Chamomile, German
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Matricaria recutita L. (syn. Chamomilla recutita [L.]
Rauschert;
M. chamomilla L.; M. suaveolens L.)
[Fam. Asteraceae]
Overview
Chamomile is one of the most widely used ingredients in
herbal teas worldwide. The amount of chamomile imported into the U.S. each year
is between 750,000 and one million pounds, with an estimated 90% used in teas
(Keating, 2001). In the U.S. and Europe, chamomile is also a popular ingredient
for external use in health and beauty aids. In commerce, chamomile is often
called German chamomile or Hungarian chamomile, which should not be confused
with the rarer, and more costly, Roman or English chamomile (Anthemis nobilis syn. Chamaemelum nobile).
Description
Chamomile preparations consist of the fresh or dried flower
heads of Matricaria recutita L. (syn.
Chamomilla recutita [L.] Rauschert; M. chamomilla L.; M. suaveolens L.) [Fam. Asteraceae].
Pharmacopeial grade chamomile must contain no less than 0.4% of blue volatile
oil, and no less than 0.3% of apigenin-7-glucoside (USP, 2002). Pharmacopeial
grade chamomile fluid extract contains not less than 0.3% of blue residual oil
with an ethanol content of 38%–53% (v/v)
(Ph.Eur., 2001).
Primary Uses
Internal
Gastrointestinal spasms, inflammatory
diseases of the gastrointestinal tract (Morant and Ruppanner, 2001; Blumenthal et al., 1998; Bradley, 1992; Braun et al., 1996)
Indigestion, flatulence and/or excess gas
production, bloating (Health Canada, 1996)
External
Dermatology
Inflammatory dermatosis and neurodermatitis (Aertgeerts et al., 1985)
Wound treatment after dermabrasion for
tattoo removal (Glowania et al.,
1987)
Ano-genital inflammation (baths and
irrigation) (Blumenthal et al., 1998;
Braun et al., 1996)
Other Potential Uses
Diarrhea in children (de la Motte et al., 1997)
Common cold symptoms (Saller et al., 1990)
Oncology
Alleviation of radiation and chemotherapy induced
mucositis (Carl and Emrich, 1991)
Dosage
Internal
Crude Preparations
Dried flower heads: 2–4
g, 3 times daily (Bradley, 1992), 5 g single dose (CCRUM, 1992).
Infusion: The
German Commission E dosage is 150 ml boiling water poured over approximately 3
g dried flower and steeped, covered, for 5–10 minutes, 3–4 times daily between
meals for gastrointestinal complaints (Blumenthal et al., 1998; Braun et al.,
1996). The official Swiss tea infusion dosage for the same indication is 900 mg, 3–5 times daily (Morant and
Ruppanner, 2001).
Fluid extract: 1:1
(g/ml), 38–53% ethanol (v/v), containing minimum 0.3% (w/w) blue volatile oil, 1–4 ml, 3 times
daily (Bradley, 1992).
Tincture: 1:5
(g/ml), 45% ethanol, 3–10 ml, 3 times
daily (Bradley, 1992).
Tincture: 1:4.0–4.5
(w/v) ratio in 42.8% ethanol. Adults:
5 ml in 100 ml warm water, 4 times daily. Children: 2.5 ml, 4 times daily (Asta
Medica, 1998; Gelbe Liste Pharmindex, 2000).
External
Crude Preparations
Bath additive: 50g
dried flower added per 10 liters (ca. 2.5 gallons) water as a bath for
ano-genital inflammation (Blumenthal et
al., 1998; Braun et al., 1996).
Gargle: 100
ml boiling water poured over 3–10 g dried flower and steeped, covered, for 5–10
minutes (Braun et al., 1996). The tea
infusion is used as a wash or gargle for inflammation of the mucous membranes
of the mouth and throat (Blumenthal et al.,
1998; Braun et al., 1996). Or 5 ml
tincture poured into 100 ml warm water and gargled 3 or more times daily (Asta
Medica, 1998).
Inhalation: 100
ml boiling water poured over 3–10 g dried flower and steeped, covered, for 5–10
min. (Braun et al., 1996). Or 15 ml
tincture poured into 0.5 liter boiled water, 1–3 times daily (Asta Medica,
1998). Steam vapor inhaled for inflammation of the upper respiratory tract.
Poultice:
Semisolid paste or plaster containing 3–10% (m/m) of flower heads (Blumenthal et al., 1998).
Rinse: Hot
aqueous rinse containing 3–10% infusion (Blumenthal et al., 1998).
Note: Do
not apply infusion near eyes (Braun et
al., 1996).
Duration of Administration
Internal and external
For acute complaints that last more than one week, or recur
periodically, consult a healthcare provider (Braun et al., 1996).
Chemistry
Chamomile contains from 6–8% flavonoids (Hänsel et al., 1999; Bruneton, 1999; Dölle et al., 1985), composed of flavone glycosides
including apigenin 7-glucoside and its 6’-acetylated derivative and flavonols
including luteolin glucosides, quercetin glycosides, and isorhamnetin
(Bruneton, 1999); up to 10% mucilage polysaccharides (Carle and Isaac, 1985;
Meyer-Buchtela, 1999); 0.4–2.0% volatile oil, composed of bisabolane
sesquiterpenes (up to 50%) and chamazulene (1–15%); sesquiterpene lactones
(matricin and matricarin) (Bruneton, 1999; Carle and Isaac, 1985); and up to
0.3% choline (Schilcher, 1987).
Pharmacological Actions
According to the German Commission E, chamomile is anti-inflammatory;
muscle relaxant; antispasmodic; promotes wound-healing; deodorant;
antibacterial; bacteriostatic; stimulates skin metabolism (Blumenthal et al., 1998).
Internal
Human
Sedative (Bradley, 1992; Gould et al., 1973; Mann and Staba, 1986); carminative (CCRUM, 1992).
Animal
Inhibits ulceration (Szelenyi et al., 1979); relaxes smooth muscle (Carle and Gomaa, 1991,92);
depresses central nervous system (CNS) (Della Loggia et al., 1982). Apigenin binds to central benzodiazepine receptors,
producing anxiolytic effects in mice but without any sedative or myorelaxant
effects (Viola et al., 1995). A
subsequent study reports, in contrast, that apigenin has sedative action
without anxiolytic and/or myorelaxant effect. The study links the sedative
action of chamomile extracts not to an activation of GABAA receptors
by apigenin, but to other compounds with benzodiazepine-like activity (Avallone
et al., 2000).
In vitro
Antipeptic (reduces proteolytic activity of pepsin by 50%)
(Thiemer et al., 1972; Isaac and
Thiemer, 1975); prevents and relieves inflammation (Ammon and Sabieraj, 1996).
External
Human
Anti-inflammatory (Aertgeerts et al., 1985); astringent; cooling (Nasemann, 1975); promotes
wound-healing (Glowania et al.,
1987).
Animal
Anti-inflammatory (Carle and Gomaa, 1991,92; Tubaro et al., 1984; WHO, 1999).
Mechanism of Action
Whole plant extracts of chamomile have
demonstrated antispasmodic action, though the mechanism of action was unclear
(Forster et al., 1980). Antispasmodic
effects are due mainly to chamomile’s water-soluble constituents (Carle and
Gomaa, 1991,92) such as the flavonoids apigenin and apigenin-7-O-glucoside and
the volatile oil (–)-a-bisabolol, which act similarly to
papaverine (Bruneton, 1999; WHO, 1999).
Sedative effects are attributed to the
flavonoids, including apigenin, which acts as a ligand for the central
benzodiazepine receptors. Apigenin competitively inhibits the binding of
flunitrazepam, thus providing a molecular basis for possible weak
CNS-depressing activity of water-based preparations (e.g., teas) (Viola et al., 1995).
Apigenin may be an anti-inflammatory
constituent (Hadley and Petry, 1999), due to the water-soluble and lipophilic
components. The flavones block the arachidonic acid pathway by inhibiting
phospholipase A, cyclo-oxygenase, and lipoxygenase pathways. The volatile oil
components, chamazulene and a-bisabolol,
have also demonstrated anti-inflammatory action by interfering with
5-lipoxygenase and cyclo-oxygenase production (Carle and Gomaa, 1991,92).
The
azulene components of the volatile oil have anti-allergenic and
anti-inflammatory actions, though the mechanism of action was unclear
(Farnsworth and Morgan, 1972).
Azulene may prevent histamine discharge
from tissue by activating the pituitary-adrenal system, causing the release of
cortisone (Stern and Milin, 1956); or azulene may prevent allergic seizures
caused by histamine release, activating cellular resistance and speeding the
process of healing (Meer and Meer, 1960).
Chamomile
extract accelerates wound-healing, reportedly by reducing inflammation and
promoting tissue granulation and regeneration on topical application (Carle and
Isaac, 1987).
Contraindications
Known hypersensitivity to plants of the Asteraceae (Compositae) family such as arnica flower (Arnica spp.), chamomile flower (Matricaria
spp.), marigold flower (Calendula
officinalis L.), and yarrow flower (Achillea
spp.) (Braun et al., 1996);
ragweed (Ambrosia spp.); asters (Aster tataricus L. f.); and
chrysanthemums (Chrysanthemum spp.)
(WHO, 1999).
Pregnancy and Lactation: No
known restrictions in pregnancy or lactation (De Smet et al., 1992; McGuffin et
al., 1997). No adverse teratogenic effects have been reported in vivo (WHO, 1999).
Adverse Effects
Minor side effects are recorded by several references
(McGuffin et al., 1997). There is
empirical evidence of extremely rare contact allergy (Bradley, 1992; Brinker,
2001). Eye washing with chamomile tea may induce allergic conjunctivitis in
rare cases (Subiza et al., 1990).
Highly concentrated hot tea has been reported to act as an emetic (Chadha,
1952–1988). The unprocessed crude flower is free from any toxic effects (CCRUM,
1992). Case reports describing contact dermatitis and urticaria have been
documented (Foti et al., 2000; Giordano-Labadie, 2000;
Rodriguez-Serna et al., 1998;
Pereira, 1997; McGeorge and Steele, 1991; van Ketel, 1982). A case report
regarding a fatal outcome of anaphylaxis when a chamomile-containing enema was
given during labor has been documented (Jensen-Jarolim
et al., 1998). Rarely,
anaphylactic reactions can occur (Casterline, 1980; Subiza et al., 1989).
There have been several reports in the literature of
suspected anaphylaxis associated with the use of chamomile. One authoritative
source, reviewing the available literature from over almost 100 years,
concluded, “This rather remote possibility may have been greatly overemphasized
in the nonmedical literature. Only five cases of allergy specifically
attributed to German chamomile were identified worldwide between 1887 and 1982;
however, a recent report indicates that a German chamomile ether extract used
in allergic patch testing from 1985 to 1990 in 3,851 tested individuals
produced an allergic reaction in sixty-six patients or 1.7%.” (Robbers and
Tyler, 1999). One of the reports receiving widespread attention in the medical
press was based on a misinterpretation of the taxonomic identity of the
so-called “chamomile” (Anon., 1979). This article warned readers to avoid teas
made from the Composite family, including chamomile, goldenrod (Solidago virgaurea), marigold, and
yarrow. The article cited a paper titled “Anaphylactic reaction to chamomile
tea” (Benner and Lee, 1973), which does not specify the genus or species of the
purported chamomile material implicated in the single case described, a 35-year
old woman who suffered from ragweed hay fever and who developed anaphylaxis
following ingestion of one cup of the purported “chamomile tea” (Awang, 1990).
The incident was incorrectly inferred to be the popular German or Hungarian
chamomile (M. recutita). The actual
case was based on ingestion of dog fennel (Anthemis
cotula), a plant not widely used in commercial products, and generally
unavailable in the U.S. Dog fennel is a member of the genus Anthemis, the same as Roman or English
chamomile (A. nobilis, syn. Chamaemelum nobile) — hence the
erroneous appellation “chamomile” by the authors of the case reports (Lewis,
1992). Dog fennel contains a higher
level of anthecotulid, a sesquiterpene lactone that has demonstrated activity
in primary irritant contact dermatitis (Hausen et al., 1984).
However, there have been some recent reports of anaphylaxis
to German chamomile (M. recutita). In
one study, 10 out of 14 patients with a history of allergy to chamomile,
spices, or “weeds” tested positive to chamomile in a skin prick/RAST test
(Reider et al., 2000). Curiously,
chamazulene in German chamomile has anti-allergenic and anti-inflammatory
activity, and another constituent, an EN-IN-dicycloether, has demonstrated
anti-inflammatory, anti-anaphylactic, spasmolytic, and bacteriostatic activity
(Farnsworth and Morgan, 1972).
Drug Interactions
According to the German Commission E, no interactions are
known (Blumenthal et al., 1998). The
fluid extract may prevent ethyl alcohol-induced ulcer formation (Brinker,
2001). In vitro studies of the
inhibitory effect of ethanolic herbal extracts and tinctures on the cytochrome
P450 3A4 (CYP3A4) system revealed a median inhibitory concentration (IC50) of a
chamomile extract ranging from 1–2%. This
might have implications for predicting the likelihood of potential herb-drug
interactions (Budzinski et al.,
2000), although such reactions have not been reported. Potential interactions
with warfarin have been reported, and caution regarding their concomitant use
has been suggested (Heck et al.,
2000), although this remains speculative.
American Herbal Products Association (AHPA) Safety Rating
Class 1:
Herbs that can be safely consumed when used appropriately (McGuffin et al., 1997).
Regulatory Status
Austria: Official
in the Austrian Pharmacopoeia (ÖAB)
(Wichtl, 1997).
Belgium: Herbal
medicine for oral or external use for specific indication (Bradley, 1992; Van
Hellemont, 1986; WHO, 1998).
Canada: Permitted
as a Traditional Herbal Medicine (THM) or homeopathic drug for oral use.
Requires premarket authorization and assignment of a Drug Identification Number
(DIN) if labeled as a THM or homeopathic drug (Health Canada, 1996). Food, if
no claim statement is made.
Council of Europe: Dried
flower, essential oil and fluid extract official in European Pharmacopoeia, 3rd edition (Ph.Eur., 2001).
France: Traditional
Herbal Medicine (THM) for oral and external use for specific indications
(Bradley, 1992; Bruneton, 1999). Official in the French Pharmacopoeia, 10th edition (Ph.Fr.X) (WHO, 1999).
Germany: Approved
nonprescription drug of the German Commission E for oral and external use
(Blumenthal et al., 1998). Tea
infusion form is an approved nonprescription drug in the German Standard License monographs (Braun et al., 1996). The alcoholic fluid extract and the volatile oil
forms are official in the German Pharmacopoeia
(DAB, 1999).
India: Licensed
single drug in Unani system of medicine (CCRUM, 1992). Also listed in compound
formulations official in the National
Formulary of Unani Medicine (NFUM I) with standards approved by the Unani
Pharmacopoeia Committee (UPC) (NFUM, 1983).
Italy: Listed
in the Italian Pharmacopoeia (Newall et al., 1996).
Russian Federation: Official
in the USSR X (Bradley, 1992; Newall et
al., 1996).
Sweden: Natural
remedy for self-medication. Requires marketing authorization by the Medical
Products Agency (WHO, 1998).
Switzerland: Official
in the Swiss Pharmacopoeia (Ph.Helv.)
(Wichtl, 1997). Creams, fluid extracts, powders, sprays, and tea infusions are
Category D non-prescription drugs with sale limited to pharmacies and
drugstores (Morant and Ruppanner, 2001; Asta Medica, 2000; WHO, 1998).
U.K.: Herbal
medicine specified in the General Sale
List, Schedule 1 (medicinal products requiring a full product license),
Table A (internal or external use) (GSL, 1990).
U.S.: Generally
recognized as safe (GRAS) (US FDA, 1998). Food or dietary supplement, depending
on the claim statement (USC, 1994). Listed in the Official Monographs of the
U.S. National Formulary, 19th edition
(USP, 2002). Tincture of the whole flower plant, 1:10 (w/v) in 45% alcohol (v/v),
is a Class C over-the-counter (OTC) drug of the Homeopathic Pharmacopoeia of the United States (HPUS, 1990).
Clinical Review
Ten studies are outlined in the following table, “Clinical
Studies on German Chamomile,” including a total of 8,668 participants. All but
one of the studies (Fidler et al.,
1996) demonstrated positive effects for indications including dermatological,
neurological, and respiratory conditions. Three studies (Fidler et al., 1996; Carl and Emrich, 1991;
Nasemann, 1975) focused on the the use of chamomile as a mouthwash for its
astringent and cooling effects, stomatitis, and mucositis (Fidler et al., 1996; Carl and Emrich, 1991; Nasemann, 1975). One stomatitis
study did not notice significant improvement (Fidler et al., 1996). Other dermatological studies included one
controlled, bilateral, comparative study investigating a chamomile cream
against inflammatory dermatoses (Aertgeerts et
al., 1985), and a DB study on using a
chamomile extract to promote wound-healing after dermabrasion (Glowania et al., 1987). Other studies
demonstrating positive results included inhalation of the steam vapor of
chamomile extract to treat respiratory tract conditions related to the common
cold (Saller et al., 1990);
inhalation of volatile oil to determine the effect of olfactory stimulation on
mood (Roberts and Williams, 1992); and oral ingestion of the aqueous infusion
to investigate cardiac effects after ventricular catheterization (Gould et al., 1973). In a study of 8,058
mothers in childbirth conducted over a period of eight years, two essential
oils, clary sage (Salvia sclarea L.)
and chamomile were shown to be effective in alleviating pain during labor
(Burns et al., 2000). A recent DB,PC
study investigated the use of a chamomile fluid extract and apple pectin
combination product for treating young children with acute, non-complicated
diarrhea (de la Motte et al., 1997).
Branded Products
Diarrhoesan® Chamomile fluidextract: Dr. Loges
& Co. GmbH / Postfach 1262 / Schützenstrasse 5 / 21423 Winsen / Germany /
Tel.: +49-041-71-7070 / Fax: +49-041-71-7071-00 / Email: info@loges.com. Each
100 ml of solution contains 2.5 ml of chamomile fluidextract (1:1),eluent:
ethanol 55% and 3.2 g of apple pectin.
Kamillosan® Creme: VIATRIS GmbH & Co. KG /
Weismüllerstrasse., 45 / D-60314 Frankfurt/Main / Germany / Tel: +49-69-4001
2811 / Fax: +49-69-4001 2951 / Email: info@viatris.com / www.viatris.com
(formerly known as ASTA Medica AG). One gram cream contains 20 mg ethanolic dry
extract (2.75:1) in a fatty ointment base. The extract contains no less than
0.2 mg volatile oil and a minimum of 0.07 mg (-)-a-bisabolol.
Kamillosan® Konzentrat: VIATRIS GmbH & Co.
KG. Hydroalcoholic tincture extracted with 38.5% (m/m) ethanol; drug-to-extract ratio of approximately 1:4.0–4.5 (w/v), in 42.8% ethanol. Each 100 ml of
tincture contains 150–300 mg essential oil; 150–300 mg apigenin-7-glucoside and
50 mg (-)-a-bisabolol.
Kamillosan® Liquidum: VIATRIS GmbH & Co. KG.
Standardized hydroalcoholic fluid extract; 150 mg of essential oil per 100 ml
fluid extract containing a minimum of 3 mg chamazulene and 50 mg a-bisabolol.
Kneipp® Kamillen-Konzentrat: Kneipp Werke
/105-107 Stonehurst Court / Northvale, NJ 07647 / U.S.A. / Tel: (201) 750-0600
/ Fax: (201) 750-2070 / www.kneipp.com. Hydroalcoholic fluid extract.
American equivalents, if any, are found in the Product Table
beginning on page 398.
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