Echinacea is rarely associated with side effects when taken orally.⁵¹ There is one case report of acute hepatitis occurring in a person taking echinacea, but a cause-and-effect relationship was not proven.⁵² According to the German Commission E monograph, people should not take echinacea if they have an autoimmune illness, such as lupus, or other progressive diseases, such as tuberculosis, multiple sclerosis, or HIV infection. However, the concern about echinacea use for those with autoimmune illness is not based on clinical research and some herbalists question the potential connection. Those who are allergic to flowers of the daisy family should not take echinacea. Cases of allergic responses to echinacea (e.g., wheezing, skin rash, diarrhea) have been reported in medical literature.⁵³ In the first study to look at echinacea’s possible effect on fetal development and pregnancy outcome, women taking echinacea during pregnancy were found to have no greater incidence of miscarriage or birth defects than women not taking the herb.⁵⁴

Echinacea root contains approximately 20% inulin,⁵⁵ a fiber widely distributed in fruits, vegetables, and plants. Inulin is classified as a food ingredient (not as an additive) and is considered safe to eat.⁵⁶ In fact, inulin is a significant part of the daily diet of most of the world’s population.⁵⁷ However, there is a report of a 39-year-old man having a life-threatening allergic reaction after consuming high amounts of inulin from multiple sources.⁵⁸ Allergy to inulin in this individual was confirmed by laboratory tests. Such sensitivities are exceedingly rare. Moreover, this man did not take echinacea. Nevertheless, people with a confirmed sensitivity to inulin should avoid echinacea.