Echinacea Tea: What Research Shows About the Tea, Safety and Cautions

Read this first: who should be careful

• Daisy-family allergy and atopic people. Echinacea belongs to the daisy family (Asteraceae). [1] NIH says echinacea species are closely related to sunflowers, daisies and ragweed, and that some people have allergic reactions to echinacea, which may be severe. [2] The EU herbal monograph says it must not be used by people hypersensitive to echinacea or other Asteraceae plants, and describes a possible risk of severe hypersensitivity reactions in atopic patients (people prone to allergies). [3] Cases of serious allergic reactions, including asthma and anaphylactic shock, have been reported with echinacea medicines for colds. [4] Severe allergic reactions are an emergency; in the US, call 911. See allergies and plant cross-reactions.
• Autoimmune disease and weakened immunity. The EU monograph says use is not recommended in progressive systemic disorders, autoimmune diseases, immunodeficiencies and immunosuppression. [3] NIH adds a theoretical reason to suspect an interaction with immunosuppressant medicines. [2] Ask the prescriber or pharmacist; never change a prescribed medicine on your own.
• Before surgery. Tell the surgical team about herbal teas (supplements before surgery).

What echinacea tea is

Echinacea tea is an infusion of echinacea plant material, often a blend. The plants are Echinacea purpurea (L.) Moench, Echinacea angustifolia DC. and Echinacea pallida, perennials native to the area east of the Rocky Mountains in the United States. [1][2] Which species and which part (root, leaf, flower) is in a bag matters, because studies of different echinacea preparations are not interchangeable: Cochrane reviewers noted that products sold under the name echinacea differ appreciably in their composition. [5] A tea is also a different thing from the preparations regulators have assessed: the EU assessment covers the expressed juice of the fresh flowering aerial parts of E. purpurea, not a tea. [4] The plant profile is in Echinacea in Herbs & Botanicals.

Traditional use and what regulators concluded

These are two different things. Traditional use: NIH says E. purpurea was originally discovered by Native Americans in North America, who used the plant medicinally for respiratory tract infections, tooth pain and snakebite. [2]

Regulatory view: the EU herbal committee (HMPC) concluded that purple coneflower herb medicines taken by mouth can be used short term for prevention and treatment of common colds, for adults and adolescents over 12. [4] Its monograph says not to use the product for more than 10 days. [3] The preparation it assessed is expressed juice, so this does not carry over to tea. [4] (Public summary EMA/481797/2015; monograph EMA/HMPC/48704/2014.)

What research found about the tea and related forms

Labels used here: promising but limited, mixed, insufficient evidence.

The Cochrane review included only single-ingredient echinacea preparations compared with placebo, so the compound tea trial above was not part of it. [5] Proper evidence not found for a trial of a single-herb echinacea tea: a PubMed phrase search for "echinacea tea" in titles and abstracts returned no records. [7] We do not carry capsule, juice or extract results over to the tea, or the reverse.

Safety details

• Medicines. NIH describes conflicting evidence about whether echinacea interacts with some drugs processed by the liver, and theoretical reasons to suspect interactions with immunosuppressants or caffeine. [2] See how interactions work.
• Side effects. NIH says the most common are digestive symptoms, such as abdominal pain and nausea. [2]
• Pregnancy and breastfeeding. NIH says some studies of solid or liquid extracts suggest it is possibly safe for up to 7 days in the first trimester, and that little is known about breastfeeding. [2] The EU monograph says that, in the absence of sufficient data, use in pregnancy and lactation is not recommended unless advised by a doctor. [3] The same monograph adds that limited data, from several hundred exposed pregnancies, indicated no adverse effects of echinacea on pregnancy or on the health of the fetus or newborn. [3] The committee's assessment report calls those data not sufficient, because no study of adequate scientific quality prospectively followed enough first-trimester exposures, and it keeps the recommendation of not using it in pregnancy unless advised by a doctor. [8] These statements are about extracts and juice, not tea. Ask your clinician; see pregnancy and breastfeeding.
• Children. The EU says use under 12 is not recommended. [3] NIH says some children in a trial developed rashes that may have been allergic and advises talking to the child's provider first. [2]
• Liver, kidney, bleeding: Proper evidence not found in the sources we read for echinacea tea itself.
• Quality. NIH notes that dietary supplements are not approved by the FDA before they are sold. [2] See quality testing and certifications.