Medical Herbalism: A Journal for the Herbal Practitioner
A German regulatory commission has recently listed several contraindications for echinacea, including "progressive systemic diseases like tuberculosis, leukosis, collagen disorders, or multiple sclerosis." This class of diseases would include auto immune conditions such as systemic lupus. I recently researched the question of echinacea contraindication in auto immunity thoroughly, and published the opinion last Spring in the book The Healing Power of Echinacea and Goldenseal (Prima Publishing) that echinacea was not so contraindicated. The best clinicians are always ready to eat their words, or their previous opinion, when clinical facts get in the way, and a patient may be hurt, and I now have to do the same. In ten years of searching scientific literature and interviewing both physicians and scientists on the question, I had been unable to find a single case or even a rumor where echinacea in oral doses made any auto immune disease worse. Within a month of the book publication, however, I met my first patient with a severe exacerbation of an auto immune disease possibly due to taking echinacea. A month later, one of my long term lupus patients told me that echinacea had caused a worsening of flare-ups before she became my patient. And then a third had an aggravation of ulcerative colitis within twenty-four hours of beginning to take echinacea for the first time. Unfortunately I was not able to take a detailed case in any of these instances. The facts I do have follow.
The first was a case of unidentified auto immune disease with damage to the kidney. The kidney component of the illness was being controlled by unidentified immunosuppressive drugs, and the dose had recently been reduced by half. About a week later, the patient began to get a sore throat, and took echinacea for it in large doses, again unidentified. The pathogen affecting the throat is also unidentified. Very soon the kidney inflammation returned, and the patient was hospitalized to receive dialysis. The flare-up could have been caused by the reduction of the medication, or by the organism that provoked the sore throat, but echinacea must still be held suspect. The patient, who has professional experience with herbal medicines, thought that echinacea was in fact responsible.
The second patient had severe systemic lupus with kidney inflammation, poorly controlled by steroids, methotrexate, Plaquenil, and other drugs. She reports that when she took echinacea during an active lupus attack, many of the symptoms would get worse. She repeated this with the same results, and the symptoms would subside when she stopped the echinacea. She is now completely off drugs and managing the lupus with diet, herbs, and other lifestyle factors, and says that now echinacea does not cause the problem it did in the past.
The third patient had ulcerative colitis reasonably well-controlled with steroids. She had never taken echinacea before. When she heard about it, she thought it would be good for her. Within twenty-four hours of beginning to take a dropper three times a day, the ulcerative colitis flared up with a severe attack of bloody diarrhea. This dose of echinacea can elevate with white blood count within twenty-four hours, and could reasonably be the culprit in this case. I invite the reader to form their own opinion of these facts. The details of the cases are too scanty to prove anything. For myself, I no longer hold that echinacea is harmless in auto immune disease. Echinacea is known to increase phagocytosis (and thus antigen presentation to the T cells) and it rapidly (within 24 hours) increases lymphocyte counts. Each of these may be related with an acute auto immune attack.
Due to the rarity of reports of such instances, the word "contraindication" is too strong, but practitioners may be prudent to carefully observe reactions to the use of echinacea in auto immune conditions, especially in patients undergoing an acute exacerbation or whose condition is kept in precarious balance with immunosuppressive drugs.