Echinacea in the Hot Spot
On Monday 20th August the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA) decided in their wisdom to announce that Echinacea should not be taken by children under 12 years of age because of an association with a ‘low risk of allergic reactions’.
As a practitioner of 23 years experience running the UK’s oldest and one of the largest herbal dispensaries and clinic I was surprised and slightly perplexed. I have never in all my clinical practice had to deal with any adverse reactions from Echinacea. In fact it is in my opinion a very safe and well tolerated medicine. Further investigation was needed.
It seems that the data that has been used to reach this conclusion has been in circulation for a number of years. I suspect the research paper they have used was based on work done by Mullins and Heddie in Australia in 2002. They looked at patients who had an underlying predisposition to atopic allergy situations. Their conclusion was that atopic patients should be cautioned about the possibility of adverse reactions if they used Echinacea.
In my experience patients who have atoptic allergy situations are always cautious about trying new products and often seek medical advice. Mullins and Heddie suggest cautioning atopic patients. I would go further and suggest that patients who want to use Echinacea and who have known atopic situations should have a consultation with a Medial Herbalist. After all, we are the health care practitioners who have the most experience of this herbal drug.
The other document that the MHRA uses to reach this decision is a monograph that was published 4 years ago by the European Medicines Agency, Committee on Herbal Medicinal Product. It states that traditional use of Echinacea for the under 12s is not recommended. This statement is not backed up and elsewhere it states that with Echinacea, as a well established use medicine, "specific risk in children over 1 year of age is not documented". Confused?
I think this is a situation where we have to use our common sense. There are hundreds of foods and medicines that people can be sensitive to. We see children with allergies to strawberries, lettuce, milk products, as well as those who are sensitive to E45, plasters, and wet wipes.
There have been a number of clinical studies on long term use of Echinacea that have shown no adverse reactions.¹
My professional body the NIMH (The National Institute of Medical Herbalists) operates a yellow card adverse reaction reporting scheme for prescribed herbal medicines and, to date, we do not have any reports of adverse reaction amongst children who have been prescribed Echinacea. This scheme has been in place since 1994 and again, to date, there have been no reports of adverse reactions with Echinacea and children.
A final irony is that Dr Linda Anderson of the MHRA Herbal Medicines licensing division in a book she co-wrote "Herbal Medicines A guide for health care professionals" states, in the section on "Echinacea Contra-indications and warnings," None documented.²
As a Medical Herbalist who spends over thirty hours each week in clinical practice and as the owner of a busy herbal dispensary and natural medicine pharmacy where qualified staff work with and dispense herbal medicines to the public six days a week, I would like to say that I do not think there is any reason to stop using Echinacea when managing health problems in children.
- Coeugniet E, Kulhnast R "Adjuvant immunotherapy with different formulations of Echinacea. Therapiewoche 36:3352-3358, 1986
- Herbal Medicines. A guide for health care professionals. Newell, Anderson, Phillipson 1996