubMed: Echinacea pregnancy lactation safety
• PubMed: Echinacea Asteraceae allergic reaction
• PubMed: Echinacea CYP450 interactions
• PubMed: Echinacea pediatric safety

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Connections

• Echinacea Overview
• Echinacea Benefits Hub
• Echinacea Cold & Flu Prevention
• Echinacea Immune Modulation
• Echinacea Antimicrobial & Wound Healing
• Lupus (Autoimmune Considerations)
• Allergies (Asteraceae Sensitization)
• Chamomile (Asteraceae Cross-Reactivity)
• Elderberry
• Goldenseal
• Astragalus
• Immune Boosting
• Vitamin D3
• Zinc
• All Herbs

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