Herbfacts

Camomile Flower, German

Latin name; Matricaria recutita (syn. Chamomilla recutita)

Pharmacopoeial name ; Matricariae flos

Other names ; Hungarian Camomile, wild camomile

About German camomile (chamomile)

German camomile is a low growing annual herbaceous plant native to southern and eastern Europe and Northern and West Asia, now common in wastelands and neglected field as well as cultivated ground throughout Europe. In Germany, chamomile is one of the most important medicinal plants obtained from cultivation. Camomile has been described since ancient times and was an important drug in ancient Egyptian, Greek and Roman medicines. Its name is derived from the Greek “chamos” (ground) and “melos” (Apple), referring to its low growing habit and the apple scent of its fresh blooms.

Over 120 constituents have been identified in camomile flowers. Amino acids, polysaccharides and fatty acids are present in the mucilage, which makes up approximately 10% of the flower head. The yield of the volatile or essential oil from the flowers is 0.4–2.0%. The main constituents of the oil include terpenoids and azulenes, including chamazulene. Several flavonoids and other phenolic compounds have been identified in various parts of the chamomile flower head: Apigenin, quercetin, patuletin, luteolin and their glucosides (1).

In Germany, the camomile flower is licensed as a standard medicinal tea (infusion) for oral ingestion, for topical application as a rinse or gargle, cream or ointment, as a vapour inhalant, and as an additive for sitz or vapour baths. The German E Commission has approved chamomile for internal use to treat GI spasms and inflammatory diseases of the GI tract, and external use for inflammation of the skin, mucous membranes and ano-genital area, bacterial skin diseases (including those of the oral cavity and gums) and respiratory tract inflammation (2).

Uses

Anti-inflammatory effects

The therapeutic potential for apigenin as an anti-inflammatory agent was demonstrated in vitro with its ability to interfere with leukocyte adhesion and adhesion protein up-regulation in human endothelial cells (3). Other studies using apigenin in cell culture models have also shown that this flavonoid has inhibitory effects on adhesion molecule expression (4), prostaglandin (PG) E2, cyclooxygenase (COX)- 2 and nitric oxide production (5).

Anti-allergenic effects

The potential anti-allergenic activity of chamomile has been demonstrated (6). Quercetin and apigenin were the most effective inhibitors of antigen-induced histamine release from basophils among the flavonoids tested.

Gastrointestinal effects.

No clinical trials have examined the gastrointestinal effects of camomile alone, although three trials have examined its efficacy in combination with other components. Weizman et al. tested the effects of a powdered herbal tea preparation containing extracts of M. chamomilla, vervain (Verbena officinalis), licorice (Glycyrrhiza glabra), fennel (Foeniculum vulgare) and balm-mint (Melissa officinalis) as a treatment for infantile colic. In this randomized, double-blind, placebo-controlled trial, 68 healthy term infants (age 2–8 weeks) with colic were given either 150 mL of the herbal tea preparation or a placebo beverage containing no herbs for a period of 1 week. After 7 days, the colic improvement score was significantly higher in the herbal tea group than in the placebo group. Among the 33 infants given the herbal tea, colic was eliminated in 57% compared with 26% in the placebo group, although no significant differences with regard to the number of nighttime awakenings were observed (7).

A randomized, double-blind, placebo-controlled trial, determined that a standardized herbal preparation containing camomile, fennel and balm-mint administered daily for 1 week reduced crying time among breastfed colicky infants compared with a placebo. Significant results were attained within 4 days of treatment, and no side effects were observed with this dosage (8).

De la Motte et al examined the effects of a camomile extract and apple pectin preparation in 79 children with acute, non-complicated diarrhoea (9). In addition to the usual prescription of rehydration and a realimentation diet, the children received either the chamomile/pectin preparation or a placebo for 3 days. The diarrhoea ended sooner for more children in the group treated with chamomile and pectin (85%), than in the placebo group (58%).

The effects of a camomile-containing oral rinse on oral mucositis or stomatitis induced by cancer therapies have been examined in one case series and one clinical trial. Carl and Emrich observed both the prophylactic and therapeutic effects of a camomile mouthwash in a case series of 98 head and neck cancer patients treated with either radiation or systemic chemotherapy (10). In the prophylactic group, one of the 20 radiation therapy patients developed grade 3 mucositis in the final week of treatment, while 13 developed intermediate-grade and 6 developed low-grade mucositis. Only 10 of the 46 chemotherapy patients in the prophylactic group developed clinically significant mucositis. Of the 32 patients in the therapeutic treatment group (16 radiation, 16 chemotherapy), all experienced immediate relief from mouth discomfort, and within 1 week nearly all patients had no clinical signs of mucositis. In a double-blind, placebo-controlled clinical trial of 164 chemotherapy patients on their first cycle of 5-fluorouracil (5-FU), in bolus form,

Fidler et al. tested the efficacy of a chamomile mouthwash administered 3 times daily for 2 weeks (11). In addition, all patients received oral cryotherapy for 30 min with each dose of 5-FU. No differences in stomatitis between the chamomile and placebo mouthwash groups were detected at the end of the study period.

Topical effects.

Several studies have tested the effects of topically applied chamomile preparations on inflammation of the skin associated with atopic dermatitis or eczema, radiation therapy and erythema. Aertgerts compared the effects of a chamomile containing cream versus either 0.25% hydrocortisone, 0.75% fluocortin butyl ester (a glucocorticoid) or 5% bufexamac (a non-steroidal antiinflammatory) in 161 patients presenting with eczema on their hands, forearms and lower legs who had been treated initially with 0.1% difluocortolone (12). During the 3–4 week maintenance period, the chamomile cream was reported to be as effective as 0.25% hydrocortisone and more effective than both the glucocorticoid and non-steroidal antiflammatory agents.

In a 2 week trial, Patzelt-Wenczler and Ponce-Poschl compared the effects of camomile cream to 0.5% hydrocortisone and a placebo (the vehicle cream) in patients with a medium degree of atopic eczema. The camomile-treated group showed approximately 50% improvement in pruritis, erythema and desquamation (13).

Hempel reported that 1% hydrocortisone was more effective than a camomile ointment containing 1% extract in a study of 80 patients with subacute eczema who were pretreated with steroids. The difference in the global clinical impression rating between the two treatments was, however, smaller in patients pretreated with potent steroids than in those treated with weak steroids (14).

Anderson et al. found that massage with blended aromatherapeutic essential oils, some containing camomile, significantly improved night time disturbance scores and day time irritation scores in children with atopic eczema which was non-responsive to conventional therapy (15). Similar differences were also observed in the control group receiving massage without the essential oils, however, no significant between-group differences were detected.

Maiche et al. tested the effects of a topical camomile cream versus an almond oil placebo on the degree of radiation skin reaction. No significant differences were observed between the two treatments; however, radiation-induced skin reactions in the chamomile treated areas were less frequent and appeared later (16).

Topically applied camomile preparations have also been examined for their effectiveness in wound care. In a double-blind study of 14 patients with weeping wounds following dermabrasion for tattoo removal, a compress containing chamomile extract significantly decreased the wound area and increased drying of the wound (17). Patients with chronic wounds given a combination of chamomile and lavender essential oils prepared in a grapeseed oil base did better than those receiving conventional therapy in a study by Hartman and Coetzee (18).

Haemodynamic effects.

The hemodynamic effects of chamomile tea were examined in an open study of 12 heart disease patients hospitalized for cardiac catheterization. Gould et al. observed that patients had a small but significant increase in mean brachial artery pressure 30 min after drinking two cups of chamomile tea (19). Epidemiological studies have reported the intake of flavonoids, present in chamomile (apigenin, quercetin and luteolin), is inversely associated with heart disease risk (20).

Safety

There are no known side effects

Keywords; anti-inflammatory; anti-allergenic, colic; mucositisis; eczema,; skin healing; haemodynamic effects

There is currently no EMEA monograph for camomile

References

1. Mulinacci N, Romani A, Pinelli P, Vincieri FF, Prucher D. 2000.Chromatographia 51: 301–307.
2. Blumenthal M, Busse WR, Goldberg A et al. (eds). 1998. The Complete German Commission E Monographs – Therapeutic Guide to Herbal Medicines. American Botanical Council: Austin.
3. Gerritsen ME, Carley WW, Ranges GE et al. 1995. Am J Pathol 147: 278–292.
4. Panes J, Gerritsen ME, Anderson DC, Miyasaka M, Granger DN. 1996. Microcirculation 3: 279–286.
5. Liang YC, Huang YT, Tsai SH, Lin-Shiau SY, Chen CF, Lin JK. 1999. Carcinogenesis 20: 1945 –1952.
6. Middleton E, Drzewiecki G. 1982. Biochem Pharmacol 31: 1449–1453.
7. Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. 1993 J Pediatr 122: 650 –652.
8. Savino F, Cresi F, Castagno E, Silvestro L, Oggero R. 2005. Phytother Res 19: 335– 340.
9. De la Motte S, Bose-O’Reilly S, Heinisch M, Harrison F. 1997. Arzneimittelforschung 47: 1247–1249.
10. Carl W, Emrich LS. 1991. J Prosthet Dent 66: 361–369.
11. Fidler P, Loprinzi CL, O’Fallon JR et al. 1996. Cancer 77: 522–525.
12. Aertgeerts P, Albring M, Klaschka F et al. 1985. Z Hautkr 60 270–277
13. Patzelt-Wenczler R, Ponce-Poschl E. 2000. Eur J Med Res 5: 171–175.
14. Hempel B (ed). 1999. Acta Hortic 503: 15 –19.
15. Anderson C, Lis-Balchin M, Kirk-Smith M. 2000. Phytother Res 14: 452–456
16. Maiche AG, Grohn P, Maki-Hokkonen H. 1991. Acta Oncol 30: 395–396.
17. Glowania HJ, Raulin C, Swoboda M. 1987. Z Hautkr 62: 1267–1271
18. Hartman D, Coetzee JC. 2002. J Wound Care 11:317–320.
19. Gould L, Reddy CV, Gomprecht RF. 1973. J Clin Pharmacol New Drugs 13: 475–479.
20. Hertog MG, Feskens EJ, Hollman PC, Katan MB, Kromhout D. 1993. Lancet 342: 1007–1011.