INTRODUCTION
Chamomile, also called German or Hungarian chamomile, is known by the Latin binomial Matricaria chamomilla, although the synonyms M. recutita and Chamomilla recutita are still used by some.1 The common name chamomile and specific name chamomilla come from the Greek chamos, meaning ground, and melos, meaning apple, which refers to the plant’s low-growing habit and apple-like scent.2 The generic name, Matricaria, comes from the Latin matrix, meaning womb, because it was used historically to treat disorders of the female reproductive system.3
Growing up to 30 inches (76 cm) in height, chamomile is an herbaceous annual plant with ferny, fragrant leaves. It has heterogamous (having multiple sexes) inflorescences with tubular yellow disc florets surrounded by white ray flowers.3,4 The brownish-yellow fruit, or achene, contains a single seed that does not split open upon drying.
Chamomile is native to eastern and southern Europe as well as parts of western Asia, and now occurs throughout almost all of Europe as well as Turkey, the Caucasus region (Georgia), and parts of Iran and Afghanistan. The material of commerce is obtained, for the most part, from farms in Egypt, Germany, Argentina, Poland, and, to a lesser extent, Chile, the Czech Republic, Slovakia, Spain, and several of the Balkan countries (Bosnia and Herzegovina, Bulgaria, Croatia, and Serbia).5 It is also wild-collected for commercial trade in Hungary,6 as well as in Albania, Bulgaria, Croatia,7 Kosovo,8 and Macedonia.9
This article addresses only M. chamomilla and not the many other herbs also referred to in commerce as chamomile, such as English or Roman chamomile (Chamaemelum nobile, syn. Anthemis nobilis), corn chamomile (A. arvensis), dyer’s chamomile (Cota tinctoria), Moroccan chamomile (Cladanthus mixtus), Moroccan blue chamomile (Tanacetum annuum), rayless chamomile (M. discoidea), and scentless chamomile (Tripleurospermum perforatum), all of which belong to the family Asteraceae.10,11 Although chamomile and Roman chamomile have been used interchangeably, their growth habits and essential oils are vastly different.3
Roman chamomile sometimes causes allergic reactions in individuals who are sensitive to ragweed (Ambrosia artemisiifolia, Asteraceae), which rarely occur with M. chamomilla.3,12 However, the World Health Organization (WHO) contraindicated chamomile use in people with known sensitivities to plants in the Asteraceae family.13 Proper identification of plant material is imperative to avoid allergic reactions. In one notable instance, a voucher specimen was misidentified as chamomile but was, in fact, dog’s chamomile (Anthemis cotula, Asteraceae), which is highly allergenic due to its anthecotulid content.14
HISTORY AND CULTURAL SIGNIFICANCE
Ancient Egyptian, Greek, and Roman medicine texts contain descriptions of using chamomile as a calming tisane (herbal tea infusion) and for treating erythema (superficial reddening of the skin) and xerosis (abnormally dry skin) caused by dry weather.12 Both the Egyptians and Saxons held chamomile sacred, and, in Slovakia, a person was supposed to bow to chamomile plants when he or she encountered them. Chamomile is found in the writings of early Greek botanists/physicians Hippocrates (5th century BCE) and Dioscorides (1st century CE), and the Roman physician Galen (2nd century CE).2 By the 16th and 17th centuries, chamomile was used extensively for intermittent fever.12
The Unani system of medicine, which is practiced on the Indian subcontinent, uses chamomile (called Gul-e-Babuna) by itself or in combination with other herbs for the following conditions: headache, gonorrhea, conjunctivitis, chest pain, renal calculi (kidney stones), vesical calculi (bladder stones), general debility, hysteria, dyspepsia, and fever.15
Chamomile was first cultivated in the United States by German settlers and became an important medicine employed by 19th century American Eclectic physicians, who used it specifically for conditions in pregnant women and young children.2,16Traditionally, chamomile flower extracts have been used internally for the following: nervous system conditions (e.g., restlessness and anxiety), depression, insomnia, flatulence, indigestion, constipation, diarrhea, hemorrhoids, amenorrhea (abnormal absence of menstruation), dysmenorrhea (painful menstruation), anorexia nervosa, asthma, bruxism (teeth grinding), bronchitis, colic, dentition and infantile convulsions caused by teething, gout, gum bleeding and soreness, canker sores (ulcers), malaria, travel sickness, alcohol withdrawal, mastitis (breast inflammation or infection), neuralgia, skin irritations, eczema, bruises, burns, and wounds.12,16,17
Externally, chamomile extracts have been used to address cracked nipples, chicken pox, diaper rash, eye conditions (e.g., blocked tear ducts and conjunctivitis), ear infections, nasal conditions, and poison ivy reactions.17 They also have been used in cosmetics and body care products such as hair dyes, shampoos, sunscreens, mouthwashes, toothpastes, deodorants, and bath preparations.18 Chamomile essential oil has been included as an ingredient in creams, lotions, perfumes, soaps, and detergents.
Germany has always been a major producer and consumer of German/Hungarian chamomile. The herb enjoys relatively widespread use and cultural acceptance in the country. (In addition to its German name Kamillenblüten, it is also known there as alles zutraut, which means “capable of anything.”) Between 1930 and 1945, Germany’s average annual demand was about 1,000 metric tons (MT), most of which was wild-collected with only six hectares (ha) being cultivated.5 And as late as 1955, Germany was still its own main source of chamomile (mainly from the state of Saxony and the Franconia region of Bavaria) followed by imports from Hungary, the Balkan countries, the former Soviet Union, Czechoslovakia, and Yugoslavia, among others.
In the 1950s, an estimated 40-50% of world demand could be satisfied with wild-collected chamomile from Hungary.6 But, in the 1990s, lower-cost production of cultivated chamomile, particularly in Egypt and Argentina, scaled up and eventually ruined the market for wild Hungarian chamomile.
In 1984, the German Commission E approved the use of chamomile flower preparations as internal nonprescription medicines for gastrointestinal spasms and inflammatory diseases of the gastrointestinal tract, and as external medicines for skin and mucous membrane inflammation, bacterial skin diseases (including those of the oral cavity and gums), and inflammation or irritation of the respiratory and anogenital tracts. The British Herbal Compendium lists chamomile for internal use for spasms or inflammatory conditions of the gastrointestinal tract, peptic ulcers, and mild sleep disorders, and for external use for eczema, inflammation, and irritation of skin or mucosa.2
CURRENT AUTHORIZED USES IN COSMETICS, FOODS, AND MEDICINES
In 1982, the US Food and Drug Administration (FDA) considered the inclusion of chamomile flower as an active ingredient in its establishment of a monograph for over-the-counter (OTC) digestive aids.19 But, in 1993, due to an insufficient amount of human clinical evidence submitted to the FDA, the agency ruled that chamomile flower was not generally recognized as safe and effective (GRASE) for use as a digestive aid active ingredient.20
However, in 2000, the FDA ruled that some OTC drug monograph claims would now be acceptable as structure/function claims for certain dietary supplement products.21 At that point, it became clear that chamomile flower could be labeled and marketed as a dietary supplement with “digestive aid,” “relief of occasional indigestion,” or similar claims, so long as the product’s marketer had fulfilled all of the regulatory requirements for the manufacture and marketing of dietary supplements (e.g., substantiation of claim[s], submission of FDA notification letter within 30 days of marketing, etc.).
For use of chamomile flower as an ingredient with an associated structure/function claim, the United States Pharmacopeia (USP) has established a quality standards monograph (for dried flower heads) that can serve as the basis of a company’s specifications for verifying composition, identity, quality, purity, and strength.22
For use in conventional food products, the FDA has determined that (German/Hungarian) chamomile flower is generally recognized as safe (GRAS) for use as a spice, natural seasoning, or flavoring.23 Furthermore, the FDA classifies essential oils, solvent-free oleoresins, and natural extracts (including distillates) of chamomile as GRAS for use in food products.24 TheFood Chemicals Codex (FCC) includes a quality standards monograph for “German Type Chamomile Oil” for use as a food flavoring agent. The monograph is available from USP.25
In Canada, German chamomile is regulated as an active ingredient of licensed natural health products (NHPs), requiring pre-marketing authorization from the Natural and Non-prescription Health Products Directorate (NNHPD).26 The authorized uses for labeling of German chamomile NHPs vary depending on buccal, oral, or topical application:
Buccal: “to help relieve minor inflammation and/or irritation of the mucous membranes of the mouth and/or throat”;
Oral: (1) “to help relieve inflammatory conditions of the gastrointestinal tract”; (2) “to help relieve mild digestive disturbances (such as dyspepsia, flatulence, bloating, and/or belching)”; (3) “as a calmative and/or sleep aid”; and
Topical: “to help relieve minor inflammation and/or irritation of the skin.”
German chamomile is also listed in the NNHPD draft “Cognitive Function Products” monograph as a sedative active ingredient.27 German chamomile essential oil is listed in the draft “Aromatherapy – Essential Oils” monograph with the following proposed claim statements:
Topical: (1) “for symptomatic relief of acne/boils”; (2) “to relieve minor skin irritation/cuts/bruises/burns”; and
Topical and/or inhalation: (1) “as a nervine/calmative”; (2) “to help relieve joint/muscle pain associated with sprain/strain/rheumatoid arthritis”; (3) “to help relieve headache”; and (4) “as a carminative/antispasmodic for symptomatic relief of digestive discomfort.”28
At the time of this writing (September 2015), there were 960 chamomile-containing licensed NHPs in Canada (521 listed as Matricaria chamomilla, 329 as Matricaria recutita, and 110 as chamomile), of which 723 product licenses list chamomile, in some form, as a medicinally active ingredient.29 German chamomile flower water is allowed as a non-medicinal fragrance ingredient of topical NHPs. The essential oil is also allowed as a non-medicinal fragrance ingredient and skin-conditioning agent.
In the European Union (EU), various defined chamomile preparations — in particular, herbal tea infusions (for oral ingestion, oromucosal use [gargle and rinse], topical application [dressings and washes], and steam inhalation), essential oils, and varying strengths of dry and liquid extracts — are regulated as traditional herbal medicinal products (THMPs), requiring registration and pre-marketing authorization.30 Therapeutic indications for the herbal tea, dry extract, and liquid extract forms include:
Oral: “for the symptomatic treatment of minor gastrointestinal complaints such as bloating and minor spasms”;
Steam inhalation: “for the relief of symptoms of common cold”;
Oromucosal: “for the treatment of minor ulcers and inflammations of the mouth and throat”;
Cutaneous (sitz bath): “for adjuvant therapy of irritations of skin and mucosae in the anal and genital region, after serious conditions have been excluded by a medical doctor”; and
Cutaneous (dressings and washes): “for the treatment of minor inflammation of the skin (sunburn) and superficial wounds and small boils (furuncles).”
The therapeutic indications for the essential oil are the same as those for the above-listed cutaneous use (sitz bath).31
For quality control, applicants must show that the herbal drug or preparation complies with a quality standards monograph of the European Pharmacopoeia (i.e.,“Matricaria Flower,” “Matricaria Liquid Extract,” or “Matricaria Oil”) and the relevant corresponding general monographs, such as “Essential Oils,” “Herbal Drug Extracts,” “Herbal Teas,” and “Herbal Preparations.”32
There are two distinct European chamomiles with “Protected Designation of Origin” (PDO) standards under EU regulations:Alföldi kamillavirágzat (“Wild Alföld Chamomile”) from Hungary and Chamomilla Bohemica (“Bohemian Chamomile”) from the Czech Republic.
The Alföldi kamillavirágzat PDO standard requires that it is hand-picked using a chamomile comb (made from wood, iron, or tin) from the saline soils of the Great Hungarian Plain (specifically in the counties of Szabolcs-Szatmár-Bereg, Borsod-Abaúj-Zemplén, Heves, Jász-Nagykun-Szolnok, Hajdú-Bihar, Békés, Csongrád, Bács-Kiskun, and Pest). The unique characteristics of this low-growing wild chamomile are attributed to the traditional methods of harvesting and processing and the area’s ecological features, including saline soil, high temperatures, abundant sunshine (approximately 2,000 hours/year), and low annual precipitation (500-600 mm, or about 20-24 inches).33
When harvested, dried, and handled according to the PDO specifications, the herb’s quality should, at a minimum, conform to the requirements of the Hungarian Pharmacopoeia. Depending on the year, the alpha-bisabolol content of the essential oil fraction should be at least 20%, and possibly as high as 58%, which is significantly higher than the norm for cultivated chamomile of any origin.34 The Alföldi kamillavirágzat PDO standard correlates its high alpha-bisabolol content with antispasmodic, anti-inflammatory, and anti-ulcerative effects.
The Chamomilla Bohemica PDO standard requires the plant to be grown in Bohemia (including the regions of Prague, Central Bohemia, South Bohemia, Plzeň, Karlovy Vary, Ústí nad Labem, Liberec, Hrádec Králové, Pardubice, and Vysočina, as well as the districts of Havlíčkův Brod, Jihlava, and Pelhřimov).35 The unique characteristics of this chamomile are attributed to a combination of factors such as climate (altitude, plentiful sunshine, and average rainfall of 500-700 mm, or about 20-28 inches), soil (pH of 7.3-8.1 and loamy/sandy-type), and traditional harvesting methods.
When harvested, dried, and handled according to the PDO specifications, Chamomilla Bohemica should have a blue essential oil content of up to 1%, which is 2.5 times the minimum requirement of the Czech Pharmacopoeia (min. 0.4%).34Furthermore, the chamazulene content must average 0.06-0.07%, or about twice the pharmacopeial minimum level of 0.035%. The Chamomilla Bohemica PDO standard also correlates its flavonoid content (about 0.015%) with spasmolytic effects and its spiroether content (0.03%) with bacteriostatic and fungicidal effects.
Besides the Czech and Hungarian national pharmacopeias and PDO specifications, there are English-language quality standards monographs for various forms of chamomile published in the European Pharmacopoeia (“Matricaria Flower,” “Matricaria Liquid Extract,” and “Matricaria Oil”),32 Food Chemicals Codex (“German Type Chamomile Oil”),25 International Organization for Standardization (ISO) standards (“Oil of Blue Chamomile”),36 and the United States Pharmacopeia(“Chamomile [dried flower heads]”),22 as well as in WHO Monographs on Selected Medicinal Plants (“Flos Chamomillae”).13
MODERN RESEARCH
In pharmacological and animal studies, chamomile extracts have exhibited the following properties: anti-anxiety and stress relieving, anticancer, anti-inflammatory, anti-insomnia, antioxidant, antimutagenic, antinociceptive (reducing sensitivity to pain), antipeptic, antispasmodic, antistaphylococcal, anti-ulcerative, anti-itch, cytotoxic, immunomodulating, hepatoprotective, neuroprotective, skin-metabolizing, stress-relieving, and wound-healing.2,12,15,16 Chamomile essential oil and its constituents have demonstrated antispasmodic, anti-inflammatory, antimicrobial, antiedemic, antipeptic, anxiolytic, bactericidal, chemopreventive, fungicidal, and wound-healing properties.15
In 1985, a controlled, bilateral, comparative study investigated the effects of chamomile cream on inflammatory dermatoses.37 Patients (N = 161) who had previously been treated with 0.1% difluocortolone valerate were given one of four preparations to apply for three to four weeks: Kamillosan® cream (a dry extract of chamomile flowers [2.75:1, ethanol 95.4% (v/v)] in a fatty ointment base containing no less than 0.2 mg volatile oil and no less than 0.07 mg (-)-a-bisabolol; VIATRIS GmbH & Co; Frankfurt, Germany), 0.25% hydrocortisone, 0.75% fluocortin butyl ester, or 5% bufexamac. Kamillosan was as effective as hydrocortisone and superior to fluocortin butyl ester and bufexamac in treating inflammatory dermatoses. Additionally, Kamillosan was comparable to hydrocortisone and superior to other tested products in treating neurodermatitis.
A 2009 randomized, double-blind, placebo-controlled study investigated the efficacy of chamomile extract on generalized anxiety disorder (GAD).38 Over an eight-week period, 57 patients with mild-to-moderate GAD took either chamomile extract (n = 20) standardized to 1.2% apigenin (Spectrum Pharmacy Products; New Brunswick, New Jersey) or placebo (n = 29) at the rate of one 22 mg capsule per day for the first week, increasing one capsule per day for each week through week four. Patients with a 50% reduction in symptoms or less were increased to five capsules daily for weeks five through eight of therapy. Symptoms were measured at baseline and after two, four, six, and eight weeks of treatment. A statistically significant superiority in anxiety test scores (P = 0.047, Hamilton Anxiety Rating, or HAM-A) was seen in the chamomile group compared to placebo.
Using data from the previous study, Amsterdam et al. investigated whether the chamomile extract also treated depression.39 Of the 57 participants in the 2009 study, 19 had anxiety with depression, 16 had anxiety with a history of depression, and 22 had anxiety with no history of depression. Researchers analyzed the Hamilton Depression Rating (HAM-D) questionnaire completed by participants (before, during, and after treatment) and discovered significantly greater reductions in scores over time for the chamomile group versus the placebo group (P < 0.05), and a meaningful but nonsignificant reduction in participants with current depression (P = 0.062).
A randomized, pre-post study performed in 2009-2010 investigated the efficacy of chamomile in treating irritable bowel syndrome (IBS). Patients diagnosed with IBS (N = 45) took 20 drops per day of a chamomile extract (69.47 mg/100 mL bisabolol and chamazulene; SohaJissa Company; Tehran, Iran) for four weeks.40 Patients filled out a questionnaire on day one, at weeks two and four, and two and four weeks after the end of the intervention. Symptoms were significantly reduced at weeks two and four (P = 0.001), and relief from symptoms continued up to two weeks after the intervention ended.
A few studies have assessed the usefulness of chamomile in treating stomatitis, a painful inflammation of the oral mucosa that can include ulceration. In two experiments, chamomile was found to be as effective as the conventional pharmaceutical comparison drugs (allopurinol mouthwash vs. chamomile mouthwash,41 and triamcinolone in Orabase® vs. chamomile in Orabase,42 respectively). In the first study, the allopurinol and chamomile mouthwashes were equally effective in reducing stomatitis in chemotherapy patients, but the authors noted that the lower cost and greater availability of chamomile (i.e., it does not require a physician’s prescription) may make it a better choice for some patients. In the second study, while chamomile did not resolve all symptoms as rapidly as the conventional pharmaceutical drug triamcinolone, pain intensity reduction and patient satisfaction scores were similar between groups.
In a third study, chamomile mouthwash was more effective in treating recurrent aphthous stomatitis (RAS; canker sores) than placebo.43 In this triple-blind study, 50 patients with aphthous lesions were randomized to receive either chamomile tincture (amount not specified; Matrica Drop; Iran Darouk, formerly Barij Essence; Tehran, Iran) or placebo. Patients were instructed to apply 10 drops three times per day, rinse for three minutes, expectorate, and refrain from eating for 30 minutes. Patients were examined after two, four, and six days, then weekly. The changes in the chamomile group — fewer number of lesions (P = 0.025), smaller lesion size (P = 0.03), and less pain and burning sensation (P = 0.001) — were statistically significant at each examination compared to the placebo group.
In a 2015 study that investigated the efficacy of chamomile in treating knee osteoarthritis (OA), 84 patients with OA were randomized to three groups and instructed to apply their assigned medication to the knee and surrounding area three times per day for three weeks.44 One group applied 1.5 mL chamomile oil (prepared at Shiraz University in Iran by traditional direct-heat extraction*); the second group applied diclofenac gel; and the control group applied paraffin. Patients were allowed to take 500 mg acetaminophen as needed, and use of the analgesic was examined as one of the outcome measures, along with a self-administered Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at the beginning of the study and every week during the study. The number of acetaminophen tablets taken by the chamomile group was significantly lower than those taken by the other two groups, and, while the chamomile oil showed some beneficial effects on pain, stiffness, and physical activity, these effects did not differ significantly different from the other two groups. The authors recommended further research with larger study populations.
A 2014 prospective, randomized, double-blind study compared chamomile extract to mefenamic acid (MA; a non-steroidal anti-inflammatory drug [NSAID] used to treat pain) for reducing the intensity of mastalgia (breast pain) associated with premenstrual syndrome.45 Ninety female university students were randomized to receive either 100 mg chamomile (capsules prepared from plant material purchased from Zarband; Tehran, Iran; no further information supplied) or 250 mg MA three times per day from the 21st day of their menstrual cycle until onset for six months. Both chamomile and MA relieved mastalgia intensity with no significant difference between the groups. The authors recommended further studies that do not rely on data collection through subject self-reporting.
In a randomized, double-blind, placebo-controlled pilot study published in 2015, chamomile oil obtained through traditional direct-heat method was investigated for its efficacy in treating severe carpal tunnel syndrome (sCTS) when applied topically as a complementary therapy.46 Twenty-six patients with documented sCTS were randomized to apply chamomile oil or placebo (paraffin, sesame oil, and 1% chamomile essential oil to mimic the aroma of the chamomile oil) twice daily for four weeks, in addition to wearing an immobilizing wrist splint at night. Primary and secondary outcomes were measured at enrollment and after four weeks. The patients in the chamomile oil group showed significant improvements in severity of symptoms (P = 0.019) and functional ability (P = 0.016) compared to placebo.
Chamomile performed well in a 2011 controlled study comparing its efficacy in managing peristomal skin lesions in colostomy patients versus treatment with hydrocortisone ointment.47 Participants were assigned to the chamomile group (n = 36) or control group (n = 36) based on matching demographics, history, and skin-condition variables. Patients in the experimental group applied a chamomile compress (6 g air-dried and powdered flower heads steeped in 150 mL boiled water for 10 minutes, strained, and applied to gauze) to the wound for one hour once per day. The control group applied 1% hydrocortisone ointment to their wound once per day. Lesions were evaluated every three days for 28 days, and healing occurred significantly faster in the chamomile group than in the hydrocortisone group (8.89 ± 4.89 days versus 14.53 ± 7.6 days, respectively). Additionally, pain and itching around the stoma was relieved more quickly in the chamomile group.
A 2005 controlled, double-blind, crossover study investigated a chamomile mouthwash for its ability to reduce dental plaque and gingival inflammation.48 For two four-week periods separated by a washout period of two weeks, 25 randomly assigned patients with gingivitis rinsed with either a chamomile mouthwash (air-dried and powdered chamomile flowers percolated at room temperature with 55% ethanol, extracts filtered, evaporated under vacuum at low temperature, dried residue suspended in water) or control (solvent with no other ingredients). Both groups were instructed to dilute 20 drops of mouthwash with 20 mL water and rinse twice a day for two minutes, once before bedtime. Plaque, gingival inflammation, and stain indices were recorded at baseline and measured at the end of each experimental period and the end of the washout period. Mean reduction for plaque (22 ± 17.83 vs. 5.4 ± 7.93) and gingival indices (0.31 ± 0.23 vs. 0.03 ± 0.11) were significantly greater for the chamomile mouthwash than for the control. Also, there was no significant staining or reduction in baseline staining in the chamomile group.
A prospective epidemiological study published in 2015 explored the connection between chamomile tea consumption and all-cause mortality over the course of seven years in a sample of older Mexican-Americans in the southwestern United States.49 Of the sample, 13.95% consumed chamomile. Per the Kaplan-Meier estimator, chamomile consumers showed increased overall survival (P = 0.008), with women consumers demonstrating even greater survival (P = 0.011). In the Cox proportional hazards model for all-cause mortality, chamomile was linked to a 29% reduction in mortality risk for the entire sample, a 33% reduction in risk for women, and a nonsignificant reduction for men.
In a 2015 age- and gender-matched case-control study, chamomile tea consumption was associated with a reduction in both benign and malignant thyroid diseases (P < 0.001).50 The odds of developing any type of thyroid disease decreased significantly with increased frequency of chamomile consumption. Additionally, the risk of developing benign thyroid diseases or thyroid cancer was significantly reduced in those who had consumed chamomile tea for 30 or more years.
FUTURE OUTLOOK
Today, the most important chamomile cultivation areas in Germany are in the states of Thuringia, Bavaria, Saxony, Saxony-Anhalt, and Lower Saxony.51 Chamomile ranks as Germany’s third most popular herbal tea in terms of volume purchased, with an overall 2014 demand of 4,095 MT.52
Annual global trade volume for chamomile flower has been estimated to be up to 8,000 MT, mainly supplied by farms in Egypt, Germany, Poland, Argentina, and Slovakia.5 The area of farmland dedicated to chamomile cultivation is approximately 1,500 ha in Egypt and 1,200 ha in Germany (1,000 ha of which are in the state of Thuringia).5 Poland has an estimated 750 ha of chamomile cultivation.53 Other countries that produce and consume significant amounts of chamomile are not included in external trade data. For example, Iran has an estimated 1,000 ha of chamomile production.5
While Egypt is the world’s top producer and exporter of chamomile, Germany is the top importer. According to El-Shrief et al., Egypt exported an average of 2,592 MT of chamomile annually between 1996 and 2008. Germany imported an average of 1,025 MT (39.5%) followed by 391 MT imported by Spain (15.1%), 202.6 MT by the United States (7.8%), 185 MT by Italy (7.1%), and 131.5 MT by the Netherlands (5.1%).54 However, a market study funded by the German Ministry for Economic Cooperation and Development (BMZ) found that Egypt’s annual export of chamomile was significantly higher, at 5,878 MT, of which 4,013 MT (68.3%) was imported by member states of the EU (mainly Germany, Poland, and the Netherlands), followed by the United States (405 MT; 6.9%), Venezuela (365 MT; 6.2%), and Russia (234 MT; 3.9%).55 On average, Germany’s annual demand accounts for more than half the estimated global d emand, at about 4,500 MT, of which about 600 MT are produced domestically and about 3,900 MT are imported.56
There are several quality grades of chamomile, each playing a distinct role in the market:
• Chamomile flower (Matricariae flos) is of pharmacopeial quality and consists of the capitula (infloresence) separated from leaf and stem. It is used in medicinal teas, tinctures, and other phytomedicinal preparations;
• Chamomile fines (Camomile fines) is what is left after removing the capitula. If the essential oil content is high enough, it may be used in pharmaceutical preparations; otherwise, it is used in food products;
• Chamomile herb with flowers (Chamomillae cum floribus herba) is machine-harvested with a high stem content. This material does not conform to pharmacopeial standards and is used in food products or non-medicinal beverage teas; and
• Chamomile herb (Chamomillae herba) is not produced by plucking the flowers, but rather by cutting the entire aerial parts and without further post-harvest sorting or separating. Due to the high content of plant parts other than the flower heads, this material is used primarily to make extracts for the cosmetics industry.5
There are other lower-quality grades as well. One of the authors of this article (JB) has observed the blending of inferior grades destined for the low-price beverage tea market, comprised mainly of chamomile herb (stems and leaves) after the flowers have been mostly sifted out, with as much as 25% chamomile seed admixed.
For reasons including quality assurance, safety, and traceability, there has been a resurgence of interest in the cultivation of medicinally and economically important herb crops in Europe, especially chamomile. A 2014 market analysis determined that at least 7,200 ha of chamomile cropland in Germany would be necessary for the country to produce 100% of its herbal industry's demand. Presently, Germany produces roughly 16% of its annual chamomile demand.57
Cultivation of chamomile is also increasing in other European countries. For example, there is an ongoing US Agency for International Development (USAID) project in Kosovo to support the development of cultivated medicinal and aromatic plant crops for its export market. More than 60% of the acreage in this project is dedicated to chamomile.58 Chamomile cultivation in neighboring Serbia is also increasing with an estimated 250 ha in 2013.59
Serbia is home to Euro Prima, one of the world’s leading producers and suppliers of harvest and post-harvest machines specifically designed for German chamomile crops.60 Because pharmacopeial-quality chamomile is composed of only the capitula, specialized equipment is needed when machine-harvesting the entire aerial parts in order to effectively separate the inflorescence from the stalks before drying.
If they are not picking flowers manually, most chamomile farmers around the world are still using mechanical harvesters developed in the mid-1970s. Until recently, very little research has been conducted to improve the technology. A four-year study from 2010-2013 funded by the German Federal Ministry of Food, Agriculture and Consumer Protection (BMELV) evaluated current methods and equipment used for mechanical harvesting of chamomile with the goal to develop a modernized harvesting machine for improved efficiency and quality.61-63 A related one-year German government-funded project in 2014-2015 aimed to optimize the newly developed chamomile flower harvester in order to finalize the design of a production-ready prototype.64
Chamomile flower remains one of the most in-demand medicinal plants in global trade, and annual demand predictably will continue to grow. Up until the mid-20th century, market requirements were satisfied by wild collection in eastern and central Europe — particularly in Germany, Hungary, and the Balkan countries — but, in recent decades, cultivation has scaled up in certain African and South American countries (e.g., Egypt and Argentina, respectively) where production costs are lower.
In the 21st century, increasing demand for sustainable (organic and fair trade) chamomile has become a new factor for producers to consider.65 While still considered a niche market, dual-certified “organic and fair trade” herbs, particularly chamomile, have been showing triple-digit growth rates.
While certified organic, wild-collected chamomile is available from Albania, Hungary, and Macedonia, and certified organic and fair trade cultivated chamomile is available mainly from Egypt, market demand has consistently exceeded supply in the past few years. Producers in several countries are working to increase production of organic and fair trade chamomile to catch up with demand. The trend of sustainable chamomile production in developing countries in Africa, Asia, and South America is expected to continue, as is the concurrent trend to increase sustainable chamomile production (both cultivated and wild) in areas within the herb’s geographical origin in Europe and western Asia.
—Gayle Engels and Josef Brinckmann
REFERENCES
1. Applequist W. The Identification of Medicinal Plants: A Handbook of the Morphology of Botanicals in Commerce. Austin, TX: American Botanical Council; 2006.
2. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council; Newton, MA: Integrative Medicine Communications; 2000.
3. Tucker AO, Debaggio T. The Encyclopedia of Herbs: A Comprehensive Reference to Herbs of Flavor and Fragrance. Portland, OR: Timber Press; 2009.
4. Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): an overview. Pharmacogn Rev.January-June 2011;5(9):82-95.
5. Franke R, Hannig HJ. Kamille (Matricaria recutita L.). In: Hoppe B, et al. Handbuch des Arznei- und Gewürzpflanzenbaus, Band 4. Bernburg, Germany: Verein für Arznei- und Gewürzpflanzen SALUPLANTA e.V. 2012;618-648.
6. Gosztola B. Doctoral thesis: Morphological and chemical diversity of different chamomile (Matricaria recutita L.) populations of the Great Hungarian Plain. Budapest: University of Budapest. 2012.
7. Kathe W, Honnef S, Heym A. Medicinal and Aromatic Plants in Albania, Bosnia-Herzegovina, Bulgaria, Croatia and Romania. Bonn, Germany: German Federal Agency for Nature Conservation; 2003.
8. Primavera A. Products, calendar, map of the herbs value chain in Dragash (Kosovo). Rome: International Link and Services for Local Economic Development Agencies. August 13, 2013.
9. Brinckmann JA, Huggins K, Gardner ZE. Managing natural resources for sustainable livelihoods: threats to the future of sustainable wild collection and field experience with implementation of the FairWild standard for medicinal plants.International Journal on Biodiversity Watch. 2014;3:13-29.
10. The Plant List (2013). Version 1.1. Available at: www.theplantlist.org/. Accessed August 22, 2015.
11. USDA Germplasm Resources Information Network (GRIN). Available at: www.ars-grin.gov/cgi-bin/npgs/html/tax_search.pl?language=en. Accessed August 22, 2015.
12. Das M. Chamomile: Medicinal, Biochemical, and Agricultural Aspects. Boca Raton, FL: CRC Press; 2015.
13. World Health Organization (WHO). WHO Monographs on Selected Medicinal Plants. Vol. 1. Geneva, Switzerland: World Health Organization; 1999;86-94.
14. Awang DVC. Regulating herbal products: an historical Canadian perspective. HerbalGram. 2010;89:52-54.
15. Unani Pharmacopoeia Committee. Gul-e-Babuna (flower). In: The Unani Pharmacopoeia of India. Part 1. Vol 2. New Delhi, India: Government of India, Ministry of Health and Family Welfare, Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH). 2007;39-40.
16. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Edinburgh: Churchill Livingstone; 2000.
17. Srivastava JK, Shankar E, Gupta S. Chamomile: a herbal medicine of the past with a bright future (review) [published online September 27, 2010]. Molecular Medicine Reports. 2010;3:895-901. doi:10.3892/mmr.2010.377.
18. Khan IA, Abourashed EA. Leung’s Encyclopedia of Common Natural Ingredients. 3rd ed. Hoboken, NJ: John Wiley and Sons, Inc.; 2010.
19. Food and Drug Administration. 21 CFR Part 357: Digestive aid drug products for over-the-counter human use; establishment of a monograph. Federal Register. January 5, 1982;47(2):454-487.
20. Food and Drug Administration. 21 CFR Part 310. Status of certain additional over-the-counter drug category II and III active ingredients; final rule. Federal Register. May 10, 1993;58(88):27443-27650.
21. Food and Drug Administration. 21 CFR Part 101: Regulations on statements made for dietary supplements concerning the effect of the product on the structure or function of the body; final rule. Federal Register. January 6, 2000;65(4):1000-1050.
22. United States Pharmacopeial Convention. Chamomile. United States Pharmacopeia, Thirty-Eighth Revision (USP 38). Rockville, MD: United States Pharmacopeial Convention. 2015;5955-5958.
23. Food and Drug Administration. § 182.10 Spices and other natural seasonings and flavorings. In: Code of Federal Regulations, Title 21 (21 CFR). Washington DC: US Government Printing Office. 2015;474-475.
24. Food and Drug Administration. § 182.20 Essential oils, oleoresins (solvent-free), and natural extractives (including distillates). In: Code of Federal Regulations, Title 21 (21 CFR). Washington DC: US Government Printing Office. 2015;475-477.
25. United States Pharmacopeial Convention. Chamomile oil, German type. In: Food Chemicals Codex, Ninth Edition (FCC 9). Rockville, MD: United States Pharmacopeial Convention. 2015.
26. Natural and Non-prescription Health Products Directorate (NNHPD). German chamomile. Ottawa, ON: Health Canada. July 31, 2009. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/dbImages/mono_chamomile-german--buccal_english.pdf. Accessed August 22, 2015.
27. Natural and Non-prescription Health Products Directorate (NNHPD). Monograph: cognitive function products. Ottawa, ON: Health Canada. May 21, 2014. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/dbImages/mono_cognitive-function-products-under-consultation_english.pdf. Accessed August 22, 2015.
28. Natural and Non-prescription Health Products Directorate (NNHPD). Monograph: aromatherapy – essential oils. Ottawa, ON: Health Canada. October 7, 2014. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/atReq.do?atid=aromatherap&lang=eng. Accessed August 22, 2015.
29. Natural and Non-prescription Health Products Directorate (NNHPD). Licensed natural health products database. Available at: http://webprod5.hc-sc.gc.ca/lnhpd-bdpsnh/index-eng.jsp. Accessed: August 22, 2015.
30. European Medicines Agency (EMA) Committee on Herbal Medicinal Products (HMPC) [draft]. Community herbal monograph on Matricaria recutita L., flos. London, UK: EMA. July 1, 2014.
31. European Medicines Agency (EMA) Committee on Herbal Medicinal Products (HMPC) [draft]. Community herbal monograph on Matricaria recutita L., aetheroleum. London, UK: EMA. July 1, 2014.
32. European Pharmacopoeia Commission. European Pharmacopoeia, Eighth Edition (PhEur 8.0). Strasbourg, France: European Directorate for the Quality of Medicines. 2014.
33. European Commission. Commission implementing regulation (EU) No 165/2012 of 24 February 2012 entering a name in the register of protected designations of origin and protected geographical indications (Alföldi kamillavirágzat (PDO)).Official Journal of the European Union. 2012;55:4-9. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2012:053:0004:0009:EN:PDF. Accessed August 22, 2015.
34. Brinckmann JA. Emerging importance of geographical indications and designations of origin — authenticating geo-authentic botanicals and implications for phytotherapy. Phytotherapy Research. 2013;27(11):1581-1587.
35. European Commission. Publication of an application pursuant to Article 6(2) of Council Regulation (EC) No 510/2006 on the protection of geographical indications and designations of origin for agricultural products and foodstuffs. Official Journal of the European Union. 2007;50(C 243):11-13. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2007:243:0011:0013:EN:PDF. Accessed August 22, 2015.
36. International Organization for Standardization. International standard 19332:2007: oil of blue chamomile (Chamomilla recutita (L.) Rauschert syn. Matricaria chamomilla auct.). Geneva, Switzerland: International Organization for Standardization. 2007.
37. Aertgeerts P, Albring M, Klaschka F, et al. Vergleichende Prüfung von Kamillosan®-Creme gegenüber steroidalen (0,25% Hydrocortison, 0,75% Fluocortinbutylester) und nichtsteroidalen (5% Bufexamac) Externa in der Erhaltungstherapie von Ekzemerkrankungen. Z Hautkr. 1985;60(3):270-277.
38. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oralMatricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol.2009;29:378-382.
39. Amsterdam JD, Shults J, Soeller I, Mao JJ, Rockwell K, Newberg AB. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Alt Ther Health Med. 2012;18(5):44-49.
40. Agah S, Taleb A, Moeini R, Gorji N, Nikbakht H, Soltani-Kermanshahi M. Chamomile efficacy in patients of the irritable bowel syndrome. Der Pharma Chemica. 2015;7(4):41-45.
41. Shabanloei R, Ahmadi F, Vaez J, et al. Alloporinal, chamomile and normal saline mouthwashes for the prevention of chemotherapy-induced stomatitis. Journal of Clinical and Diagnostic Research. 2009;3:1537-1542.
42. Tadbir AA, Pourshahidi S, Ebrahimi H, Hajipour Z, Memarzade MR, Shirazian S. The effect of Matricaria chamomilla(chamomile) extract in Orabase on minor aphthous stomatitis, a randomized clinical trial. Journal of Herbal Medicine.2015;5:71-76.
43. Seyyedi S-A, Sanatkhani M, Pakfetrat A, Olyaee P. The therapeutic effects of chamomilla tincture mouthwash on oral aphthae: a randomized clinical trial. Oral Medicine and Pathology. 2014;6(5):e538-538.
44. Shoara R, Hashempur MH, Ashraf A, Salehi A, Dehshahri S, Habibagahi Z. Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: a randomized controlled clinical trial. Complementary Therapies in Clinical Practice. 2015;21:181-187.
45. Sharifi F, Simbar M, Mojab F, Majd HA. Comparison of the effects of Matricaria chamomile (chamomile) extract and mefenamic acid on the intensity of mastalgia associated with premenstrual syndrome. Women’s Health Bull.2014;1(2):e20042.
46. Hashempur MH, Lari ZN, Ghoreishi PS, et al. A pilot randomized double-blind placebo-controlled trial on topical chamomile (Matricaria chamomilla L.) oil for severe carpal tunnel syndrome. Complementary Therapies in Clinical Practice. 2015;21:223-228.
47. Charousaei F, Dabirian A, Mojab F. Using chamomile solution or a 1% topical hydrocortisone ointment in the management of peristomal skin lesions in colostomy patients: results of a controlled clinical study. Ostomy Wound Management. 2011;57(5):28-36.
48. Pourabbas R, Delazar A, Chitsaz MT. The effect of German chamomile mouthwash on dental plaque and gingival inflammation. Iranian Journal of Pharmaceutical Research. 2005;2:105-109.
49. Howrey BT, Peek MK, McKee JM, Raji MA, Ottenbacher KJ, Markides KS. Chamomile consumption and mortality: a prospective study of Mexican origin older adults [published online April 29, 2015]. The Gerontologist.doi:10.1093/geront/gnv051.
50. Riza E, Linos A, Petralias A, de Martinis L, Duntas L, Linos D. The effect of Greek herbal tea consumption on thyroid cancer: a case-control study [published online April 4, 2015]. European Journal of Public Health.doi:http://dx.doi.org/10.1093/eurpub/ckv063.
51. Bundesministerium für Ernährung, Landwirtschaft und Verbraucherschutz (BMELV). Natürlich gesund: Arzneipflanzen sind ein Markt mit Zukunft. Themendienst Biobasierte Wirtschaft. 2013;4:1-3.
52. Beutgen M. 2014: Kräuter- und Früchtetee-Absatz auf hohem Niveau stabil — Der Trend geht zur Vielfalt. Hamburg City Süd: Wirtschaftsvereinigung Kräuter- und Früchtetee e.V. (WKF). 2015. Available at: www.wkf.de/. Accessed August 22, 2015.
53. Seidler-Lozykowska K. Chamomile cultivars and their cultivation in Poland. Acta Horticulturae. 2007;749:111-115.
54. El-Shrief LM, Hassan HBA, Hassan MB, Abdel-Fattah HY. An economic study of the Egyptian exports of major medicinal and aromatic crops. Journal of Applied Sciences Research. 2009;5(12):2171-2178.
55. Sallam W. A market study analysis study on the Egyptian herbs and spices sub-sector. Cairo, Egypt: Egyptian-German SME Promotion Programme. December 2006.
56. Plescher A. Kamilleblüten – ein pflanzlicher Ausgangsstoff für hochwertige pharmazeutische Erzeugnisse. In: Gülzower Fachgespräche Band 44: Tagungsband zur 2. Tagung Arzneipflanzenanbau in Deutschland. Gülzow-Prüzen, Germany: Fachagentur Nachwachsende Rohstoffe e.V. (FNR). 2014;61-79.
57. Meo Carbon Solutions GmbH. Marktanalyse Nachwachsende Rohstoffe. Schriftenreihe Nachwachsende Rohstoffe, Band 34. Gülzow-Prüzen: Fachagentur Nachwachsende Rohstoffe e.V. (FNR). 2014. Available at: http://fnr.de/marktanalyse/marktanalyse.pdf. Accessed August 23, 2015.
58. Tetra Tech ARD. Kosovo new opportunities for agriculture program, fiscal year 2013 annual report. Pristina: Kosovo. USAID. October 2013. Available at: http://pdf.usaid.gov/pdf_docs/PA00K2QT.pdf. Accessed August 23, 2015.
59. Turudija-Živanović S, Stevanetic S, Ceranić S, Živanović T. Trends in production of raw medicinal and aromatic plants in Serbia. In: Fifth International Scientific Agricultural Symposium “Agrosym 2014” Proceedings. Jahorina: Bosnia and Herzegovina. October 23-26, 2014; 1106-1111.
60. Euro Prima doo website, Novi Sad, Serbia. Available at: www.europrima.rs/. Accessed August 23, 2015.
61. Beier K, Ehlert D. Methods for evaluation of picking performance of chamomile (Matricaria recutita L.) harvesters. Part I: comparison of established methods. Journal of Applied Research on Medicinal and Aromatic Plants. 2014;1(1):e1-7.
62. Beier K, Ehlert D. Methods for evaluation of picking performance of chamomile (Matricaria recutita L.) harvesters. Part 2: Development of new methods. Journal of Applied Research on Medicinal and Aromatic Plants. 2014;1(2):35-42.
63. Ehlert D, Beier K. Development of picking devices for chamomile harvesters. Journal of Applied Research on Medicinal and Aromatic Plants. 2014;1(3):73-80.
64. Market Insider. New research for improved chamomile harvesting technology and quality. Geneva: International Trade Centre. December 22, 2014. Available at: www.intracen.org/blog/New-research-for-improved-chamomile-harvesting-technology-and-quality/. Accessed August 24, 2015.
65. Brinckmann JA. Market potential for wild-collected Chinese medicinal and aromatic plants with sustainability certifications. Geneva, Switzerland: International Trade Centre. 2015. xv, 140 pages. In press.
