Matricaria chamomilla L.

Last updated: 24 May 2015

Scientific Name

Matricaria chamomilla L.

Synonyms

Camomilla deflexa Gilib. [Invalid], Chamaemelum suaveolens E.H.L.Krause, Chamaemelum vulgare Bubani, Chamomilla chamomilla (L.) Rydb. [Illegitimate], Chamomilla courrantiana (DC.) K.Koch, Chamomilla officinalis K.Koch, Chamomilla patens Gilib. [Invalid], Chamomilla recutita (L.) Rauschert , Chamomilla recutita (L.) Rausch, Chamomilla vulgaris Gray, Chrysanthemum chamomilla (L.) Bernh, Chrysanthemum suaveolens (L.) Cav. Courrantia chamomilloides Sch.Bip. Matricaria bayeri Kanitz Matricaria capitellata Batt. & Pit, Matricaria courrantiana DC, Matricaria exigua Tuntas, Matricaria kochiana Sch.Bip, Matricaria pusilla Willd, Matricaria recutita L, Matricaria salina (Schur) Schur Matricaria suaveolens L. [1]

Vernacular Name

English Chamomile, german chamomile,Hungarian chamomile, genuine chamomile, matricaria [2], baboonig, babuna, babuna camornile, babunj, german chamomile, Hungarian chamomile, roman chamomile, english chamomile, camomilla, flos chamomile, single chamomile, sweet false chamomile, pinheads, and scented mayweed [3]
China Mu ju [4], yan gan ju [6]
India Babuna, bikh babuna, gul babunab, gul babunah, gul-babunah, roghan babunah [5] baboanh [6]
Japan Kamitsure, kamiture [6]
Korea Kamille [4]
France Camomile allemande, camomile vraie, matricaire [4], camomile, camomile commune, camomile commune ou d’allemagne, camomile sauvage, camomile vraie, herba de la mera, kamile matricaire, matricaire fausse camomile, matricaire odorante, matricaire tronquee [6]
German Kamille, echte kamille [4], apfelblumlein, apefelkraut, feldkamille, frauenblume, ganile,garnille, german chamomile, germeine kamile, gramilen, haugenblume, helmergen, helmriegen, hermel, hermelin, herminzel, johanniskopfehen, kamelle, kamille, kammerblime, kummerblume, kuhmelle, laugen blume, mariamadgalenakraut, muskatblume, mutterkraut, magdeblume, ramerian, remi, romerei [6]
Italy Camomirra, camomilla, camomila cammune, capomilla [6]
Netherland Echte Kamille, roomse kamille sort [6]
Spain camomila, manzanilla [4]
Rusia Romaska apteenaja [6]
Sweeden Kamomill [4], akta kamomil, sotblomster, sotblomster kamomil [6]
Denmark Egte kamille, kamille, laegekamiller, moderurt, pigeurt, velduftende kamille, vellugtende kamille [6]
Finland Kamomillasaunio, kamelinsaunio [6]
Portugal Camomile [3] camomile, camonila-alema, camomile-da- alemanha, camomile-dos- alemaes, camomile-vulgar, camomilla legitima, chamomilla, macela, macella, mancanila, margaca-das-boticas, matricaria [6]
Spain Amargaza, bastardilla, bonina, camila, camamila del comercio, camamilda, camomilla, chamomilla, larrambillo, magarza, magarza comun, magarza montesina, magarzuela manzanilla, manzanilla alemana, manzanilla basta, manzanilla bastarda, manzanilla blanca, manzanilla comun, manzanilla de almania, manzanilla de aragon, manzanilla de castilla, manzanilla de los corrales, manzanilla de urgel, manzanilla del huerto, manzanilla oridinaria, manzanilla real, manzanilla Silvestre, manzanilla vera, manzanilla vulgar [6]
Albania Maraqi [6]
Guatemala Manzanilla [6]
Honduras Manzanilla [6]
Hungary Orvosi Szekru, kamilla [6]
Iceland Kryddbaldursbra [6]
Poland Runiabek, rumianek pospolity [6]
Saudi Arabia Baabunaj, babunej [6]
Egypt Babounang [6]
Turkey Papatya [6]
Bolivia Manzanilla [6]
Colombia Camomilla, manzanilla, chiquita, manzanilla commun, manzanilla dulce [6]
Mexico Chamomille, manzanilla [6]
Norway Ettarig kamille, kamille, kamileblom, kamomileblom, kanneblom, kvitblom, moderurt [6]
Republic Czech Heomanek pravy, hermanek lekarsky, hermanek pravy [6]
Brazil Camomila, camomile comum, camomile vulgar, camomilha-verdadeira, macanilha, matricaria [6]

Geographical Distributions

Matricaria chamomile is native to Europe and Northern and Western Asia and it also cultivated in North America and Australia. [6]

Botanical Description

M. chamomile is a member of Compositae family. The branched stem is erect, heavily ramified, and grows to a height of 10–80 cm. The long and narrow leaves are bi- to tripinnate. The flower heads are placed separately, they have a diameter of 10–30 mm, and they are pedunculate and heterogamous. The golden yellow tubular florets with 5 teeth are 1.5–2.5 mm long, ending always in a glandulous tube. The 11–27 white plant flowers are 6–11 mm long, 3.5 mm wide, and arranged concentrically. The receptacle is 6–8 mm wide, flat in the beginning and conical, cone-shaped later, hollow—the latter being a very important distinctive characteristic of Matricaria—and without paleae. The fruit is a yellowish brown achene. [3]

Cultivation

M. chamomile can be grown on any type of soil, but growing the crop on rich, heavy, and damp soils should be avoided. It can also withstand cold weather with temperature ranging from 2°C to 20°C.[3]

Soil Suitability and Climate Requirement

No documentation

Field Preparation

No documentation

Field Planting

No documentation

Field maintenance

Fertilisation

The effect of nitrogen (N) is very marked on the fresh flowers and oil yield, whereas that of phosphorus (P) and potassium (K) is negligible. Dutta and Singh observed that application of N in the form of ammonium sulfate at 40 kg/ha significantly increased fresh flower and oil yield, while the oil content decreased from 0.64 to 0.59%. Addition of organic matter increases the humus content of such soil and thereby improves the crop performance. Application of 15–25 t/ha of FYM is proved beneficial before transplanting. El-Hamidi et al.advocates the ratio of 2:2 for N2 and P for obtaining the highest yield. Application of N at a higher level caused a notable decrease in the chamazuler percentage. Paun and Mihalopafound that the application of P and K at 50 kg/ha each in autumn before sowing and application of N at 50 kg/ha in early spring was responsible for satisfactory crop growth. However, neither volatile oil nor chamazulene content was affected. On saline alkaline soils, Singh found plants showing good response to N and P fertilizers. Application of 20–25 t/ha of FYM was useful before transplanting the crop. Misra and Kapoor found the optimum dose of N and P to be between 50–60 kg N/ha and 50 kg P2O5/ha. It is reported that N significantly increased the contents of α-bisabolol and chamazulene, but significantly decreased the contents of bisabolol oxides A and B in the essential oil. N significantly increased essential oil yield per unit dry flower weight in both Bohemia and Tisane varieties. The quantity of essential oil in chamomile was inversely related to its quality in terms of α-bisabolol and chamazulenes. [3]

No deficiency symptoms of trace elements have been observed on the crop in the country so far. Peskova has reported the good effect of the sulfates of manganese and cobalt; and borax on lime soils, whereas Koeurik and Dovjakindicated that combined application of boron and molybdenum increased dry matter significantly. [3]

Weed Control

There are many herbicides for the control of weeds in M. chamomilla. Generally 3–4 weedings are required for a good crop. The application of 1–1.5 kg/ha of sodium salt of 2,4-dichlorophenoxyacetic acid (2,4-D); four weeks after transplanting gave good control of weeds for four weeks. The experimental results of researchers in other countries suggests that herbicides, such as atrazine, prometryene, propyzamide, chloropropham, mecoprop, trifluralin, linurones, give satisfactory control of weeds, but these should be used with caution. It was found that afalone was the best selective weedicide. [3] Herbicide-treated crop had lower chamazulene content, and bisabolol content was lower in the second harvest as herbicides interfere with the metabolism of secondary products. Certain herbicides have little influence on the total essential oil content, but greater differences were found in the quantitative composition of useful substances. [3]

On saline–alkali soils only one thorough weeding and hoeing one month after transplanting, may be enough, as the plant once established, smothers the weed and no further weeding is required. [3] It was reported that weed removal during 5–11 weeks after planting the crop was necessary to obtain a higher yield of the flower and oil. [3] The uncontrolled weed growth caused 34.4% reduction in the dry flower yield as compared with the weed-free condition. The application of oxyfluorfen (0.6 kg/ha) gave higher returns. [3]

Water management

No documentation

Pest and Disease Control

The various insects, fungi, and viruses have been reported, which attack the chamomile crop. The following fungi are known to attack this plant: Albugo tragopogonis (white rust), Cylindrosporium matricariae, Erysiphe cichoracearum (powdery mildew), E. polyphage, Halicobasidium purpureum, Peronospora leptosperma, Peronospora radii, Phytophthora cactorum, Puccinia anthemedis, Puccinia matricaiae, Septoria chamomillae, and Sphaerotheca macularis (powdery mildew). Also, yellow virus (Chlorogenus callistephi var. californicus Holmes, Callistephus virus 1A) causes severe damage to this plant. In the years 1960–1964 when the crop was cultivated in the Regional Research Laboratory, Jammu, no incidence of disease was reported. However, after 20 years in the month of February about two dozen plants were observed to produce symptoms resembling those of plant viruses. These plants were burnt to prevent further spread of the disease. In early March, the incidence of leaf blight caused by Alternaria spp. was observed in the crop. A spray of Benlate (0.1%) controlled the disease. Fluister reported that black bean aphids (Aphis fabae) were feeding on M. Chamomilla.The insect Nysius minor caused shedding of M. chamomilla flowers, whereas Autographa chryson causes defoliation of the plant. The one spray with fosfothion 0.2%, controlled successfully aphid infestation (Doralis fabae Scop.) on chamomile. Methyl bromide (3 kg/100 m3) proved satisfactory as a fumigant against pest infestation of Ephestia elutella Hb in the desiccated herb of chamomile. Metalydacolus longistriatus in the Giza region of Egypt, was found to be associated with the roots of chamomile. [3]

Besides damaging the cultivated crop of chamomile, fungi and insects also cause extensive damage to the dry flowers during storage and reduce the quality of the dried raw product. This is because dried chamomile, the flowers in particular, contain a large amount of hydrophilic constituents (sugars, flavonoids, mucilages, phenyl carbonic acids, amino acids, choline, salts), and also chamomile herbs are hygroscopic. Microbiological deterioration caused by fungal agents occurs in a very short time. Thus, at the marginal condition of the dry product, the most xerophilic species, molds of the species Aspergillus and Penicillium form first. The metabolism of bacteria and fungi releases more and more moisture for the more demanding organisms, such as Fusarium and Rhizopus, so the attack continues to develop in a kind of cascade effect. [3] The metabolic excretions from the microbiological agents also make the stored product smell musty or damp, which is rated very negatively in terms of quality. In addition there is a risk that the stored product will be contaminated with mycotoxins, which are a health hazard.

The dried product is also a favorite habitat for certain insects. Larvae and beetles generally damage the stored product by eating away and polluting it with excreta and webs. This considerably reduces the quality and leads to total deterioration in a short time. The main stock pests that affect the drug are Plodia interpunctella Hb. (copper red-Indian meal moth), Ptinus latro F. (dark brown thief beetle), P. testaceus Oliv. (yellow brown thief beetle), Gibbium psylloides Gzemp. (smooth spider beetle), Lasioderma servicorne, and Stegobium paniceum. [3]

Harvesting

Harvesting is the most labor-intensive operation in chamomile cultivation, accounting for a major portion of the cost of production. The success of M. chamomilla cultivation as a commercial venture lies in how efficiently and effectively one can collect the flowers at the right stage during the peak flowering season extending over a period of 3–6 weeks during March-April. Flowering is so profuse that practically every alternate day at least 30–40 units of labor will be required to be employed to pluck the flowers from an area of 0.25–0.3 ha. Flower plucking is a selective process as flowers in all stages, namely, buds, semi-opened buds, flowers in all stages of bloom appear on the plants. Flowers at the near full bloom stage give the best quality of the product, hence care has to be exercised to see that as little as possible buds, stems, leaves, and extraneous material is plucked. Flowering will be observed on plants here and there all over the field from the later half of February and these flowers are plucked at the appropriate stage. Flowers are produced in flushes and 4-5 flushes are obtained. The 2nd, 3rd, and 4th flushes are the major contributors to flower yield. The peak period of plucking is between the 2nd week of March and the 3rd week of April in North India. In normal soils, Singh obtained a maximum yield of 7637 kg of fresh flowers, the average being 3500-4000 kg/ha. In saline–alkaline soils, Singh obtained a yield of 3750 kg fresh flowers/ha. [3] Temperature affects the number of flowers per kg. The weight of 1000 flowers is reduced from 130 to 80 g by the 2nd week of April. [3]

Postharvest handling

No documentation

Estimated cost of production

No documentation

Chemical Constituent

M. chamomile has been reported to contain flavonoids (apigenin and luteoline), bisabolols, matricin, and essential oils. [6][7]

Plant Part Used

Flowers and essential oil [8]

Traditional Use

M. chamomile is used mainly as an antiinflammatory and antiseptic, also antispasmodic and mildly sudorific. [3] It is used internally mainly as a tisane (infuse 1 table-spoonful of the drug in 1 L of cold water and do not heat) for disturbance of the stomach associated with pain, for sluggish digestion, for diarrhea and nausea; more rarely and very effectively for inflammation of the urinary tract and for painful menstruation. Externally, the drug in powder form may be applied to wounds slow to heal, for skin eruptions, and infections, such as shingles and boils, also for hemorrhoids and for inflammation of the mouth, throat, and the eyes. [3] Tabulated products from chamomile flower extracts are marketed in Europe and used for various ailments. M. chamomile tea eye washing can induce allergic conjunctivitis. Pollen of M. chamomilla contained in these infusions are the allergens responsible for these reactions. [3]

Preclinical Data

Pharmacology

Anxiety/Sedation activity

The bisabolols, chamazulene, and flavonoids contribute to the anti-inflammatory, sedative, and antispasmodic activity of chamomile. [9] Apigenin has been reported to be a ligand for the central benzodiazepine receptors exerting anxiolytic and slight sedative effects, but not being anticonvulsant or myorelaxant. [10] Also, the phytochemicals chrysin and apigenin, both found in chamomile, have been reported in the literature to be potential anxiolytic agents. [11] It should be noted that chemical modification of the flavone nucleus dramatically increases their anxiolytic potency. The essential oil of Chamomile is also used for its sedative/anxiety effects. [12]

A small randomized, double-blind, placebo-controlled efficacy and tolerability study in 57 patients with mild to moderate generalized anxiety disorder (GAD) found that Chamomile extract had a modest anxiolytic activity in these individuals, supporting the supportive use of Chamomile in GAD and other anxiety disorder. [13]

A small open trial found that Chamomile extract improved symptoms including hyperactivity, inattention and immaturity factors in 3 adolescent males with attention deficit/hyperactivity disorder (ADHD). [14]

Laboratory studies have reported a spasmolytic effect of Chamomile in the GI tract of rats by cAMP-PDE inhibition; support the use of Chamomile in digestive disturbances. [15]

Wound healing activity

Wound healing effects are partly due to the anti-inflammatory activity of M. chamomile, where (-)-a-bisobolol promotes granulation and tissue regeneration. [16] Proprietary M. chamomile creams for topical inflammation and wound healing are available.

A proprietary M. chamomile cream has been reported to be beneficial in local therapy of atopic eczema, without causing a Chamomile-related allergy. [17] In a partially double-blind, randomized study, the M. chamomile cream was tested against a 0.5% hydrocortisone cream and the vehicle cream as placebo in patients suffering from medium-degree atopic eczema. After a 2-week treatment, the proprietary M. chamomile cream showed a mild superiority towards 0.5% hydrocortisone and a marginal difference as compared to placebo.

Other activity

M. chamomile has demonstrated weak estrogenic agonist activity as well as weak progestational activity. [18] Also of note, in a study evaluating the effect of herbal teas on hepatic drug metabolism in rats, Chamomile tea significantly decreased the activity of CYP1A2 by 39%. No alterations in activity were noted for the CYP2D and CYP3A enzymes. [19]

An in vitro laboratory study reported anticancer effects of Chamomile extract against various human cancer cell line. [20]

Laboratory studies have reported blood sugar lowering effects when using Chamomile in mice. Chamomile was reported to suppress blood glucose levels, increase liver glycogen levels, and inhibit aldose reductase which can inhibit the accumulation of sorbitol in human erythrocytes. [21]

The oil used as a mild sedative and for digestion besides being antibacterial and fungicidal in action. [3] The dry flowers of chamomile are also in great demand for use in herbal tea, baby massage oil, for promoting the gastric flow of secretion, and for the treatment of cough and cold.The use of herbal tea preparations eliminated colic in 57% infants. [3]

Toxicity

No documentation

Clinical Data

Clinical findings

It is most frequently used as a mild sedative for individuals with minor anxiety or nervousness. [22] M. chamomile does not seem to induce drowsiness or impair motor activity in most individuals. Chamomile has also been used to soothe digestive upset and is considered a carminative (anti-gas) agent. [23] M. chamomile has been used topically for various conditions such as acne, infections, burns, and wounds. [23] M. chamomile also has been reportedly used as an anti-infective agent against strains of Staphylococcus, Streptococcus and Candida. [24] M. chamomile oral rinse is used in Europe for aphthous mouth ulcerations, especially associated with chemotherapy and radiation. However, one study did not show benefits when using chamomile oral rinse in treating 5-FU-induced oral mucositis. [25]

Precautions

Use with caution in individuals with severe ragweed allergy or allergy to members of the daisy/chrysanthemum family (Compositae), as M. chamomile has been reported to cause atopic dermatitis. [26][27][28][29][30]

In a study evaluating allergic sensitization to tea in a tea packing facility, 10 (5.6%) of the employees tested had developed specific immunoglobulin E antibodies to black or M. chamomile tea, though no specific allergic sensitization was noted. [31]31]

Side effects

No documentation

Pregnancy/Breast Feeding

Based on pharmacology, use with caution in pregnancy and lactation. [8]

Age limitation

Do not use in children under 2 years of age unless recommended by a physician.

Adverse reaction

M. chamomile has been reported to cause occasional allergic reactions. [8]

Interaction & Depletion

Interaction with drug

A human case study reported that constituents in chamomile influenced the effects of warfarin. This may affect the dose needed for treatment. Use with caution. [7]

These drugs include warfarin, heparin, dalteparin, tinzaparin, enoxaparin, danaparoid sodium, antithrombin III, lipirudin, argatroban, bivalirudin.

An animal study reported that chamomile may act in the body like some of these medications, which may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [7]

These drugs include temazepam, triazolam, alprazolam, diazepam, zolpidem, lorazepam, estazolam, flurazepam, quazepam, clorazepate dipotassium, chlordiazepoxide, zaleplon, glutethimide, acetylcarbromal, dexmedetomidine, chloral hydrate, paraldehyde, phenobarbital, pentobarbital, secobarbital, amobarbital, mephobarbital, butabarbital. [7]

An animal study reported that chamomile may act in the body like some of these medications, which may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [7]

These drugs include alprazolam, diazepam, lorazepam, clorazepate dipotassium, chlordiazepoxide, oxazepam, buspirone, doxepin, hydroxyzine, meprobamate. [7]

Interaction with other Herbs

No documentation

Contraindications

Person with known allergy to the herb should avoid using chamomile product. [8]

Case Report

No documentation

Dosage

Dosage Range

Typical adult dosage range:

  • 6 to 12 d/day of dried flower heads or by infusion [8]
  • 3 to 12 mL/ day of a 1:2 liquid extract [8]
  • 3 to 6 mL/day of a 1:2 liquid extract or equivalent in table or capsule form [8]
  • 9 to 30mL/day of a 1:5 ticture [8]

Poisonous Management

No documentation

Line drawing

No documentation

References

  1. The Plant List. Ver1.1. Matricaria chamomilla L. [homepage on the Internet]. c2013 [updated 2012 Feb 11; cited 2016 May 12]. Available from: http://www.theplantlist.org/tpl1.1/record/gcc-103038
  2. Herbal Medicine Research Centre, Institute for Medical Research. Compendium of medicinal plants used in Malaysia. Volume 2. Kuala Lumpur: HMRC IMR, 2002; p. 128.
  3. Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev. 2011;5(9):82-95.
  4. Science name finder . Matricaria chamomilla L. [ updated 2013, cited 2016 May 12] Available from http://www.sciname.info/Default.asp?SciName=Matricaria%20chamomilla&Option=BeginWith
  5. Quattrocchi U. CRC world dictionary of medicinal and poisonous plants: Common names, scientific names, eponyms, synonyms, and etymology. Volume IV M-Q. Boca Raton, Florida: CRC Press, 2012; p. 74.
  6. Lim TK. Edible medicinal and non-medicinal plants: Volume 7, flower. Dordrecht, Netherlands: Springer, 2013; p. 397-400.
  7. Bradley PR, editor. British Herbal Compendium. Bournemouth: British Herbal Medicine Association, 1992; p. 154-57
  8. Mills S, Bone K. The essential guide to herbal safety. Missouri: Elsevier, 2005; p. 525-326.
  9. Isaac O. Pharmacological investigations with compounds of chamomile I. On the Pharmacology of (-)-alpha-Bisabolol and Bisabolol Oxides. Planta Med. 1979;35(2):118-24.
  10. Viola H, Wasowski C, Levi de Stein M, et al. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med. 1995;61(3):213-216.
  11. Paladini AC, Marder M, Viola H, et al. Flavonoids and the central nervous system: from forgotten factors to potent anxiolytic compounds. J Pharm Pharmacol. 1999;51(5):519-526.
  12. Setzer WN. Essential oils and anxiolytic aromatherapy. Nat Prod Commun. 2009;4(9):1305-1316.
  13. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (Chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-382.
  14. Niederhofer H. Observational study: Matricaria chamomilla may improve some symptoms of attention-deficit hyperactivity disorder. Phytomedicine. 2009;16(4):284-286.
  15. Maschi O, Cero ED, Galli GV, Caruso D, Bosisio E, Dell'Agli M. Inhibition of human cAMP-phosphodiesterase as a mechanism of the spasmolytic effect of Matricaria recutita L. J Agric Food Chem. 2008;56(13):5015-5020.
  16. Glowania HJ, Raulin C, Swoboda M. Effect of chamomile on wound healing--A clinical double-blind study. Z Hautkr. 1987;62(17):1262, 1267-1271. German.
  17. Patzelt-Wenczler R, Ponce-Poschl E. Proof of efficacy of kamillosan(r) cream in atopic eczema. Eur J Med Res. 2000;5(4):171-175.
  18. Rosenberg Zand RS, Jenkins DJ, Diamandis EP. Effects of natural products and nutraceuticals on steroid hormone-regulated gene expression. Clin Chim Acta. 2001;312(1-2):213-219.
  19. Maliakal PP, Wanwimolruk S. Effect of herbal teas on hepatic drug metabolizing enzymes in rats. J Pharm Pharmacol. 2001;53(10):1323-1329.
  20. Srivastava JK, Gupta S. Antiproliferative and apoptotic effects of chamomile extract in various human cancer cells. J Agric Food Chem. 2007;55(23):9470-9478.
  21. Kato A, Minoshima Y, Yamamoto J, Adachi I, Watson AA, Nash RJ. Protective effects of dietary chamomile tea on diabetic complications. J Agric Food Chem. 2008 10;56(17):8206-8211.
  22. Wichtl M, editor. Herbal drugs and phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers, 1994; p. 140-42.
  23. Kell T. More on infant colic. Birth Gaz. 1977;13(2):3.
  24. Grochulski A, Borkowski B. Influence of chamomile oil on experimental glomerulonephritis in rabbits. Planta Med. 1972;21(3):289-292.
  25. Fidler P, Loprinzi CL, O'Fallon JR, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-fu-induced oral mucositis. Cancer. 1996;77(3):522-525.
  26. Newall CA, Anderson LA, Philipson D. Herbal medicines: A guide for health care professionals. London: The Pharmaceutical Press, 1996; p. 69-71.
  27. Giordano-Labadie F, Schwarze HP, Bazex J. Allergic contact dermatitis from chamomile used in phytotherapy. Contact Dermatitis. 2000;42(4):247.
  28. de la Torre Morin F, Sanchez Machin I, Garcia Robaina JC, Fernandez-Caldas E, Sanchez Trivino M. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol. 2001;11(2):118-122.
  29. Vandenplas O, Pirson F, D'Alpaos V, Vander Borght T, Thimpont J, Pilette C. Occupational asthma caused by chamomile. Allergy. 2008;63(8):1090-1092.
  30. Andres C, Chen WC, Ollert M, Mempel M, Darsow U, Ring J. Anaphylactic reaction to chamomile tea. Allergol Int. 2009;58(1):135-136.
  31. Abramson MJ, Sim MR, Fritschi L, Vincent T, Benke G, Rolland JM. Respiratory disorders and allergies in tea packers. Occup Med (Lond). 2001;51(4):259-265.