About Herbs

Bottom Line: It is not clear from clinical trials whether chamomile mouth wash helps prevent chemotherapy-induced mucositis. More studies are needed.

Several studies have used chamomile extracts in animals to test their effects. They show that substances in chamomile can kill bacteria, reduce inflammation, calm muscle spasms, inhibit the growth of polio and herpes viruses and cancer cells, and prevent the growth of ulcers. Several chemicals found in chamomile leaves are known to inhibit substances in the body that cause an inflammatory response. Apigenin, a compound isolated from chamomile, binds to brain cells in the same areas as well-known depressant drugs, which could explain chamomile's sedative effects. A clinical trial showed that chamomile may have a modest effect on generalized anxiety disorder. Further research is needed.

Chemotherapy-induced mucositis:
A clinical trial evaluated the use of a chamomile mouthwash for the treatment of mucositis (inflammation of the mucous membranes of the mouth) resulting from chemotherapy with 5-fluorouracil. Starting on the first day of chemotherapy, half of the patients used a chamomile mouthwash and the other half used a placebo mouthwash three times a day for two weeks. Mouth inflammation ratings were not very different between the groups, indicating that chamomile mouthwash is not helpful in treating chemotherapy-induced mucositis.

Hypersensitivity allergic reactions, ranging from dermatitis (redness and swelling of the skin) to anaphylactic shock.

Case report: A 38-year-old Caucasian man developed an episode of severe anaphylaxis with generalized urticaria, angioedema and severe dyspnoea one hour after consuming camomile tea. The symptoms improved followed an emergency treatment with an intravenous antihistamine.

Hungarian chamomile, wild chamomile, Chamomilla recutita

Chamomile, a traditional herbal remedy, is widely used in teas for its relaxing and calming effects. Topical and oral administrations are safe except in patients with allergies to ragweed or chrysanthemums ⁽²⁾. Chamomile extract was shown to possess anti-inflammatory ⁽¹¹⁾, antihyperglycemic ⁽¹²⁾, antigenotoxic ⁽¹³⁾, and anticancer ⁽¹⁴⁾ properties in vitro and in animal studies. Apigenin, a flavone present in chamomile, has strong chemopreventive effects ⁽¹⁵⁾.

Chamomile extract may have a mild to moderate effect in patients with generalized anxiety disorder ⁽¹⁶⁾. Studies of chamomile mouthwash produced conflicting results regarding its benefit in reducing 5-FU induced mucositis ^{(8) (9) (17)}. More research is warranted.
Potential drug interactions include platelet inhibition leading to additive anticoagulant effect and potentially increased sedation from sedatives or hypnotics ⁽⁴⁾.

Flower head

Coumarins

Flavonoids (up to 8%): Quercetin, rutin, apigenin, luteolin, apigetrin and apiin

Volatile oils: Alpha bisabolol (up to 50%), azulene and chamazulene

Other constituents: Amino acids, choline polysaccharide, plant and fatty acids, tannin, triterpene hydrocarbons
⁽¹⁾

In animal studies, a wide range of pharmacological activities have been documented including antibacterial, anti-inflammatory, antispasmodic, anti-ulcer, antiviral, and hypouraemic activities. Apigenin, a flavone, interacts with GABA(A)-benzodiazepine receptors in vitro and inhibits locomotor behavior in rats ⁽⁵⁾. It also has strong chemopreventive properties ⁽¹⁵⁾.The azulene components of the volatile oil are thought to contribute by inhibiting histamine release, and they have been reported to prevent allergic seizures in animals. Matricin, the precursor to chamazulene, is reported to be a more effective anti-inflammatory agent than chamazulene. Anti-inflammatory and antiulcerogenic activity has also been documented for alpha bisabolol. The coumarin constituents were shown to have antibacterial activity. In addition, antispasmodic activity was demonstrated by the flavonoid and bisabolol constituents ⁽²⁾.

People allergic to ragweed or members of the Compositae family, such as chrysanthemums, should avoid this product.

Hypersensitivity reactions in people allergic to ragweed or members of the Compositae family, ranging from contact dermatitis to anaphylaxis ^{(2) (3)}.
Case report: A 38-year-old Caucasian man developed an episode of severe anaphylaxis with generalized urticaria, angioedema and severe dyspnoea one hour after consuming camomile tea. The symptoms improved followed an emergency treatment with an intravenous antihistamine ⁽¹⁸⁾.

Anticoagulants / Antiplatelets: Chamomile may increase anticoagulant effects and inhibit platelets due to coumarin content ⁽¹⁰⁾.
Sedatives: Chamomile may cause additive drowsiness⁽⁴⁾.

May increase PT, APTT, and INR

Fidler P, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77: 522-5.
A phase III, double-blind, placebo-controlled clinical trial with 164 patients equally randomized to both treatment groups. Patients received 30 minutes of oral cryotherapy prior to bolus of 5-FU-based chemotherapy. Chamomile or placebo mouthwash was used three times a day for fourteen days beginning on the first day of chemotherapy. Graded stomatitis scores were not significantly different between the two treatment groups. Chamomile mouthwash did not appear to be beneficial in the prevention of 5-FU induced stomatitis.