Movies and literature depicting a bygone era frequently feature a kind elderly grandmother or aunt suggesting a cup of chamomile tea to calm the nerves of an anxious young female protagonist.

Chamomile has been one of the more common and readily used herbs for centuries. Today, most chamomile comes from Germany (although there are a multitude of technically different species).1 At last count, chamomile was included in the pharmacopeias of 26 different countries.2

One source estimates that an average of more than 1 million cups of chamomile tea are ingested worldwide each day.2 Though chamomile is most famous for mild sedative effects, its German name actually means “capable of anything.” The word “chamomile” is derived from the Greek chamos (ground) and melos (apple). A perennial native to Europe and member of the aster family, chamomile is a low-growing branched plant with narrow leaves. In June and July, it produces small white daisylike flowers that have an apple scent.3

Background

Also known as “scented mayweed,” chamomile has traditionally been used to treat GI upset and irritable bowel problems and as a mild sleep aid or sedative.4 Documentation also exists recommending the topical use of chamomile preparations for skin irritations, including anogenital conditions and generalized rashes and infections.5 The pharmacologically active compounds of chamomile are extracted from the dried flower heads.1


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Technical data

The essential oil distilled from the dried chamomile flower heads contains the primary active ingredient a-bisabolol, an unsaturated monocyclic sesquiterpene alcohol. Some other compounds found in the essential oils include angelic and tiglic acid esters, farnesol, nerolidol, germacranolide, amyl and isobutyl alcohols, anthemol, anthemic acid, phenolic acid, and fatty acids.1

A Cochrane review did not find any randomized controlled trials evaluating the efficacy and safety of chamomile. Scattered small trials conducted for irritable bowel syndrome and mild insomnia showed only moderate efficacy, with both design of the trials and quality of data yielding evidence levels no greater than “C.”6

While anecdotal evidence abounds, perhaps the most complete compendium of pharmacologic information is found in the monograph on chamomile by the German regulatory agency for herbs (Commission E, made up of an expert panel of the German Institute for Drugs and Medical Devices). The commission approved the use of German chamomile for GI spasms and skin and mucous membrane inflammation. However, the commission reported there is no clinical evidence to support the use of German chamomile as a sedative. 7

A promising chamomile-containing compound, STW 5, has been studied for its GI relief potential. The compound, comprised of peppermint, chamomile, and iberis (a member of the evergreen family), showed positive results for the treatment of mild dyspepsia.8

Chamomile has also been used in cosmetic applications, including as a rinse for blond hair.3 The movement toward “natural” skin care makes these products popular, in spite of conflicting reports of atopic dermatitis.9

Physiologically, chamomile is purported to smooth and tighten the skin and soothe hypersensitive or dry skin.

Safety

While allergic reactions are always possible with a botanical product, other types of contraindications and adverse side effects are rare with chamomile. In a European monograph on chamomile produced by the European Scientific Cooperative for Phytotherapy, there are no listed contraindications, special warnings, or interactions.1 In a concurrent publication, the German Commission E agrees that there are no known adverse reactions or contraindications for the use of German chamomile.1

An article on the topical use of chamomile in cosmetics, however, raised a significant concern over the increasing cases of allergic contact dermatitis being attributed to this herb.10

Dose and how supplied

This versatile compound is equally broad in its form and type of use. In an array ranging from teas to tinctures, the summation of dosing is best stated as one tablespoon (3 g) of dried flower head.11 Since the volatile oil is not very water-soluble, the actual concentration of chamomile depends largely on the brewing or steeping method used.

For chronic digestive ailments, daily consumption of the brewed tea is suggested for at least two to three months to assist in healing.1 Other conditions warrant “as needed” usage.

Cost

Chamomile is inexpensive. The cost largely depends on the formulation chosen. Concentrated tinctures or extracts will be more expensive than teas, but overall costs will be minimal.

Summary

While not singularly potent and probably not efficacious enough to replace prescription pharmacologic therapy in moderate-to-severe cases, use of chamomile is safe and may be helpful as a mild sedative and gastric calmative. Persons with atopic histories should be cautious in its use.

Ms. Sego is a staff clinician at the Veterans Administration Hospital in Kansas City, Mo., where she practices adult medicine and women’s health. She also teaches at the nursing schools of the University of Missouri and the University of Kansas.

References

1. Fetrow CW, Avila JR. Professional’s Handbook of Complementary & Alternative Medicines. Springhouse, Pa.: Springhouse Corp; 1999:152.

2. Herbwisdom.com. Chamomile. Available at www.herbwisdom.com. Accessed July 9, 2007.

3. Wikipedia. Chamomile. Available at http://en.wikipedia.org/wiki/German_Chamomile. Accessed July 9, 2007.

4. Skidmore-Roth L. Mosby’s Handbook of Herbs & Natural Supplements, 3rd ed. St. Louis, Mo.: Elsevier Mosby; 2006:264.

5. Blumenthal M, Hall T, Goldberg A, et al. eds. The ABC Clinical Guide to Herbs. Austin Tex.: American Botanical Council; 2003:51-60.

6. The University of Texas MD Anderson Cancer Center. Complementary/Integrative Medicine Education Resources (CIMER). Available at www.mdanderson.org/departments/CIMER. Accessed July 9, 2007.

7. American Cancer Society. Chamomile. Available at www.cancer.org/docroot. Accessed July 9, 2007.

8. Melzer J, Rösch W, Reichling J, et al. Meta-analysis: phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (Iberogast). Aliment Pharmacol Ther. 2004;20:1279-1287.

9. North Dakota Pharmacists Association. Continuing education for pharmacists. Available at www.nodakpharmacy.net/cem/cequiz/CE_10_2005.pdf. Accessed July 9, 2007.

10. Blumenthal M, Hall T, Rister R, Steinhoff B, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin Tex.: American Botanical Council; 1996:573-575.

11. Paulsen E. Contact sensitization from Compositae-containing herbal remedies and cosmetics. Contact Dermatitis. 2002;47:189-198.