Oral dose forms and topical preparations tend to be well tolerated, although allergic reactions are possible in rare cases (mainly to the aerial parts, in contact dermatitis). One study using E. purpurea in children found that rash occurred in 7.1 % of children using echinacea compared with 2.7% with placebo (Taylor et al 2003).
There is no clear evidence from basic science or human studies to show that echinacea causes liver toxicity (Ulbricht & Bäsch 2006).
Clinical note — Safety of echinacea
The safety of echinacea has come into question in recent years due to two different articles that were poorly described in the press. One was a case report of suspected anaphylaxis reported in the Medical Journal of Australia (Mullins 1998). On closer inspection, the article describes an atopic woman who had taken nearly a dozen supplements at once, as well as double the recommended dose of a liquid echinacea product, before experiencing symptoms suggestive of anaphylaxis. Successful treatment consisted of oral promethazine and no other intervention. After the event, hypersensitivity was confirmed by skin prick and RAST testing, suggesting that an allergic response did occur.
In 2002, a second report described in detail five allergic reactions to different echinacea preparations and further stated that 51 adverse reaction reports involving echinacea had been made to ADRAC (Mullins & Heddle 2002). Unfortunately, this time the media omitted the important fact that these cases were reported over a © 2007 Elsevier Australia
21 -year period. Once again, a closer look at the article finds approximately half of those reports were of suspected allergic responses and of those, only two could certainly be linked to echinacea use, with 10 classified as probable and 12 as possible. Considering an estimated 200 million doses of echinacea are used by Australians each year, the relative lack of adverse reports is impressive.
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