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Mallow

Scientific Name(s): Althaea officinalis L., Malva neglecta Wallr., Malva sylvestris L.
Common Name(s): Common mallow, Common marshmallow, Malva

Clinical Overview

Use

Limited clinical trial data consist mostly of studies on the anti-inflammatory properties of the plant for skin, oral, and pharyngeal conditions. Despite the lack of clinical data, the German Commission E approved mallow for treating irritation of oral and pharyngeal mucosa, as well as for dry cough.

Dosing

Commercial tea products are the primary dosage forms of mallow.

Contraindications

Avoid use if allergic or hypersensitive to any components of the plant species. Animal studies document that the plant may lower blood sugar levels; thus, use with caution in patients with diabetes or in those sensitive to changes in blood glucose levels.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

No serious adverse reactions were reported in 2 clinical trials.

Toxicology

No toxicity studies could be found.

Botany

The Malvaceae family is represented by the genera Althaea, Malva, and Lavatiera, and the mallow plants are members of this family.1 Mallows are perennial plants native to Europe, North Africa, and southwestern Asia. The plants have been naturalized in North America and are cultivated from western Europe to Russia. They prefer damp areas, such as the ocean, salt marshes, meadows, sides of ditches, and banks of tidal rivers. They grow from 1 to 2 m tall, and the leaves, flowers, and roots have been used for medicinal purposes. The flowers bloom in late spring, and the roots must be at least 2 years old before harvesting.2, 3, 4, 5

History

Mallow has a rich ethnomedicinal history and has been used since ancient Greece and Roman times. The leaves and shoots of common mallow have been used as food sources since the 8th century BC.3 The aboveground portions of the plant have been used in pancakes and salads, cooked as greens, and used as stuffing.6 The immature fruits may be consumed raw as a snack.7

Ethnomedicinal references document the plant's efficacy as an anti-inflammatory for the respiratory tract, GI tract, and the skin.8, 9, 10, 11, 12, 13 The plant can be used topically or in a bath to treat abscesses, bruises, burns, dermatitis, swellings, and varicose ulcers.5, 8 A decoction may be chewed, gargled, or used as a wash to treat sore throat as well as mouth, throat, and gingival inflammations.10, 13 Respiratory conditions, such as bronchitis and whooping cough, can also be treated with a decoction.4, 11 It may be used as a compress on the stomach to help heal abdominal pains.12 Mallow may be taken as food to treat constipation or similar GI discomfort.5, 13 Other uses have been documented.5

The mucous compounds in the plant species are of commercial interest, particularly in dermatology and cosmetic preparations. The plant species has been used to treat acne.5, 10, 13, 14

Chemistry

The active components of the plant species are found in the leaves, flowers, and roots. Several studies document the mucilaginous polysaccharide content in the plant; the primary components are composed of rhamnose, galactose, galacturonic acid, and glucuronic acid.15, 16, 17, 18 Flavonoids, phenolic acids, tannins, and volatile oils have also been isolated.4, 19, 20, 21 Malonated anthycyanins have been isolated from the flowers.22, 23, 24

Pharmaceutical-grade marshmallow leaf must have a swelling index of at least 12 and pass macroscopic and microscopic authentication for botanical identification. The British Herbal Pharmacopoeia requires marshmallow leaf to be harvested before the flowering period and identified by thin-layer chromatography (TLC). The water-soluble extract must be at least 15%. Pharmaceutical-grade marshmallow root also must pass macroscopic and microscopic authentication tests and have a swelling index of at least 10 with the pulverized root. The British Herbal Pharmacopoeia requires botanical identification by TLC and additional quantitative standards for marshmallow root. A swelling index of at least 15 is required by The Swiss Pharmacopoeia.4, 25, 26

Uses and Pharmacology

Limited clinical trial data mainly focuses on the anti-inflammatory properties of the plant for dermal, oral, and pharyngeal conditions. Commission E approves mallow for treating irritation of oral and pharyngeal mucosa, as well as dry cough.

Antitussive activity

Animal data

A 100 mg/kg complex extract and 50 mg/kg polysaccharide dosage form isolated from the roots of A. officinalis were effective as antitussive agents in cats. The cough suppressant activity of the polysaccharide was more effective than prenoxidiazine but not dropropizine.27 Tracheobronchial smooth muscle contractility was inhibited by extracts of Althaea root in studies in rats, suggesting a potential role in asthma.28, 29

Clinical data

A multi-ingredient preparation, which included marshmallow root (A. officinalis), was evaluated for effect versus placebo in a clinical study of acute pharyngitis (n=60). Although reported findings were positive, attribution of effect to A. officinalis is not possible.30 Similarly, other clinical studies have evaluated multi-ingredient preparations as a cough expectorant.31, 32

Efficacy of oral preparations of A. officinalis are considered to be due to observed bioadhesive properties, thereby acting to relieve mucosal irritation and hyposalivation.33, 34

Other uses

In vitro studies document antioxidant properties in the plant.35, 36, 37 A. officinalis has antibacterial activity and may be useful in periodontal prophylaxis.20, 38, 39 Histopathological results document that M. neglecta extracts protected rats from gastric lesions induced by ethanol.40 Antiulcerogenic activity may be associated with the high mucilage content from the plant species.

A. officinalis inhibited intracellular calcium mobilization in normal human melanocytes (NHMC) activated by endothelin-1 (ET-1). ET-1 expression increased in the epidermis after ultraviolet (light) B (UVB) irradiation, which is likely to contribute to UVB-induced pigmentation. ET-1 also is involved with inducing NHMC. The results of the study suggest the extracts from A. officinalis inhibit the physiological effect of ET-1 on NHMC after UVB irradiation and may be useful when used in combination with other preparations in treating hyperpigmentary conditions or disorders.41

Root extracts were shown to reduce UVA-induced DNA damage in cultured human lung and skin fibroblasts.42

One study in rats investigated the effects of anthocyanin from M. sylvestris on plasma lipids. Decreases in total cholesterol (20%) and triglycerides (34%) were found.43

A carbohydrate in mallow has anticomplementary activity on the immune system. In vitro analysis of an acidic polysaccharride from the seeds of a related mallow stimulated the reticuloendothelial system. In vitro analysis of a crude powder from another mallow species showed antitumor activity.17, 44, 45

Dosing

Commercial tea products are the primary dosage forms of mallow.4, 32

Pregnancy / Lactation

There is no clinical evidence to support the safe use of the herb during pregnancy and lactation.

Interactions

None well documented.

Adverse Reactions

No serious adverse reactions were reported in 2 clinical trials.

Toxicology

No toxicity studies could be found.

References

1. Milin V, Kustrak D. Officinal and unofficinal polysaccharide-containing drugs (Mucilagenous drugs). Farm Glas. 2003;59:57-67.
2. Malva sylvestris. USDA, NRCS. 2017. The PLANTS Database (http://plants.usda.gov, December 2017). National Plant Data Team, Greensboro, NC 27401-4901 USA.
3. Chevallier A. The Encyclopedia of Medicinal Plants. New York: DK Publishing, 1996.
4. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Marshmallow leaf. Austin, TX: American Botanical Council; Newton, MA: Integrative Medicine Communications; 2000.
5. National Standard: the authority on integrative medicine [internet]. Cambridge (MA): Natural Standard; © 2005. Marshmallow (Althaea officinal L.); [updated 2005 Sep 1; cited 2006 Dec 12]. Available from http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient_marshmallow.html.
6. Dogan Y, Baslar S, Ay G, Mert HH. The use of wild edible plants in western and central Anatolia (Turkey). Econ Bot. 2004;58:684-690.
7. Tardio J, Pascual H, Morales R. Wild food plants traditionally used in the province of Madrid, central Spain. Econ Bot. 2005;59:122-136.
8. Camejo-Rodrigues J, Ascensão L, Bonet MA, Vallès J. An ethnobotanical study of medicinal and aromatic plants in the Natural Park of "Serra de São Mamede" (Portugal). J Ethnopharmacol. 2003;89:199-209.14611883
9. Novais MH, Santos I, Mendes S, Pinto-Gomes C. Studies on pharmaceutical ethnobotany in Arrabida Natural Park (Portugal). J Ethnopharmacol. 2004;93:183-195.15234752
10. Pieroni A, Quave CL, Villanelli ML, et al. Ethnopharmacognostic survey on the natural ingredients used in folk cosmetics, cosmeceuticals and remedies for healing skin diseases in the inland Marches, Central-Eastern Italy. J Ethnopharmacol. 2004;91:331-344.15120458
11. Pieroni A, Quave CL, Santoro RF. Folk pharmaceutical knowledge in the territory of the Dolomiti Lucane, inland southern Italy. J Ethnopharmacol. 2004;95:373-384.15507363
12. Pieroni A, Muenz H, Akbulut M, Baser KH, Durmuskahya C. Traditional phytotherapy and trans-cultural pharmacy among Turkish migrants living in Cologne, Germany. J Ethnopharmacol. 2005;102:69-88.16002248
13. Guarrera PM. Traditional phytotherapy in Central Italy (Marche, Abruzzo, and Latium). Fitoterapia. 2005;76:1-25.
14. Hlavaty P, Capek P, Rosik J, et al. Althaea officinalis-source of mucous compounds for dermatology and cosmetics. Farm Obz. 1989;58:155-163.
15. Karawya MS, Balbaa SI, Afifi MS. Investigation of the carbohydrate contents of mucilaginous plants. Planta Med 1971;20:14-23.5154598
16. Tomoda M, Gonda R, Shimizu N, Yamada H. Plant mucilages. XLII. An anti-complementary mucilage from the leaves of Malva sylvestris var. mauritiana. Chem Pharm Bull. 1989;37:3029-3032.2632049
17. Gonda R, Tomoda M, Shimizu N. Structure and anticomplementary activity of an acidic polysaccharide from the leaves of Malva sylvestrisvar. mauritiana. Carbohydr Res. 1990;198:323-329.2379192
18. Classen B, Blaschek W. An arabinogalactan-protein from cell culture of Malva sylvestris. Planta Med. 2002;68:232-236.11914960
19. Billeter M, Meier B, Sticher O. 8-hydroxyflavonoid glucuronides from Malva sylvestris. Phytochemistry. 1991;30:987-990.
20. Proestos C, Chorianopoulos N, Nychas GJ, Komaitis M. RP-HPLC analysis of the phenolic compounds of plant extracts. Investigation of their antioxidant capacity and antimicrobial activity. J Agric Food Chem. 2005;53:1190-1195.15713039
21. Cutillo F, D'Abrosca B, Dellagreca M, Fiorentino A, Zarrelli A. Terpenoids and phenol derivatives from Malva silvestris. Phytochemistry. 2006;67:481-485.16403542
22. Takeda K, Enoki S, Harborne JB, Eagles J. Malonated anthocyanins in malvaceae: malonylmalvin from Malva sylvestris. Phytochemistry. 1989;28:499-500.
23. Pourrat H, Texier O, Barthomeuf C. Identification and assay of anthocyanin pigments in Malva sylvestris L. Pharm Acta Helv. 1990;65:93-96.
24. Mas T, Susperregui J, Berké B, et al. DNA triplex stabilization property of natural anthocyanins. Phytochemistry. 2000;53:679-687.10746881
25. Rosik JK, Kardosová A, Toman R, Capek P. Isolation and characterization of mucilages from Althaea officinalis L. and Malva silvestris L., ssp. mauritiana (L.) Thell. Cesk Farm. 1984;33:68-71.
26. Ullmann V, Kubelka W. Mallow mucilaginous crude drugs: determination of the swelling index. Deutsche Apotheker Zeitung. 1990;130:2303-2305.
27. Nosal'ova G, Strapkova A, Kardosová A, Capek A, Zathurecky L, Bukovska E. Antitussive action of extracts and polysaccharides of marsh mallow (Althaea officinalis L., var. robusta) [in German]. Pharmazie. 1992;47:224-226.1615030
28. Alani B, Zare M, Noureddini M. Bronchodilatory and B-adrenergic effects of methanolic and aqueous extracts of Althaea root on isolated tracheobronchial smooth rat muscle. Adv Biomed Res. 2015;4:78.25879003
29. Sutovská M, Nosálová G, Sutovský J, et al. Possible mechanisms of dose-dependent cough suppressive effect of Althaea officinalis rhamnogalacturonan in guinea pigs test system. Int J Biol Macromol. 2009 45(1):27-32.19447256
30. Brinckmann J, Sigwart H, van Houten Taylor L. Safety and efficacy of a traditional herbal medicine (Throat Coat®) in symptomatic temporary relief of pain in patients with acute pharyngitis: a multicenter, prospective, randomized, double-blinded, placebo-controlled study. J Altern Complement Med. 2003;9:285-298.12804082
31. Büechi S, Vögelin R, von Eiff MM, Ramos M, Melzer J. Open trial to assess aspects of safety and efficacy of a combined herbal cough syrup with ivy and thyme. Forsch Komplementärmed Klass Naturheilkd. 2005;12:328-332.16391481
32. Puodziuniene G, Janulis V, Milasius A, Budnikas V. Development of cough-relieving herbal teas [in Lithuanian]. Medicina (Kaunas). 2005;41:500-505.15998989
33. Benbassat N, Kostova B, Nikolova I, Rachev D. Development and evaluation of novel lozenges containing marshmallow root extract. Pak J Pharm Sci. 2013;26(6):1103-1107.24191313
34. Skrinjar I, Vucicevic Boras V, Bakale I, et al. Comparison between three different saliva substitutes in patients with hyposalivation. Clin Oral Investig. 2015;19(3):753-757.25617026
35. Mavi A, Terzi Z, Ozgen U, Yildrim A, Coskun M. Antioxidant properties of some medicinal plants: Prangos ferulacea (Apiaceae), Sedum sempervivoides (Crassulaceae), Malva neglecta (Malvaceae), Cruciata taurica (Rubiaceae), Rosa pimpinellifolia (Rosaceae), Galium verum subsp. verum (Rubiaceae), Urtica dioica (Urticaceae). Bio Pharm Bull. 2004;27:702-705.15133249
36. Kardosová A, Machová E. Antioxidant activity of medicinal plant polysaccharides. Fitoterapia. 2006;77:367-373.16797146
37. Ferreira A, Proença C, Serralheiro ML, Araujo ME. The in vitro screening for acetylcholinesterase inhibition and antioxidant activity of medicinal plants from Portugal. J Ethnopharmacol. 2006;108:31-37.
38. Iauk L, Lo Bue AM, Milazzo I, Rapisarda A, Blandino G. Antibacterial activity of medicinal plant extracts against periodontopathic bacteria. Phytother Res. 2003;17:599-604.12820224
39. de Souza GC, Haas AP, von Poser GL, Schapoval EE, Elisabetsky E. Ethnopharmacological studies on antimicrobial remedies in the south of Brazil. J Ethnopharmacol. 2004;90:135-143.14698521
40. Gürbüz I, Özkan AM, Yesilada E, Kutsal O. Anti-ulcerogenic activity of some plants used in folk medicine of Pinarbasi (Kayseri, Turkey). J Ethnopharmacol. 2005;101:313-318.16085377
41. Kobayashi A, Hachiya A, Ohuchi A, Kitahara T, Takema Y. Inhibitory mechanism of an extract of Althaea officinalis L. on endothelin-1-induced melanocyte activation. Biol Pharm Bull. 2002;25:229-234.11853172
42. Curnow A, Owen SJ. An Evaluation of root phytochemicals derived from Althea officinalis (marshmallow) and Astragalus membranaceus as potential natural components of UV protecting dermatological formulations. Oxid Med Cell Longev. 2016;2016:7053897.26953144
43. Wang ZY. Impact of anthocyanin from Malva sylvestris on plasma lipids and free radical. J For Res. 2005;16:228-232.
44. Gonda R, Tomoda M, Shimizu N, Kanari M. Characterization of an acidic polysaccharide from the seeds of Malva verticillata stimulating the phagocytic activity of cells of the RES. Planta Med. 1990;56:73-76.2141426
45. Huang CY, Zeng LF, He T, et al. In vivo and in vitro studies on the antitumor activities of MCP (Malva crispa L. Powder). Biomed Environ Sci. 1998;11:297-306.10095926

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