Chamomile

“Chamomile” covers several daisy-family plants. The two used medicinally are German chamomile (Matricaria recutita / chamomilla) and Roman or sweet chamomile (Chamaemelum nobile) (DermNet). Families use it as a cream, a bath infusion, a cooled tea compress, an essential oil, or a calming tea to drink. Its claimed anti-inflammatory and anti-itch effects come from flavonoids and volatile-oil constituents. Most of the mechanistic support is laboratory or network-pharmacology work, not human eczema data (see round 0). Like Calendula, it belongs to the Compositae (Asteraceae) family. Its allergens, nobilin in Roman chamomile and desacetylmatricarin in German chamomile, are Sesquiterpene Lactones (DermNet).

Chamomile [part-of] Herbal and Home Remedies for Eczema Sesquiterpene Lactones [part-of] Chamomile Chamomile [relates] Calendula

Strength of evidence: Patzelt-Wenczler 2000. The only controlled eczema trial is a manufacturer study (ASTA Medica) of Kamillosan cream, made from the “Manzana” chamomile cultivar. It was a “partially double-blind, randomized” half-side comparison in patients (ages not stated in the abstract) with medium-degree atopic eczema. Each patient’s two sides got Kamillosan and either 0.5% Hydrocortisone or the vehicle cream. After 2 weeks, Kamillosan showed “a mild superiority towards 0.5% hydrocortisone and a marginal difference as compared to placebo”. Schäfer’s systematic CAM review counted 69 patients. It notes that there was “no difference between the camomile preparation and the foundation cream” for pruritus, erythema and desquamation, and that “the publication does not give information on the results of statistical tests”. In plain terms, the cream did about as well as its own base, which suggests its benefit is that of an emollient. Half-strength (0.5%) hydrocortisone is also a weak comparator. No paediatric trial was found.

Chamomile [relates] Hydrocortisone Chamomile [relates] Emollient Therapy Chamomile [treats] Atopic Dermatitis

Conflict: [Patzelt-Wenczler & Ponce-Pöschl, Eur J Med Res, 2000] says the Manzana chamomile in Kamillosan “has been proved not to exhibit a chamomile-related allergen potential”. [DermNet NZ, n.d.] says “the available proprietary chamomile cream has also been reported to cause allergic dermatitis on a number of occasions” and cites Rudzki 1998, “Positive patch test with Kamillosan in a patient with hypersensitivity to camomile”. Unresolved — added to open_questions.

Traditional use. Chamomile tea and flower oil are long-standing European folk remedies. Kamillosan is promoted for nappy rash and as a nipple cream, and eye-washing with chamomile tea is a folk treatment for conjunctivitis (DermNet). Parents may meet it in baby bath products and “calming” balms. Evidence: traditional/anecdotal.

Toddler safety: contact dermatitis, cross-reactivity and anaphylaxis. Several risks are documented.

• Essential oils in children. In the massage study cited by DermNet (Anderson 2000), children with atopic eczema who received aromatherapy massage did no better than those massaged without oils, and “a number of the children went on to develop worsening of their eczema due to allergy to the essential oils, including chamomile”.
• Sensitisation in atopic children. Compositae sensitisation clusters in atopic children (Paulsen 2008, 2020; see Compositae Allergy).
• Cross-reactivity. Reider 2000 studied 14 camomile-sensitised patients. Ten had immediate-type reactions to camomile, some of them life-threatening, and 11 were co-sensitised to mugwort. Mugwort cross-reacts with ragweed, and mugwort–chamomile cross-reactivity syndromes are described (Denisow-Pietrzyk 2019). A child with ragweed or mugwort hay fever is therefore at higher risk. DermNet notes that Compositae dermatitis is called “ragweed dermatitis” in some regions.
• Drinking chamomile tea. Anaphylaxis has been reported in an 8-year-old boy who drank chamomile tea (Subiza 1989, via Denisow-Pietrzyk 2019). In already-sensitised people, chamomile tea may cause systemic allergic dermatitis, although most of the evidence for this is anecdotal (Paulsen 2017).

Chamomile [causes] Compositae Allergy Chamomile [causes] Allergic Contact Dermatitis Chamomile [relates] Allergic Rhinitis Essential Oils [worsens] Atopic Dermatitis

Plant allergens and essential oils on broken skin

Chamomile creams, bath infusions and especially chamomile essential oil put Sesquiterpene Lactones and fragrance allergens directly onto eczematous skin, which absorbs them more easily. In the childhood eczema massage study, some children’s eczema worsened because they developed allergy to the oils, chamomile included. Sensitisation can carry over to the whole daisy family (Calendula, arnica, echinacea) and to mugwort and ragweed pollen. Do not use chamomile essential oil on a toddler. Avoid chamomile products on broken skin, and seek patch testing if a “soothing” product makes the rash worse. See Essential Oils.

What parents report (evidence: anecdotal). Parent-community data on chamomile for toddler eczema could not be retrieved this round, because the Reddit API returned 403. This gap is recorded in open_questions.

Connections

• Herbal and Home Remedies for Eczema — listed remedy; Compositae allergy risk, source: Paulsen 2020
• Compositae Allergy — chamomile is a Compositae sensitiser; atopic children at risk, source: DermNet; Paulsen 2008
• Sesquiterpene Lactones — nobilin and desacetylmatricarin are chamomile’s allergens, source: DermNet
• Hydrocortisone — 0.5% comparator in the Kamillosan half-side trial, source: Patzelt-Wenczler 2000
• Essential Oils — chamomile oil massage sensitised children with eczema, source: DermNet (Anderson 2000)
• Allergic Contact Dermatitis — reported from chamomile tea and Kamillosan cream, source: DermNet
• Calendula — same plant family, cross-reaction risk, source: DermNet
• Fragrance Allergy — botanical extract as hidden fragrance-type allergen, source: DermNet