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Complementary, Holistic, and Integrative Medicine Chamomile

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Paula Gardiner at Boston Medical Center
Paula Gardiner
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Abstract

As part of any medication history, pediatricians always should ask a child's caregiver about the child's use of over-the-counter remedies and herbal products. Chamomile is used widely to treat children who have GI disorders such as colic, dyspepsia, and diarrhea and to treat skin conditions such as dermatitis. Clinical studies have demonstrated that chamomile may have a positive effect in the treatment of atopic dermatitis, colic, and diarrhea. There are few adverse effects in children. However, children who are allergic to ragweed, asters, and chrysanthemums should use chamomile with caution.
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Complementary, Holistic, and
Integrative Medicine: Chamomile
Paula Gardiner, MD*
Author Disclosure
Dr Gardiner disclosed
that she is supported
by an NIH
Institutional National
Research Service
Award, Grant No.
T32-AT0051-03 from
the National Center
for Complementary
and Alternative
Medicine (NCCAM).
NOTE: The agents
discussed in this series
are designated as dietary
supplements rather than
drugs. Although dietary
supplements are
regulated by the United
States Food and Drug
Administration (FDA),
their manufacturers may
make claims with little
evidence and need not
prove safety prior to
marketing. The burden is
on the FDA to monitor
safety after the product
is on the market. Readers
are referred to the 1994
Dietary Supplement
Health and Education
Act (www.cfsan.fda.gov/
⬃dms/dietsupp.html).
Definition and Description
Chamomile is a common flowering plant and a member of the daisy family. There are two
primary types: German chamomile (Matricaria recutita) and Roman chamomile (Anthe-
mis nobilis). Most research has focused on German chamomile. Chamomile is one of the
most widely used herbs in the world, especially in children. (1)(2) It is used topically for
rashes, eczema, and hemorrhoids or orally as a mild sedative or for indigestion, diarrhea,
and colic. (3)(4)(5)(6)
Evidence of Efficacy in Pediatrics
Colic
Only two clinical trials have evaluated the efficacy of chamomile for the treatment of colic
in children, and both combined chamomile with other herbs. In a prospective, random-
ized, double-blind, placebo-controlled study, 68 healthy term infants who had colic (2 to
8 weeks old) received either herbal tea (German chamomile, vervain, licorice, fennel, balm
mint) or placebo tea (glucose, flavoring). (7) Each infant was offered treatment with every
bout of colic, up to 150 mL/dose, no more than three times a day. After 7 days of
treatment, parents reported that the tea eliminated the colic in 57% of the infants,
whereas placebo was helpful in only 26% (P⬍0.01). No adverse effects were noted in
either group.
A randomized, double-blind, placebo-controlled trial of 93 breastfed colicky infants
compared a standardized extract of chamomile (M recutita), fennel (Foeniculum vulgare),
and lemon balm (Melissa officinalis) with placebo twice a day for 1 week. (8) Crying time
was reduced in 85.4% of the chamomile/fennel/lemon balm group and in 48.9% of the
placebo group (P⬍0.005). No adverse effects were reported.
Dyspepsia
Chamomile often is combined with peppermint, anise, fennel, and other carminative herbs
to treat stomachaches, gas, indigestion, and bloating. German chamomile has anti-
inflammatory and spasmolytic effects on the stomach and duodenum. (9) No single
product studies of chamomile as a treatment for upper gastrointestinal (GI) symptoms in
children have been published.
Diarrhea
Although oral rehydration therapy remains the mainstay of treatment for diarrhea in
children, a few clinical trials have evaluated the efficacy of chamomile. In a prospective,
double-blind, randomized, controlled multicenter study, 79 children from the ages of 6
months to 5.5 years who had acute, noncomplicated diarrhea were given either a liquid
preparation containing apple pectin and chamomile fluid extract standardized to 2.5 g/
100 g of chamazulene or placebo for 3 days. (10) Both groups received standard medical
treatment of hydration and electrolyte repletion. The chamomile and apple pectin com-
bination decreased the diarrhea more frequently than did the placebo (P⫽0.05). There was
a nonsignificant trend in satisfaction of parents in the apple pectin/chamomile group.
A follow-up multicenter, randomized, double-blind, placebo-controlled parallel study
of 255 children who had acute diarrhea demonstrated that the chamomile and apple
pectin combination was superior to placebo in significantly reducing stool frequency.
(3) Treatment was well tolerated, with the incidence of adverse effects similar to that
of placebo.
*Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston,
Mass.
Article complementary medicine
e16 Pediatrics in Review Vol.28 No.4 April 2007 . Provided by Amer Acad of Pediatrics on December 17, 2009 http://pedsinreview.aappublications.orgDownloaded from
Dermatologic Conditions
Chamomile has been used to treat conditions other than
diaper rash. Clinical studies have consistently shown
positive results in the treatment of atopic dermatitis,
acute weeping skin disorders, decubitus ulcers, and
radiation- and chemotherapy-induced oral mucositis.
(11)(12)(13)(14)(15)(16) Most of the studies are small
and of poor quality. Therefore, more research is needed
to assess the efficacy of chamomile for the treatment of
skin conditions. Clinical trials and systematic reviews did
not find that chamomile was effective in preventing acute
radiation dermatitis. (17)(18)
Safety
Adverse Events
A few case reports have documented atopic and contact
dermatitis with the use of chamomile. (19)(20)(21)(22)
Some individuals allergic to other members of the aster
family (ragweed, asters, chrysanthemums) are allergic to
chamomile. (19) There are case reports of chamomile
eyewashes causing allergic conjunctivitis. There have
been rare cases of anaphylaxis to chamomile.
(4)(23)(24)(25)(26) No long-term problems have been
identified from taking chamomile.
Drug Interactions
Three cases of chamomile interacting with cyclosporine
in patients who have had renal transplants have been
reported. (27) The mechanism is inhibition of the activ-
ity of P450 CYP1A2 and 3A4. (28)(29) Potential inter-
actions with warfarin have been reported, theoretically
through the same mechanism of inhibition of P450.
(30)(31) There is a theoretical additive effect with other
sedative and anxiolytic medications.
Use in Pregnancy and Lactation
No studies have reported the safety of using chamomile
for women who are pregnant or breastfeeding, although
chamomile is widely consumed during pregnancy as a
beverage to treat morning sickness. (32)(33)
Pharmacologic Action
A total of 120 chemical constituents have been identified
in chamomile, including terpenoids (chamazulene),
flavonoids (apigenin and luteolin), and coumarins (um-
belliferone, alpha-bisabolol). (34)(35) The flavonoids
apigenin and luteolin possess anti-inflammatory, carmi-
native, and antispasmodic properties. (34) The anti-
inflammatory, wound-healing, and antimicrobial effects
of German chamomile are attributed to a blue essential
oil that contains sesquiterpene alcohol, alpha-bisabolol,
chamazulene, and flavonoids. (36)(37)(38)
Administration/Dosage Forms
Adult doses of chamomile usually are one cup of tea or
1 to 4 mL of tincture (1:1 in 45% alcohol), three times
daily by mouth. The pediatric dose of flower head is 2 g
three times daily and for a single dose of fluid extract
(ethanol 45% to 60%) is 0.6 mL to 2 mL. (39)
Summary
As part of any medication history, pediatricians always
should ask a child’s caregiver about the child’s use of
over-the-counter remedies and herbal products. Cham-
omile is used widely to treat children who have GI
disorders such as colic, dyspepsia, and diarrhea and to
treat skin conditions such as dermatitis. Clinical studies
have demonstrated that chamomile may have a positive
effect in the treatment of atopic dermatitis, colic, and
diarrhea. There are few adverse effects in children. How-
ever, children who are allergic to ragweed, asters, and
chrysanthemums should use chamomile with caution.
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complementary medicine
e18 Pediatrics in Review Vol.28 No.4 April 2007 . Provided by Amer Acad of Pediatrics on December 17, 2009 http://pedsinreview.aappublications.orgDownloaded from
DOI: 10.1542/pir.28-4-e16
2007;28;e16-e18 Pediatr. Rev.
Paula Gardiner
Complementary, Holistic, and Integrative Medicine: Chamomile
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Background: Remarkable properties of Matricaria chamomilla L. (Mch) have caused it to be considered widely in the treatment of different ailments including gastrointestinal disorders. Objective: In the present study, the Mch extract-loaded coated pellets were developed with the aim to mask its bitter taste and to improve its dosing flexibility and patient compliance, especially in children. Methods: The plant extract was obtained by maceration with ethanol 70 % and dried using rotary evaporating and freeze drying methods. Then it was used for pellet preparation along with different proportions of various additives such as Avicel, starch and lactose by extrusion-spheronization technique. The pellets were analyzed for their size, sphericity, aspect ratio and friability. The optimized formulation, subjected for coating by Eudragit E, was evaluated for taste-masking efficiency, dissolution and morphology. Results: The optimized pellets were produced with particle size, sphericity and aspect ratio equal to 1.13 mm, 0.924 and 1.172, respectively. Low friability, suitable flow properties (carr’s index = 3.01 %) as well as dissolution led this sample to be considered for taste-masking coating. Based on in vitro dissolution studies, although the coating layer significantly decreased the release of the components at higher pH compared to the uncoated particles, acceptable dissolution was observed at pH 1.2. Appropriate taste-masking of the product was also confirmed by in vivo analysis. Conclusion: The taste-masked Mch-loaded pellets with suitable characteristics could be an appropriate delivery system with improved patient compliance.
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Matricaria chamomilla: A valuable insight into recent advances in medicinal uses and pharmacological activities
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Full-text available
Throughout history, Matricaria chamomilla L. (M. chamomilla) has had countless applications in traditional medicine. Its extracts, oils and teas have been used for treating diverse ailments, including wounds, rheumatic pain, menstrual cramps, eye and ear infections, gastrointestinal disorders, and respiratory illnesses. These traditional applications guided modern research into its medicinal effects through increasingly detailed in vitro and in vivo studies and clinical trials. A plethora of preclinical studies have assessed the antimicrobial, antioxidant, anti-inflammatory, antiulcer, hypoglycemic, hypolipidemic, cardioprotective, hepatoprotective, neuroprotective, nephroprotective, anti-diarrheal, antispasmodic, wound healing, and anticancer properties of M. chamomilla. These pharmacological properties of M. chamomilla are attributed to its rich reservoir of phytochemical constituents, primarily its flavonoids, such as luteolin, apigenin, and quercetin, as well as its sesquiterpenes, mainly chamazulene and (−)-α-bisabolol. Remarkably, preclinical studies have paved the way for progress towards controlled human clinical trials. M. chamomilla has been clinically evaluated for its effects against anxiety, sleep-deficiency, depression, as well as oral, women-related, inflammatory, metabolic, dermatological, gastrointestinal disorders, and children-related conditions. In this sense, this review elucidates and discusses the recent findings for M. chamomilla development as a therapeutic agent that possesses health-promoting, disease-preventing and even treatment properties. The traditional medicinal uses and evidence-based research studies, which were performed in cell culture, animal models and human subjects to assess the pharmacological activities of M. chamomilla, are extensively highlighted. Particular emphasis is given to some phytochemical constituents of M. chamomilla, which demonstrate great potential in treating various conditions.
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A Comprehensive Review on Biology, Genetic Improvement, Agro and Process Technology of German Chamomile (Matricaria chamomilla L.)
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Full-text available
  • Dec 2021
German chamomile (M. chamomilla) is recognized as a star herb due to its medicinal and aromatic properties. This plant is found across a wide range of climatic and soil conditions. Both the flower heads and blue essential oils of German chamomile possess several pharmacological properties of an anti-inflammatory, antimicrobial, antiseptic, antispasmodic and sedative, etc., nature, which makes it a highly sought after herb for use in many pharma and aroma industries. Chamomile tea, prepared from its flower heads, is also a well-known herbal tea for mind and body relaxation. Though it is a high-demand herb, farmers have not adopted this plant for large scale cultivation as a crop, which could improve their livelihood, due to the high cost in flower heads harvesting, loss in over mature and immature flower heads picking during harvesting, unavailability of varieties and agrotechnologies for machine harvesting, a lack of efficient process development of oil extraction and in the lack of improved stable varieties. There are many studies that have reported on the phytochemistry and pharmacological uses of chamomile, which further explore its importance in the medicine industry. Several studies are also present in the literature on its cultivation practices and plant ecology. However, studies on breeding behavior, genetic improvement, varietal development and mechanical harvesting are scarce in German chamomile. Hence, keeping in mind various aspects of farmers’ and researchers’ interest, earlier reports on taxonomy, floral biology, processing of oil extraction, active constituents, uses, agronomy, breeding challenges and opportunities in German chamomile are summarized in this review.
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Anaphylactic reaction after the ingestion of chamomile tea: A study of cross-reactivity with other composite pollens
Article
Full-text available
  • Oct 1989
  • J ALLERGY CLIN IMMUN
We report a case of an 8-year-old atopic boy in whom ingestion of a chamomile-tea infusion precipitated a severe anaphylactic reaction. The patient suffers from hay fever and bronchial asthma caused by a variety of pollens (grass, olive, and mugwort). This severe reaction was developed after his first ingestion of chamomile tea. Studies revealed the presence of immediate skin test reactivity and a positive passive transfer test to chamomile-tea extract. Moreover, both specific antichamomile-tea extract and anti-Matricaria chamomilla-pollen extract IgE antibodies were detected by an ELISA technique. Cross-reactivity among chamomile-tea extract and the pollens of Matricaria chamomilla, Ambrosia trifida (giant ragweed), and Artemisia vulgaris (mugwort), was demonstrated by an ELISA-inhibition study. These findings suggest a type I IgE-mediated immunologic mechanism as being responsible for the patient's anaphylactic symptoms and also suggest that the patient cross-reacted the pollens of Matricaria chamomilla contained in the chamomile tea because he was previously sensitized to Artemisia pollen.
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Prospective evaluation of a chamomile mouthwash for prevention of 5‐FU‐induced oral mucositis
Article
BACKGROUND Stomatitis has been found to be a major dose-limiting toxicity from bolus 5-fluorouracil-based (5-FU) chemotherapy regimens, despite the use of oral cryotherapy. Pursuant to preliminary data which suggested that a chamomile mouthwash might ameliorate this toxicity, a prospective trial was developed to test chamomile in this situation.METHODSA Phase III, double-blind, placebo-controlled clinical trial was designed. Patients were entered into the study at the time of their first cycle of 5-FU-based chemotherapy. All patients received oral cryotherapy for 30 minutes with each dose of 5-FU. In addition, each patient was randomized to receive a chamomile or placebo mouthwash thrice daily for 14 days. Stomatitis scores were determined by health care providers and by patients themselves.RESULTSThere were 164 evaluable and well-stratified patients equally randomized to both treatment groups. There was no suggestion of any stomatitis difference between patients randomized to either protocol arm. There was also no suggestion of toxicity. Subset analysis did reveal unsuspected differential effects between males and females that could not be explained by reasons other than chance.CONCLUSION The resultant data from this clinical trial did not support the prestudy hypothesis that chamomile could decrease 5-FU-induced stomatitis. Cancer 1996;77:522-5.
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Effect of herbal teas on hepatic drug metabolizing enzymes in rats
Article
  • Oct 2001
  • J PHARM PHARMACOL
We have investigated the effect of herbal teas (peppermint, chamomile and dandelion) on the activity of hepatic phase I and phase II metabolizing enzymes using rat liver microsomes. Female Wistar rats were divided into six groups (n = 5 each). Three groups had free access to a tea solution (2 %) while the control group had water. Two groups received either green tea extract (0.1 %) or aqueous caffeine solution (0.0625 %). After four weeks of pretreatment, different cytochrome P450 (CYP) isoforms and phase II enzyme activities were determined by incubation of liver microsomes or cytosol with appropriate substrates. Activity of CYP1A2 in the liver microsomes of rats receiving dandelion, peppermint or chamomile tea was significantly decreased (P < 0.05) to 15 %, 24 % and 39 % of the control value, respectively. CYP1A2 activity was significantly increased by pretreatment with caffeine solution. No alterations were observed in the activities of CYP2D and CYP3A in any group of the pretreated rats. Activity of CYP2E in rats receiving dandelion or peppermint tea was significantly lower than in the control group, 48 % and 60 % of the control, respectively. There was a dramatic increase (244 % of control) in the activity of phase II detoxifying enzyme UDP-glucuronosyl transferase in the dandelion tea-pretreated group. There was no change in the activity of glutathione-S-transferase. The results suggested that, like green and black teas, certain herbal teas can cause modulation of phase I and phase II drug metabolizing enzymes.
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Use of herbal drugs in pregnancy: a survey among 400 Norwegian women
Article
  • Jun 2004
  • PHARMACOEPIDEM DR S
PurposeTo investigate the use of herbal drugs by pregnant women.Methods We interviewed 400 postpartum women at Ullevål University Hospital in Oslo, Norway about the use of herbal drugs, within 3 days after giving birth by using a structured questionnaire in the period from February to June 2001.ResultsWe found that 36% of the pregnant women had used herbal drugs during pregnancy with an average of 1.7 products per woman. The proportion of women using herbal drugs increased throughout the first, second and third pregnancy trimester. The most commonly used herbs were echinacea, iron-rich herbs, ginger, chamomile and cranberry. Among the women having used herbal drugs in pregnancy, 39% had used herbal drugs that were considered possibly harmful or herbs where information about safety in pregnancy was missing. Herbal galactagogues had been used by 43% of the women who had breastfed a prior child during their breast-feeding period. Use of herbal drugs in pregnancy had most commonly been recommended by family or friends.Conclusion The widespread use of herbal drugs during pregnancy indicates an increased need for documentation about the safety of herbal drugs in pregnancy. To meet the needs of pregnant women, it is necessary for health care personnel to have knowledge about herbal drugs during pregnancy. Copyright © 2004 John Wiley & Sons, Ltd.
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Management of oral mucositis during local radiation and systemic chemotherapy: A study of 98 patients
Article
  • Oct 1991
  • J PROSTHET DENT
Oral mucositis is among the complications of head and neck irradiation and systemic chemotherapy. To determine whether or not mucositis could be prevented or reduced in intensity by using Kamillosan Liquidum as an oral rinse, 98 patients were placed on study protocols. Twenty patients who were treated with radiation therapy and 46 patients who received systemic chemotherapy participated in prophylactic oral care with Kamillosan oral rinse. Thirty-two patients were treated therapeutically after mucositis had developed. Sixteen patients receiving chemotherapy were treated therapeutically and prophylactically with Kamillosan oral rinse during repeated cycles of chemotherapy. Only one of the 20 patients who had had radiation therapy developed grade 3 mucositis in the final week of treatment. Thirty-six of the 46 patients undergoing chemotherapy did not develop clinically noticeable mucositis. It appears that resolution of mucositis is accelerated by Kamillosan rinse. Prophylactic oral care appeared to modify the oral environment favorably and maintain tissue integrity.
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Effect of chamomile on wound healing - A clinical double-blind study
Article
  • Oct 1987
In a double-blind trial, the therapeutic efficacy of chamomile extract was tested on 14 patients. As objective parameters served the epithelial and drying effect on weeping wound area after dermabrasion of tattoos. The period of the healing and drying process was judged by the doctor. The decrease of the weeping wound area as well as the drying tendency was statistically significant.
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Study of antimicrobial activity of chamomile oil
Article
  • Oct 1972
Gram positive bacteria were found to be more sensitive to the action of chamomile oil than Gram negative bacteria. In certain concentrations chamomile oil exerted selective inhibitory effect on the tested Gram positive microorganisms. The incorporation of the volatile oil in topical preparations for staphylococcal infections is suggested. The oil also showed marked fungicidal activity against Candida albicans.
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Efficacy of herbal tea preparation in infant colic
Article
  • Apr 1993
  • J Pediatr
We evaluated the effect of an herbal tea preparation on infantile colic in a prospective double-blind study. The use of tea eliminated the colic in 19 (57%) of 33 infants, whereas placebo was helpful in only 9 (26%) of 35 (p < 0.01). The mean colic score was significantly improved in tea-treated infants. No significant differences were noted between groups regarding number of night wakings.
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