1

Chamomile


Roman Chamomile Chamaemelum nobile (L.) All.


Text by Armando Gonzlez Stuart, Ph.D., 2004


Common names in Spanish: Manzanilla, Camomila

Botanical family: Asteraceae

Medicinal parts: The flowers.


History

The two species of Chamomile (Roman and German) have been used for medicinal
purposes for more than a thousand years (Mahady et al., 2001). They were first brought to
North America by the Spanish colonists, probably in the early 16
th
century.

Both species are among the most widely used medicinal plants in the world. Both German
and Roman Chamomile are traditionally employed by empirical herbalists in northern
Mexico and the American southwest as a mild infusion (tea) to treat a variety of ailments,
especially colic in small children (Davidow, 1999; Gonzlez, 1998; Kay, 1996).

In Mexican traditional medicine, Chamomile (presumably Roman chamomile) is also used
to alleviate menstrual problems as well as to stimulate labor during parturition (Adame and
Adame, 2000; Gonzlez, 1998; Linares et al., 1994).




2

Active principles


Volatile oil (bisabolol, chamazulene).
Sesquiterpene lactones.
Hydroxycoumarins.
Flavonoids.
Mucilages.

Antispasmodic and anti-inflammatory activities have been attributed to some of
chamomiles active ingredients, especially the flavonoids (anthemidin, apigenin,
luteolin, among others), bitter glycosides, coumarins (herniarin and umbelliferone)
and its volatile oils (containing alpha bisabolol and matricine, among others)
(Brinker, 2001; Avallone et al., 2000; Presser, 2000; Ottariano, 1999).

Chamazulene, a product of the thermal decomposition of matricine, probably has
the most anti-inflammatory activity. It has been shown to block the cyclooxygenase
enzyme in the synthesis of prostaglandins. Its anti-inflammatory effects could be
due to the inhibition of leukotriene formation (Dewick, 2002).

Chamazulene is present in German chamomile, but only traces occur in Roman
chamomile (Dewick, 2002; Sandberg and Corrigan, 2002).

The allergenic principles in Chamomiles are thought to be the sesquiterpene
lactones, common to many species within the botanical family Asteraceae (Barnes
et al., 2002; Burrows and Tyrl, 2001).


Applications in herbal therapy

For stomach and intestinal upsets, especially infant colic and diarrhea (Davidow,
1999; Gonzlez, 1998; Weizman et al.,1993).

To treat PMS syndrome, colic and other menstrual complaints (Castleman, 2001;
Ottariano, 1999; Gonzlez, 1998).

In concentrated infusions (teas) to stimulate labor (Kay, 1996).

As an anxiolytic and mild sedative against insomnia (Adame and Adame, 2000;
Ottariano, 1999; Martnez, 1989).

Topically, used as an eyewash for sore or tired eyes (Gonzlez, 1998).

As a mouthwash against gingivitis and halitosis (Blumenthal, 1998; Fidler et al.,
1996).
3
Externally, as a poultice or cream for minor rashes or abrasions of the skin (Rotblatt
and Ziment, 2002; Patzelt Wenczler and Ponce-Poschl, 2000; Gruenwald, 2000).




Clinical studies with Chamomile

Most clinical studies have been carried out in Europe, particularly in Germany. Many of the
trials have employed a product known as Kamillosan, which has been used in Europe
since 1921. In various clinical trials, Kamillosanointment has proven to be equal in
efficacy, if not superior, to hydrocortisone preparations for the treatment of inflammatory
dermatoses (Aertgeers et al., 1985) or experimentally induced toxic dermatitis (Nissen et
al., 1988). In an uncontrolled study, Chamomile preparations were useful in the treatment
of radiation and systemic chemotherapy induced mucositis (Carl and Emrich, 1991).

Due to the fact that there are few double blind-placebo controlled studies employing
chamomile, most information on its safety and effectiveness comes from empirical and
traditional experience (Barrett, 2004; Mahady et al., 2001; Schulz et al., 2001).



Table 1. Synopsis of Selected Clinical Trials Employing Chamomile*

Author /
Reference
Plant / Plant
product
Purpose of study Number of
subjects
Results
De la Motte et al.
1997
Diarrhoesan
(chamomile
fluid extract)
Treatment and duration of
acute diarrhea in children
79 Effective
Fidler et al.,1996 Kamillosan
Extract
Treatment of 5-FU
induced stomatitis
164 Ineffective
Weizman et al.
1993
Tea Infant colic 69 Effective
Glowania et al.,
1987
Extract applied
as compress
Abrasions of the skin 14 Effective

Nasemann, 1975 Kamillosan
mouthwash
Astringency and cooling
effect on oral mucosa
36 Effective

*Additional information about clinical trials and the products tested is available in the
following publications: Barrett, M. Handbook of Clinically Tested Herbal Remedies 2
Vols.. New York: Haworth Herbal Press; 2004, Blumenthal, M. ABCs Clinical Guide to
Herbs. New York: Thieme; 2003, Bratman S, Girman A. Handbook of Herbal,
Supplements and Their Therapeutic Uses. St. Louis: Mosby; 2003, Bascom A.
Incorporating Herbal Medicine into Clinical Practice. Philadelphia: F. A. Davis; 2002,
Yarnell, E. et al., Clinical Botanical Medicine. New York: Mary Ann Liebert; 2003,
Cassileth B, Lucarelli C. Herb-Drug Interactions in Oncology. London: BC Decker; 2003,
4
McKenna et al., Botanical Medicines. New York: Haworth Herbal Press; 2002, Rotblatt M,
Ziment I. Evidence-Based Herbal Medicine. Philadelphia: Hanley and Belfus; 2002,
Mahady et al., Botanical Dietary Supplements. The Netherlands: Swets and Zeitlinger;
2001, Cupp M. Toxicology and Clinical Pharmacology of Herbal Products. Totowa, New
J ersey: Humana Press; 2000.





German Chamomile (Matricaria recutita L.)





Safety/Precautions


Chamomile is included in the generally regarded as safe (GRAS) list by the FDA
(Bratman and Girman, 2003).

Alcohol present in some chamomile containing eyewashes may possess irritating
action on the conjunctiva (Cupp, 2000).

Do not ingest large amounts of chamomile during pregnancy, since some of the
plants components may induce uterine contractions (Fugh-Berman 2003; Barnes et
al., 2002; Rotblatt and Ziment, 2002; Brinker, 2001; 2000; Kuhn and Winston,
2000).

Highly concentrated hot teas may cause nausea and emesis (Blumenthal, 2003;
Castleman, 2001; Adame and Adame, 2000).

People allergic to other plants belonging to the same botanical family (Asteraceae),
such as ragweed, elecampane and arnica for example, may be susceptible to cross-
hypersensitivity with Chamomile (Paulsen, 2002).
5

Although a rare occurrence, Chamomile may be allergenic either by direct contact
with the plant, employing it as an eye wash, skin cream or ingesting the tea
(Rycroft, 2003; Bascom, 2002; Schempp et al., 2002; Foti et al., 2000; Rodriguez-
Serna et al., 1998; Rudzki and Rebandel, 1998; Pereira et al., 1997; Ott, 1994;
Subiza et al., 1990, 1989; Kettel, 1987). For this reason, Asthmatic patients should
employ chamomile tea with caution, especially if they are allergic to ragweed or
other members of the Daisy family (Foster and Tyler, 2000; Benner and Lee, 1973;
Casterline, 1980).

In spite of the above information, some authors believe that Chamomile is not
particularly allergenic and that the statements regarding the possibility of an allergic
reaction have been exaggerated (Bratman and Girman, 2003; Schulz et al., 2002;
Karch, 1999).

Furthermore, some claims that Chamomile is allergenic may have been based
erroneously on another species, commonly known as dog chamomile (Anthemis
cotula), which does in fact have proven allergenicity (Schulz et al., 2001; Lewis
1992; Hausen et al., 1984).

Enemas containing chamomile preparations may be dangerous if applied to patients
during labor, due to possible anaphylaxis (J ensen-J arolim et al., 1998).


Herb/Drug Interactions

As some constituents present in Chamomile may theoretically interfere with blood
clotting, do not use together with aspirin, warfarin or other substances that possess
anticoagulant action (Bratman and Girman, 2003; Heck et al., 2000).

Since apigenin is a ligand for the central benzodiazepine receptor, do not use
concurrently with diazepam or other benzodiazepinics, as this may potentiate their
action (Paladini et al., 1999; Viola et al., 1995).

Some of Chamomiles components may inhibit cytochrome P450 3A4 enzymes
(Budzinski et al., 2000).










6

Literature Cited


Adame J , Adame H. Plantas Curativas del Noreste Mexicano.
Monterrey, Mexico: Ediciones Castillo; 2000.

Aertgeerts P, Albring M, Klaschka F, Nasemann T et al. Comparative testing of Kamillosan
cream and steroidal (0.25% hydrocortisone, 0.75% fluocortin butyl ester) and non-steroidal
(5% bufexamac) dermatologic agents in maintenance therapy of eczematous diseases
Z Hautkr. 1985; 60(3):270-277.
Avallone R, Zanoli P, Puia G. et al. Pharmacological profile of apigenin, a flavonoid
isolated from Matricaria chamomilla. Biochem Pharmacol. 2000; 59(11):1387-1394.
Barnes J , Anderson L , Phillipson D. Herbal Medicines 2
nd
Ed.
London: Pharmaceutical Press; 2002.

Benner M, Lee H. Anaphylactic reaction to chamomile tea.
J Allergy Clin Immunol 1973; 52:307-308.

Blumenthal M. The ABC Clinical Guide to Herbs.
New York: Thieme; 2003.

Blumenthal M. The German Commission E Monograph System. In: Lawson R and Bauer
R, eds. Phytomedicines of Europe. Washington D.C.: American Chemical Society; 1998.

Bratman S, Girman A. Handbook of Herbs, Supplements and Their Therapeutic Uses.
St. Louis: Mosby; 2003.

Brinker F. Herb Contraindications and Drug Interactions 3
rd
Ed.
Sandy, Oregon:Eclectic Medical Publications; 2001.

Brinker F. Toxicology of Botanical Medicines 3
rd
Ed.
Sandy, Oregon:Eclectic Medical Publications; 2000.

Budzinski J W, Foster BC, Vandenhoek S, Arnason J T. An in vitro evaluation of human
cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures.
Phytomedicine. 2000; 7(4):273-282.

Burrows G, Tyrl R.. Toxic Plants of North America.
Ames: Iowa State Press; 2001.

Carl W, Emrich LS. Management of oral mucositis during local radiation and systemic
chemotherapy: A study of 98 patients. J Prost Dent 1991; 66: 361-369.

Cassileth B, Lucarelli C. Herb-Drug Interactions in Oncology.
7
London: BC Decker; 2003.

Casterline C. Allergy to chamomile tea.
J AMA 1980; 4:330-331.

Castleman M. The New Healing Herbs 2
nd
Ed.
Emmaus, Pennsylvania: Rodale Press; 2001.

Cupp M. Toxicology and Clinical Pharmacology of Herbal Products.
Totowa, New J ersey: Humana Press; 2000.

Davidow J . Infusions of Healing.
New York: Fireside: 1999; pp.144-145

De la Motte S, Bose-O'Reilly S, Heinisch M, Harrison F. Double-blind comparison of an
apple pectin-chamomile extract preparation with placebo in children with diarrhea.
Arzneimittelforschung. 1997; 47(11):1247-1249.
Dewick P. Medicinal Natural Products: A Biosynthetic Approach 2
nd
Ed.
Chichester, UK: Wiley; 2002.

Fidler P, Loprinzi, CL, OFallon J R et al. Prospective evaluation of chamomile mouthwash
for prevention of 5-FU-induced oral mucositis. Cancer; 77:522-525; 1996.

Foti C, Nettis E, Panebianco R, Cassano N, Diaferio A, Pia DP. Contact urticaria from
Matricaria chamomilla. Contact Dermatitis. 2000; 42(6):360-1.
Foster S, Tyler V. Tylers Honest Herbal.
New York: Haworth Herbal Press; 2000.

Fugh-Berman A. The 5-Minute Herb & Dietary Supplement Consult.
Philadelphia: Lippincott; 2003.

Glowania HJ , Raulin C, Swoboda M. Effect of chamomile on wound healing--a clinical
double-blind study. Z Hautkr. 1987; 62(17):1262, 1267-71.
Gonzlez M. Plantas Medicinales Del Noreste de Mxico.
Monterrey, Mexico : IMSS-Vitro; 1998.

Gruenwald J . PDR for Herbal Medicine 2
nd
Ed.
Montvale, New J ersey: Medical Economics; 2000.

Hausen BM, Busker E, and Carle R. The sensitizing capacity of Compositae plants VII.
Experimental investigations with extracts and compounds of Matricaria recutita L.
Rauschert and Anthemis cotula L. Planta Medica 1984; 34:229-234.

8
Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and
warfarin. Am J Health Syst Pharm. 2000; 57(13):1221-1227.

Karch S. Consumers Guide to Herbal Medicine.
New York: Advanced Research Press; 1999.

Kay M. Healing with Plants in the Mexican and American West
Tucson: University of Arizona Press; 1996.

Kettel W. Allergy to Matricaria chamomilla.
Contact Dermatitis 1987; 16: 50-51.

Kuhn M, Winston D. Herbal Therapy and Supplements.
Philadelphia: Lippincott; 2000.

Lewis WH. Notes on economic plants. Econ. Botany 1992; 46 (4): 426-430.

Linares E, Flores B, Bye R. Seleccin de Plantas Medicinales de Mxico.
Mxico City: Noriega-Limusa; 1994.

Martnez M. Las Plantas Medicinales de Mxico.
Mxico City: Editorial Botas; 1989.

Miller L, Murray W. Herbal Medicinals.
New York: Pharmaceutical Products Press; 1998.

Nasemann T. Kamillosan therapy in dermatology.
Z Allgemeinmed. 1975; 51(25):1105-1106.

Nissen HP, Biltz H, Kreysel HW. Profilometry, a method for the assessment of the
therapeutic effectiveness of Kamillosan ointment. Z Hautkr. 1988; 63(3):184-190.

Ott A. Piel y Plantas.
Barcelona: Edika Med; 1994.

Ottariano S. Medicinal Herbal Therapy: A Pharmacists Viewpoint.
Portsmouth, New Hampshire:Nicolin Fields; 1999.

Paladni A Marder M, Viola H, Wolfman C, Wasowski C, Medina J H. Flavonoids and the
central nervous system:from forgotten factors to potent anxiolytic compounds.
J Pharm Pharmacol 51 (5): 519-526; 1999.

Patzelt-Wenczler R, Ponce-Poschl E. Proof of efficacy of Kamillosan cream in atopic
eczema. Eur J Med Res 5 (4): 171-175, 2000.

Paulsen E. Contact sensitization from Compositae-containing herbal remedies and
cosmetics. Contact Dermatitis. 2002;47(4):189-198.
9
Pereira F, Santos R, Pereira A. Contact dermatitis from chamomile tea.
Contact Dermatitis. 1997; 36(6):307.
Presser A. Pharmacists Guide to Medicinal Herbs.
Petaluma, California: Smart Publications; 2000.
Robbers J , Tyler V. Tylers Herbs of Choice
New York: Haworth Herbal Press; 2000.

Rodrguez-Serna M, Sanchez-Motilla J , Ramon R, Aliaga, A. Allergic and systemic contact
dermatitis from Matricaria chamomilla tea. Contact Dermatitis 1998; 39(4):192-193.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine.
Philadelphia: Hanley and Belfus; 2002.
Rudzki E, Rebandel P. Positive patch test with Kamillosan in a patient with
hypersensitivity to camomile. Contact Dermatitis. 1998; 38(3):164.
Rycroft RJ . Recurrent facial dermatitis from chamomile tea.
Contact Dermatitis. 2003; 48 (4):229.

Sandberg F, Corrigan D. Natural Remedies: Their origins and uses.
London: Taylor and Francis; 2002.

Schempp CM, Schopf E, Simon J C Plant-induced toxic and allergic dermatitis
Hautarzt. 2002; 53(2):93-97.
Schulz V, Hansel R, Tyler V. Rational Phytotherapy 4
th
Ed.
Berlin: Springer-Verlag; 2001.
Subiza J , Subiza J L, Alonso M, Hinojosa M et al. Allergic conjunctivitis to chamomile tea.
Ann Allergy 1990; 65(2):127-132.
Subiza J , Subiza J L, Hinojosa M et al. Anaphylactic reaction after the ingestion of
chamomile tea: a study of cross-reactivity with other composite pollens. J Allergy Clin
Immunol. 1989; 84(3):353-358.
Viola H, Wasowski C, Levi de Stein M et al. Apigenin, a component of Matricaria recutita
flowers, is a central benzodiazepine receptor ligand with anxiolytic effects. Planta Med
1995; 61: 213-216.
Weizman Z, Alkrinawi S, Goldfarb D et al. Efficacy of herbal tea preparation in infantile
colic. J Pediatr 1993; 122:650-652.