Alternative Medicine Review Volume 13, Number 1 2008

Matricaria chamomilla(German chamomile)

DescriptionChamomile is a widely recognized herb in

Western culture. Its medicinal usage dates back toantiquity where such notahles as Hippocrates, Galen,and Asclepius made written reference to it. A com-mon ingredient today in herbal teas because of itscalming, carminative, and spasmolytic properties, it is also a popular ingredient in topical health and beauty productstor its soothing and anti-inHammarory effects on skin. Chamomile has a sweet, grassy, and lightly fruity aroma. ItsHowers are daisy-like, with yellow centers (approximately 1-1.5 cm in diameter) and white petals (between 12-20 innumher). It is from the plants fresh and dried flower heads that infusions, liquid extracts, and essential oils are made.

Two species of chamomile are generally used in traditional herbalism, Matrkaria chamomilla (Cbamomilla re-cutita; German chamomile; Hungarian chamomile) and Chamaemclum nohile (Roman chamomile). Both annual herbsbelong to the Asteraceae/Composirae family and are similar in physical appearance, chemical properties, and generalapplications. German chamomile, however, is the more familiar and more commonly used of the two.

Active ConstituentsGerman chamomile flowers contain 0.24- to 2.0-percent volatile oil that is blue in color. The two key constitu-

ents, (-)-alpha-hisabolol and chamazulene, account for 50-65 percent of total volatile oil content. Other componentsof the oil include (-)-alpha-bisaboloI oxide A and B, (-)-aipha-bisabolone oxide A, spiroethers (eis- and trans- en-yn-dicycloether), sesquiterpenes (anthecotulid), cadinene, farnesene, furfural, spathulenol, and proazulene (matricarinand matricin). Chamazulene is formed from matricin during steam distillation of the oil. Yield varies depending onthe origin and age of the flowers. European Pharmacopoeia recommends chamomile contain no less than 4 niL/kg ofblue essential oil.'

Chamomile also contains up to eight-percent flavone glycosides (apigenin 7-gIycoside and its 6'-acetylatedderivative) and flavonols (luteolin glucosides, quercetin glycosides, and isohamnetin); up to 10-percent mucilage poly-saccharides; up to 0.3-percent choline; and approximately 0.1-percent coumarins (umbelliierone and its methyl ether,lierniarin). The tannin level in chamomile is less than one percent.

Mechanisms of ActionSeveral pharmacological actions have been documented for German chamomile, based primarily on in vitro

and animal studies. Such actions include antibacterial, antifungal, anti-infîammatory, antispasmodic, and-ulcer, anti-viral, and sedative effects-

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The constituents of chamomile thought tohave antimicrobial properties include alpha-bisaholol,luteolin, quercetin, and apigenin. Hermann may alsohave antibacterial and antifungal properties in the pres-ence of ultraviolet light. Preliminaty in vitro studies onthe antimicrobial activity of chamomile have yieldedpromising results. Chamomile oil, at a concentration of25 mg/mL, demonstrates antibacterial activity againstsuch gram-positive bacteria as Bacillus subtilis, Staphy-lococcus aureus, Streptococcus tnutans, and Streptococcussaiivarius, as well as some fungicidal activity againstCandida alhicans?'' Whole plant chamomile extract at10 tng/mL demonstrates a similar effect, completely in-hibiting growth of group B Streptococcus in vitro.^ Inaddition, chamomile extract blocks aggregation of He-licobacter pylori and various strains of Escherichia co/f.''̂Chamomile extract has also been shown to inhibit thegrowth of poliovirus and herpes virus. German chamo-mile esters and lactones demonstrate activity againstMycohacterium tuberculosis and Mycobacterium avium.Chamazulene, alpha-bisabolol, flavonoids, and umbel-litcrone display antiiungal properties against Trichophy-ton mcntagrophytes and Trichophyton rubrum.''

The high alpha-bisaboIol content in chamo-mile oil is credited for providing the majority ot antibac-terial, antifungal, anti-inflammatory, and anti-ulceractivity, although the precise mechanism of action re-mains unclear.̂ "'*

In vitro, chamomile extract inhibits both cy-clooxygenase and lipoxygenase, and consequently pros-taglandins and leukotrienes."' Other anti-inflammatoryeffects are thought to occur via the influence of azulenes(chamazulene, prochamazulene, and guaiazulene) onthe pituitary and adrenals, increasing cortisone releaseand reducing histamine release/

Chamomile extracts exhibit antispasmodicproperties. Apigenin, alpha-bisabolol, and the cis-spiroethers appear to provide the most significantantispasmodic effects. When tested on spasms of iso-lated guinea pig ileum induced by barium chloride, 10mg of apigenin provided the antispasmodic activityroughly equivalent to 1 mg of papaverine (an opioidantispasmodic)." Similar results were observed withalpha-bisabolol and the cis-spiroethers."^' Other Ba-vonoids and the small amount of coumarins contributeto smooth muscle relaxation, but to a lesser degree.

In vitro studies demonstrate alpha-bisabolol in-hibits gastric ulcer formation induced by indomethacin,ethanol, or stress/ Oral administration of chamomileoil to rats at doses ranging from 0.8-80 mg/kg bisabololdemonstrate significant protective effect against gastrictoxicity of 200 mg/kg acetylsalicylic acid.̂ ^

Regarding sedative activity, one study usingintraperitoneal administration of chamomile extract inmice concluded that apigenin functions as a Hgand forbenzodiazepine receptors, resulting in anxiolytic andmild sedative effects, but no muscle relaxant or anticon-vulsant effects."' In contrast to diazepam, apigenin doesnot cause memory impairment. A lyophilized infusionof chamomile, also administered intraperitoneally inmice, elicited a depressive effect on the central nervoussystem.''

Research is exploring the antiproliferative andapoptotic effects of chamomile extract in various hu-man cancer cell lines. One preliminary study observedin vitro exposure to chamomile results in differentialapoptosis in cancer cells but not in normal cells at simi-lar doses; apigenin and apigenin glycosides appear to bethe key components responsible for these effects/"^

Clinical IndicationsAlthough chamomile is a well-known and

widely used herb in Western culture, few well designed,randomized, double-blind, placebo-controlled studiesare available to fully assess its therapeutic benefit.

Sleep EnhancementIn an open case study to examine the cardiac

effects of two cups of chamomile tea on patients under-going cardiac catheterization, the authors observed that10 of 12 patients in the snidy achieved deep sleep with-in 10 minutes of drinking the tea.''' The patients hada small but significant increase in mean brachial arterypressure. No other significant hemodynamic changeswere observed.

DiarrheaIn a prospective, randomized, multicenter,

double-blind, parallel group trial, 79 children (ages sixmonths to five years) with acute, noncomplicated diar-rhea received either a commercial preparation of applepectin and chamomile extract or placebo for three days.

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Matricaria chamomilla

in addition to a typical rehydration and re-alimentationdiet. At the end of three days, significantly more chil-dren in the pectin/chamomile group (85%) experienceddiiirrhea alleviation compared to the placebo group(58%) (p<0.05). Tlae children on the pectin/chamo-mile combination experienced a significant 5.2-hourshorter duration of symptoms compared to the placehogroup,""

ColicA double-hlind study observed the efficacy of

an herbal decoction consisting of German chamomile,vervain, licorice, fennel, and balm mint on 68 healthyinfants with colic. For seven days the infants (ages2-8 weeks) received 150 mL of the herbal preparationor placeho with each colic episode, but no more thanthree times daily. After seven days, 57 percent of theiniants receiving the herbal preparation experiencedcolic relief compared to 26 percent in the placebo group

Wound HealingA double-blind trial examined the therapeutic

efficacy of a topical chamomile extract on 14 patientswith weeping dermabrasions from tattoo applications.Those using chamomile noted a statistically significantdecrease in the weeping wound area and increased dry-ing compared to the placebo group,'^

In a double-blind, randomized, placeho-con-trolled study, 48 women receiving radiation therapytor breast cancer were treated topically with eitherchamomile cream or placebo (almond oil) to protect theradiation-treated area. While there were no significantdifferences between the two groups in objective scoresoí skin irritation, the patients preferred the chamomile-containing cream to the placebo for its rapid absorptionand stainlessness.''

MucositisMucositis, characterized by inflammation and

ulcération of the gastrointestinal tract (including themouth), is a dose-limiting consequence of some radia-tion and chemotherapy treatments. If severe, the pa-tient is unable to eat solid food (grade 3) or even liquids(grade 4). A case series examined the effect of 15 drops

of Kamillosan Liquidum, a German chamomile mouth-wash preparation, in 100 mL of water taken three timesdaily, for radiation and/or chemotherapy-induced mu-cositis. Cancer patients (n=98) were divided into twogroups. One group of 66 patients (20 undergoing radia-tion therapy, 46 undergoing chemotherapy) participa-ted in prophylactic oral care with the mouthwash. Theremaining 32 patients underwent chemotherapy andwere treated therapeutically after mucositis had devel-oped. Of the 20 patients undergoing radiation, only onedeveloped high-grade (grade 3) mucositis in the finalweek of treatment, 65 percent developed intermediate-grade mucositis, and 30 percent developed low-grademucositis. Of the 46 patients concurrently receivingchemotherapy and the mouthwash, 36 remained free ofany clinically significant mucositis. Of the 32 patientswith existing mucositis, all noted immediate relief frommouth discomfort, and within seven days almost all pa-tients had no clinical sign of mucositis,"'''

A randomized, double-blind study was con-ducted with 164 cancer patients taking 5-fluorouraciI(5-FU) chemotherapy. The patients rinsed three timesdaily with either a chamomile mouthwash or placebo.After 14 days, no difference was observed between thetwo groups in the incidence of stomatitis induced by

EczemaIn an open, bilateral comparative trial, 161 pa-

tients with eczema on their hands, forearms, and lowerlegs initially treated with 0.1-percent diflucortolone val-erate received one of four treatments: chamomile cream(Kamillosan), 0,25-percent hydrocortisone, 0.75-per-cent fluocortin butyl ester (a glucocorticoid), or 5.0-per-cent bufexamac (a nonsteroidal and-inflammatory). Af-ter 3-4 weeks, the chamomile cream was found to be aseffective as hydrocortisone and demonstrated superioractivity to bufexamac and fluocortin butyl ester,^''

Drug-Botanical InteractionsOnly one report of a possible chamomile-drug

interaction has been documented, A 70-year-old womanon warfarin was admitted to the hospital with multipleinternal hemorrhages after using chamomile products(tea and body lotion) to alleviate upper respiratory tract

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That chamomile contributed to the hem-

orrhaging is doubtful since the coumarin compounds

in German chamomile lack the chemical configuration

necessary for human anticoagulant activity.'"

Side Effects and ToxicityChamomile use has a high level of safety, as

confirmed by numerous animal models.'^^^^' One par-

ticular toxicity study using rabbit models determined

the acute oral LD^̂ , and acute dermal LD^^ to be greater

than 5 g/kg body weight.'^ Tlie U. S. Food and Drug

Administration (FDA) has classified the oil and extract

of both German and Roman chamomile as substances

Generally Regarded As Safe (GRAS)."

A few reports indicate that individuals aller-

gic to tbe Asteraceae/Compositae family (ragweed,

chrysanthemum, marigold, daisy, etc.), can experience

cross-over hypersensitivity reactions to cbamomile.

One report involved an eight-year-old boy with a his-

tory of atopy who ingested a chamomile tea infusion

that precipitated an anaphylactic reaction.''' In another

report, a 20-year-old woman with confirmed sensitiv-

ity to chamomile experienced acute rhinitis from merely

using chamomile-scented toilet

DosageIn adults, oral administration for traditional

uses are generally as follows: (1) dried flower heads: 2-8

g as an infusion three times daily; (2) liquid extract/

tincture: 1-6 mL up to three times daily of 1:1 potency;

7-15 mL up to three times daily of 1:5 potency.

Warnings and ContraindicationsIndividuals with known hypersensitivity to

members oí Asteraceae/Compositae family (ragweed,

chrysanthemum, marigold, daisy, etc.), should avoid use

of chamomile-containing products to reduce the likeli-

hood of an allergic reaction.

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