Scientific Name(s): Matricaria recutita L., Family: Asteraceae (daisy). Synonyms: Chamomilla , Chamomilla recutita , Matricaria chamomilla , Matricaria suavoelens , and Chamaemelum nobile (L.) All. Family: Asteraceae (daisy). Synonym: Anthemis nobilis L.
Common Name(s): Matricaria recutita is known as German , Hungarian , wild , or genuine chamomile. Chamaemelum nobile is commonly called English , Roman , Scotch , garden , lawn , sweet , true , or common chamomile.
Chamomile is used topically in skin and mucous membrane inflammations and skin diseases. It can be inhaled for respiratory tract inflammations or irritations; used in baths as irrigation for anogenital inflammation; and used internally for GI spasms and inflammatory diseases. However, clinical trials supporting any use of chamomile are limited.
Chamomile has been used as a tea for various conditions and as a topical cream. Typical oral doses are 9 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL of water have been used in clinical trials.
The use of chamomile-containing preparations is contraindicated in persons with hypersensitivity to ragweed pollens.
Unreferenced adverse reactions have been cited. Avoid use during pregnancy. No clinical data are available on use during lactation.
Possible interactions have been reported with warfarin or cyclosporine. Because warfarin and cyclosporine have a narrow therapeutic index, patients taking either of these medications in other than modest amounts should avoid concurrent use of chamomile.
Use of the tea and essential oil has resulted in anaphylaxis, contact dermatitis, and other severe hypersensitivity reactions. Cross-reactivity to asters, chrysanthemums, ragweed, and other members of the Asteraceae family exists.
Animal studies report low toxicity with oral ingestion of chamomile.
Known since Roman times for their medicinal properties, both plants have been used as antispasmodics and sedatives in the treatment of digestive and rheumatic disorders. Teas have been used to treat parasitic worm infections, and as hair tints and conditioners. The volatile oil has been used to flavor cigarette tobacco.
Chamomile has been used as a skin wash to cleanse wounds and ulcers, and to increase the sloughing of necrotic tissue and promote granulation and epithelialization. Chamomile is also reported to have antibacterial, anti-inflammatory, astringent, and deodorant properties. Various formulations of chamomile have been used to treat colic, cystitis, fever, flatulence, and vomiting. 3 , 4
Both plants contain similar chemical compounds. Chamomile tea contains 10% to 15% of the plant's essential oil. The blue-colored volatile oil is a complex mixture of sesquiterpenes (alpha-bisabolol, bisbolol-oxides A and B, and farnesene), sesquiterpenelactones (including the blue compound chamazulene), and acetylene derivatives. 2
Phenolic compounds found in the flowers include hydroxycinnamic acid derivatives, caffeic acid, and flavonoids (apigenin, luteolin, and chamaemeloside). 4 , 5 A nonpeptide, tachykinin NK1 receptor antagonist has been identified in Matricaria flowers. 6 Coumarin has also been identified in chamomile. 7 , 8
Uses and Pharmacology
German chamomile flower is approved by the German Commission E for use as an inhalant in skin and mucous membrane inflammations, bacterial skin diseases, including those of the oral cavity and gums, and respiratory tract inflammations and irritations. The flower has been approved for use in baths, as irrigation for anogenital inflammation, and for use internally to treat GI spasms and inflammatory diseases. 9Anti-inflammatory
Chamomile has purported anti-inflammatory effects, but there are no published clinical trials supporting the findings of animal experiments. Chemical constituents of chamomile, such as bisabolol, chamazulene, and the flavonoids apigenin and luteolin, possess anti-inflammatory properties. 10 , 11 , 12 , 13Antispasmodic/antidiarrheal
Chamomile infusions have been used traditionally as GI antispasmodics despite the lack of rigorous trials to support this use. A small trial of a tea containing chamomile and other herbs was effective in treating infantile colic, but the volume of tea required for effect limited its usefulness. 14 Chemical components in chamomile (bisabolol and flavonoids) have demonstrated antispasmodic effects in animal experiments. 15 , 16
Commercial preparations of chamomile-containing creams are widely available despite the lack of trials to support their use.
In a study designed to evaluate the effect of massage with chamomile essential oil versus massage only, no difference was found for the 2 study arms. Additionally, further use of the essential oil after the study period showed a decline in eczema severity, suggesting possible sensitization to the oils over time. 19
In another trial, chamomile cream was as effective as hydrocortisone 0.25% cream in the treatment of atopic eczema. 9 A more recent trial using a nonallergenic chamomile extract showed that chamomile extract was slightly superior to hydrocortisone 0.5%, but only marginally better than placebo. 20Skin: Radiation dermatitis
In a study designed to investigate the efficacy of chamomile cream in acute radiation dermatitis, no difference was found between chamomile and almond creams. 21 Furthermore, review of the data did not reveal any additional trials; therefore, the use of chamomile cream for this condition is discouraged. 22Estrogenic activity
Chamomile tea is reportedly among the most common herbs used for morning sickness (as a tea made from the flowers). However, there are no reports on the safety of chamomile during pregnancy. 23 Chamomile also is commonly used in menopause with a perceived high efficacy rate and few perceived adverse reactions. 24
An ethanolic extract of chamomile containing primarily apigenin demonstrated weak estrogenic and progestational activity in an in vitro tissue system. 25
An aqueous extract of chamomile demonstrated antiestrogenic activity on breast cell tissue and demonstrated a nonproliferative effect on cervical cancer cells in a study designed to measure the stimulatory effect of chamomile on bone osteoblasts. 26CNS/sensory effects
No clinical trials have been published to support the use of chamomile as an anxiolytic. Although apigenin extracted from chamomile demonstrated inhibition of benzodiazepine binding in rat brain membranes, it did not display anxiolytic effects in whole rat models, indicating that its CNS activity is not mediated through this mechanism. 27
In a small, blind, crossover, placebo-controlled study, aromatized chamomile oil demonstrated a sedative effect as well as a positive effect on mood. 13 Changes in alpha wave activity during chamomile oil inhalation were demonstrated using electroencephalogram mapping. 28 Diminished withdrawal symptoms were achieved when chamomile was coadministered with morphine. 29 In a study investigating the efficacy of essential oils in reducing maternal anxiety during labor, the use of chamomile aromatherapy resulted in a reduction in opioid use, with less than 1% reporting minimal adverse reactions. 30Mouth (mucositis)
Use of chamomile in radiation- and chemotherapy-induced mucositis have been studied in several trials with conflicting results. Prophylactic use of chamomile gargles or mouth rinses prevented the occurrence, delayed the onset, and reduced the intensity of mucositis in 2 trials 31 , 32 ; in another trial, chamomile was no more effective than placebo. 33
Chamomile has been used as a tea for various conditions and as a topical cream. Typical oral doses are 9 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL water have been used in trials. 31
Poorly documented adverse reactions have been reported (eg, abortifacient effects, menstrual cycle irregularities, uterine stimulation with excessive use). 23 , 34 As extracts of chamomile have demonstrated weak estrogenic activity, 25 , 26 use during pregnancy is best avoided.
No clinical data are available on the use of chamomile during lactation.
A patient on a stable drug regimen including warfarin experienced multiple internal hemorrhages after using chamomile. 7 Elevated cyclosporine trough concentrations occurred in a patient after drinking 1 to 1.5 L/day of chamomile tea. 35 When the tea was stopped, cyclosporine concentrations deceased to the initial range. Because warfarin and cyclosporine have a narrow therapeutic index, patients taking either of these medications in other than modest amounts should avoid concurrent use of chamomile. Chamomile also has inhibited the CYP-450 isoenzyme IA2, but this is of questionable clinical importance.
No interactions caused by sedative effects or antispasmodic properties of chamomile have been reported. 27
Allergic reactions to chamomile are commonly reported. Hypersensitivity reactions include anaphylaxis, dermatitis, GI upset, lacrimation, and sneezing. 36 , 37 , 38 In large amounts, the dried flowering heads are reported to be emetogenic. 39 Anaphylaxis resulting from chamomile-containing enemas has been documented, 40 as well as allergic conjunctivitis caused by chamomile-containing eye drops. 41
Manifestations of allergy are suggested to be dependent on the route of ingestion. Asthma, bowel cramps, diarrhea, and vomiting related to oral intake via tea have been reported; inhalation of the essential oil predominantly manifests as asthma. 42
Cross-reactivity is reported among people allergic to ragweed, asters, chrysanthemums, and other members of the Asteraceae family. 43
The toxicity of bisabolol was low following oral administration in animals, with acute LD 50 approximately 15 mL/kg in rats and mice. In a 4-week subacute toxicity study, the administration of bisabolol (1 to 2 mL/kg body weight) to rats did not cause toxicity. No teratogenic or developmental abnormalities were noted in rats and rabbits after chronic administration of bisabolol 1 mL/kg. 44
Bibliography1. USDA, NRCS. The PLANTS Database . (http://plants.usda.gov, September 2006). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
2. Ganzera M , Schneider P , Stuppner H . Inhibitory effects of the essential oil of chamomile ( Matricaria recutita L.) and its major constituents on human cytochrome P-450 enzymes . Life Sci . 2006;78:856-861.
3. Craker LE . Herb, Spices, and Medicinal Plants: Recent Advances in Botany, Horticulture, and Pharmacology. Vol 1. Phoenix, AZ: Oryx Press; 1986.
4. Carnat A , Carnat AP , Fraisse D , Ricoux L , Lamaison JL . The aromatic and polyphenolic composition of Roman camomile tea . Fitoterapia . 2004;75:32-38.
5. Morton, J . Major Medicinal Plants: Botany, Culture, and Uses . Springfield, IL: Thomas; 1977.
6. Yamamoto A , Nakamura K , Furukawa K , et al. A new nonpeptide tachykinin NK1 receptor antagonist isolated from the plants of Compositae . Chem Pharm Bull (Tokyo) . 2002;50:47-52.
7. Segal R , Pilote L . Warfarin interaction with Matricaria chamomilla . CMAJ . 2006;174:1281-1282.
8. Abebe W . Herbal medication: potential for adverse interactions with analgesic drugs . J Clin Pharm Ther . 2002;27:391-401.
9. Ross SM . An integrative approach to eczema (atopic dermatitis) . Holist Nurs Pract . 2003;17:56-62.
10. Jakovlev V , Isaac O , Thiemer K , Kunde R . Pharmacological investigations with compounds of chamomile ii. New investigations on the antiphlogistic effects of (-)-alpha-bisabolol and bisabolol oxides . Planta Med . 1979;35:125-140.
11. Milin R , Stern P . Antiallergic and antiphlogistic effect of azulenes [in German]. Arzneimittelforschung . 1956;6:445-450.
12. Hamon N . Herbal medicine. The chamomiles . Can Pharm J . 1989:612.
13. Farnsworth N , Morgan BM . Herb drinks: chamomile tea . JAMA . 1972;221:410.
14. Crotteau CA , Wright ST , Eglash A . Clinical inquiries. What is the best treatment for infants with colic? J Fam Pract . 2006;55:634-636.
15. Forster HB , Niklas H , Lutz S . Antispasmodic effects of some medicinal plants . Planta Med . 1980;40:309-319.
16. Achterrath-Tuckermann U , Kunde R , Flaskamp E , Isaac O , Thiemer K . Pharmocological investigations with compounds of chamomile. V. Investigations on the spasmolytic effect of compounds of chamomile and Kamillosan on the isolated guinea pig ileum [in German] . Planta Med. 1980;39:38-50.
17. de Ia Motte S , Bose-OReilly S , Heinisch M , Harrison F . Double-blind comparison of an apple pectin-chamomile extract preparation with placebo in children with diarrhea [in German]. Arzneimittelforschung . 1997;47:1247-1249.
18. Becker B , Kuhn U , Hardewig-Budny B . Double-blind, randomized evaluation of clinical efficacy and tolerability of an apple pectin-chamomile extract in children with unspecific diarrhea . Arzneimittelforschung . 2006;56:387-393.
19. Anderson C , Lis-Balchin M , Kirk-Smith M . Evaluation of massage with essential oils on childhood atopic eczema . Phytother Res . 2000;14:452-456.
20. Patzelt-Wenczler R , Ponce-Poschl E . Proof of efficacy of Kamillosan cream in atopic eczema . Eur J Med Res . 2000;5:171-175.
21. Maiche AG , Grohn P , Maki-Hokkonen H . Effect of chamomile cream and almond ointment on acute radiation skin reaction . Acta Oncol . 1991;30:395-396.
22. Wilkinson JM . What do we know about herbal morning sickness treatments? A literature survey . Midwifery . 2000;16:224-228.
23. Wickline MM . Prevention and treatment of acute radiation dermatitis: a literature review . Oncol Nurs Forum . 2004;31:237-247.
24. Mahady GB , Parrot J , Lee C , Yun GS , Dan A . Botanical dietary supplement use in peri- and postmenopausal women . Menopause . 2003;10:65-72.
25. Rosenberg Zand RS , Jenkins DJ , Diamandis EP . Effects of natural products and nutraceuticals on steroid hormone-regulated gene expression . Clin Chim Acta . 2001;312:213-219.
26. Kassi E , Papoutsi Z , Fokialakis N , Messari I , Mitakou S , Moutsatsou P . Greek plant extracts exhibit selective estrogen receptor modulator (SERM)-like properties . J Agric Food Chem . 2004;52:6956-6961.
27. Avallone R , Zanoli P , Puia G , Kleinschnitz M , Schreier P , Baraldi M . Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla . Biochem Pharmacol . 2000;59:1387-1394.
28. Masago R , Matsuda T , Kikuchi Y , et al. Effects of inhalation of essential oils on EEG activity and sensory evaluation . J Physiol Anthropol Appl Human Sci . 2000;19:35-42.
29. Gomaa A , Hashem T , Mohamed M , Ashry E . Matricaria chamomilla extract inhibits both development of morphine dependence and expression of abstinence syndrome in rats . J Pharmacol Sci . 2003;92:50-55.
30. Burns E , Blamey C , Ersser SJ , Lloyd AJ , Barnetson L . The use of aromatherapy in intrapartum midwifery practice an observational study . Complement Ther Nurs Midwifery . 2000;6:33-34.
31. Mazokopakis EE , Vrentzos GE , Papadakis JA , Babalis DE , Ganotakis ES . Wild chamomile ( Matricaria recutita L.) mouthwashes in methotrexate-induced oral mucositis . Phytomedicine . 2005;12:25-27.
32. Carl W , Emrich LS . Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients . J Prosthet Dent . 1991;66:361-369.
33. Fidler P , Loprinzi CL , O'Fallon JR , et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis . Cancer . 1996;77:522-525.
34. Newall CA , Anderson LA , Philipson JD . Herbal Medicines: A Guide for Health-Care Professionals . London: Pharmaceutical Press; 1996.
35. Nowack R , Nowak B . Herbal teas interfere with cyclosporin levels in renal transplant patients . Nephrol Dial Transplant . 2005;20:2554-2556.
36. Rowe A . Chamomile ( Anthemis cotula ) as a skin irritant . J Allergy . 1934;5:383.
37. Benner MH , Lee HJ . Anaphylactic reaction to camomile tea . J Allergy Clin Immunol . 1973;52:307-308.
38. Jensen-Jarolim E , Reider N , Fritsch R , Breiteneder H . Fatal outcome of anaphylaxis to camomile-containing enema during labor: a case study . J Allergy C!in Immunol . 1998;102:1041-1042.
39. Lewis W , et al. Medical Botany: Plants Affecting Man's Health . New York, NY: J. Wiley; 1977.
40. Maddocks-Jennings W . Critical incident: idiosyncratic allergic reactions to essential oils . Complement Ther Nurs Midwifery . 2004;10:58-60.
41. Fraunfelder FW . Ocular side effects from herbal medicines and nutritional supplements . Am J Ophthalmol . 2004;138:639-647.
42. Reider N , Sepp N , Fritsch P , Weinlich G , Jensen-Jarolim E . Anaphylaxis to camomile: clinical features and allergen cross-reactivity . Clin Exp Allergy . 2000;30:1436-1443.
43. Toxic reactions to plant products sold in health food stores . Med Left Drugs Ther . 1979;21:29-32.
44. Habersang S , Leuschner F , Isaac O , Thiemer K . Pharmacological studies with compounds of chamomile. IV. Studies on toxicity of (-)-alpha-bisabolol . Planta Med . 1979;37:115-123.
Copyright © 2009 Wolters Kluwer Health