What are elderberry’s main drawbacks?

Elderberry leaves, stems, and unripe or uncooked fruit contain a toxin, sambunagrin, which causes nausea, vomiting, and diarrhea, especially when taken in larger quantities.^[1] Because elderberry may act on the immune system, people who are immunocompromised or who have autoimmune conditions should not consume elderberry medicinally without a physician’s supervision.^[2] There have been case reports connecting consumption of elderberry extract with acute pancreatitis,^[3] processing of elderberries with repeat-exposure-induced allergies,^[4] and consumption of raw fruit, stems and leaves with symptoms consistent with poisoning (nausea, vomiting, dizziness, numbness, and stomach cramps).^[5]