Chamomile - Get the Facts on Herbal Supplements

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  • Most research has used German chamomile, which is more commonly used everywhere except for England, where Roman chamomile is more common.<a href="#hdng0">(More...)</a>



<a name="hdng0"></a>Most research has used German chamomile, which is more commonly used everywhere except for England, where Roman chamomile is more common. Although chamomile is widely used, there is not enough reliable research in humans to support its use for any condition. Despite its reputation as a gentle medicinal plant, there are many reports of allergic reactions in people after eating or coming into contact with chamomile preparations, including life-threatening anaphylaxis. <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> German chamomile ( Matricaria recutita ) and Roman chamomile ( Chamaemelum nobile ) are the two major types of chamomile used for health conditions. They are believed to have similar effects on the body, although German chamomile may be slightly stronger.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

Chamomile is used traditionally for numerous gastrointestinal conditions, including digestion disorders, "spasm" or colic, upset stomach, flatulence (gas), ulcers, and gastrointestinal irritation. Currently there is a lack of reliable human research available in any of these areas.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may also interact with antibacterial, antifungal, antihistamine, or diuretic herbs and supplements, as well as herbs and supplements used for high cholesterol, ulcers, diarrhea, or gastrointestinal disorders.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may have anti-estrogenic effects and interact with herbs and supplements like red clover or soy.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Theoretically, the use of chamomile with other anti-inflammatory herbs and supplements may have additive effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may have anti-inflammatory effects. Theoretically, use of chamomile with other anti-inflammatory drugs, such as NSAIDs or ibuprofen, may have additive effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. The levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> In theory, chamomile may increase the risk of bleeding when used with anticoagulants or antiplatelet drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Theoretically, chamomile may interact with SERM drugs like raloxifene (prescription drug used for osteoporosis) or tamoxifen (a prescription drug used for cancer).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may also interact with antibiotics, antifungals, antihistamines, diuretics, as well as drugs for high cholesterol, ulcers, diarrhea, or gastrointestinal disorders.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile has been used medicinally for thousands of years and is widely used in Europe. It is a popular treatment for numerous ailments, including sleep disorders, anxiety, digestion/intestinal conditions, skin infections/inflammation (including eczema), wound healing, infantile colic, teething pains, and diaper rash.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Topical chamomile preparations have traditionally been used to soothe skin inflammation. The existing human evidence shows that chamomile may be of little, if any, benefit while animal studies support its anti-inflammatory action. Additional human research is needed in this area.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Poor-quality studies have used chamomile mouthwash for the prevention or treatment of mouth mucositis caused by radiation therapy or cancer chemotherapy. Results are conflicting, and it remains unclear if chamomile is helpful in this situation.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Traditionally, chamomile preparations, such as tea and essential oil aromatherapy, have been used for insomnia and sedation (calming effects).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> In the United States, chamomile is best known as an ingredient in herbal tea preparations advertised for mild sedating effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile is not well-known for its cardiac effects, and there is little research in this area.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile is reputed to have anti-spasmodic activity, but there is little research to substantiate this claim.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Little research has been done on topical chamomile for eczema and further research is needed.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> A small amount of research suggests that massage using chamomile essential oil may improve anxiety and quality of life in cancer patients. This evidence is not high quality.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may increase the amount of drowsiness caused by some herbs or supplements.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may interact with herbs and supplements that act as cardiac depressants, cardiac glycosides, respiratory depressants, or spasmolytics.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile may interact with medications that act as cardiac depressants, central nervous system depressants, calcium channel blockers, cardiac glycosides, and respiratory depressants.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

Chamomile douche may improve symptoms of vaginitis with few side effects. Because infection (including sexually transmitted diseases), poor hygiene, or nutritional deficiencies can cause vaginitis, medical attention should be sought by people with this condition.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Maiche A, Grohn P, Maki-Hokkonen H. Effect of chamomile cream and almond ointment on acute radiation skin reaction.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> The German Commission E authorizes the use of topical chamomile for diseases of the skin.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> There is promising preliminary evidence supporting the topical use of chamomile for wound healing. The available literature is not adequate to support a recommendation either for or against this use.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> There is not enough scientific data to recommend the safe use of chamomile while breastfeeding.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> There is not enough reliable scientific data available to recommend the safe use of chamomile products in children.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

Impurities (adulterants) in chamomile products are common and may cause adverse effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Chamomile is frequently consumed as tea, and 1 to 4 cups of chamomile tea taken daily (from tea bags) is a common dose.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Saller R, Beschomer M, Hellenbrecht D, et al. Dose dependency of symptomatic relief of complaints by chamomile steam inhalation in patients with common cold.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

An extract containing Matricaria chamomile, Sideritis euboea, Sideritis clandestine, and Pimpinella anisum was associated with selective estrogen receptor modulator (SERM) properties against osteoporosis.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Based on preliminary study, constituents in chamomile may alter blood sugar or blood pressure.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Preliminary study reports that the combination of chamomile baths plus chamomile bladder washes and antibiotics is superior to antibiotics alone for hemorrhagic cystitis.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

There are multiple reports of serious allergic reactions to chamomile taken by mouth or as an enema, including anaphylaxis, throat swelling, and shortness of breath.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

People with allergies to other plants in the Asteraceae (Compositae) family should avoid chamomile.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> Cross-reactions may occur with celery, chrysanthemum, feverfew, tansy, and birch pollen. Individuals with allergies to these plants should avoid chamomile.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

Better research is needed before a conclusion can be drawn regarding the role of chamomile in the management of vaginitis.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> In theory, chamomile may increase the risk of bleeding when taken with other products that are believed to increase the risk of bleeding.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> In large doses, chamomile can cause vomiting. Due to its coumarin content, chamomile may theoretically increase the risk of bleeding.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a> In early study, inhaling steam with chamomile extract has been reported to help common cold symptoms. Further research is needed to confirm these results.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank" [1]</a>

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Section Contents:
  • NCCAM-funded research on chamomile includes studies of the herb for generalized anxiety disorder and for chronic pain caused by children's bowel disorders.<a href="#hdng1">(More...)</a>

  • Two types are German chamomile and Roman or English chamomile.<a href="#hdng2">(More...)</a>

  • A type of chamomile plant with daisy-like white flowers that is found in Europe, North America, and Argentina.<a href="#hdng3">(More...)</a>



<a name="hdng1"></a>NCCAM-funded research on chamomile includes studies of the herb for generalized anxiety disorder and for chronic pain caused by children's bowel disorders. <a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> Chamomile has been widely used in children and adults for thousands of years for a variety of health conditions. The herb is often used for sleeplessness; anxiety; and gastrointestinal conditions such as upset stomach, gas, and diarrhea. It is used topically for skin conditions and for mouth ulcers resulting from cancer treatment.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> Two types of chamomile are used for health conditions: German chamomile and Roman chamomile. While the two kinds are thought to have similar effects on the body, the German variety is more commonly used in the United States and is the focus of this fact sheet.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> The flowering tops of the chamomile plant are used to make teas, liquid extracts, capsules, or tablets.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> Reactions include skin rashes, throat swelling, shortness of breath, and anaphylaxis (a life-threatening allergic reaction). People are more likely to experience allergic reactions to chamomile if they are allergic to related plants in the daisy family, which includes ragweed, chrysanthemums, marigolds, and daisies.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> There are reports of rare allergic reactions in people who have eaten or come into contact with chamomile products.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> Chamomile has not been well studied in people so there is little evidence to support its use for any condition.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a>

Some early studies point to chamomile's possible benefits for mouth ulcers and certain skin conditions.<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank" [2]</a> Purpose This study will determine the effectiveness of chamomile extract for treating generalized anxiety disorder. Study hypotheses: 1) Chamomile extract will have a superior anti-anxiety effect compared to placebo. 2) Chamomile will have a comparable safety profile to that of placebo.<a href="http://clinicaltrials.gov/ct2/show/NCT00645983?term=Chamomile&spons=NCCAM&rank=1" TARGET="_blank" [3]</a>

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<a name="hdng2"></a>Two types are German chamomile and Roman or English chamomile. These are used in teas to calm and relax, to improve sleep, and to help with stomach problems. <a href="http://www.cancer.gov/dictionary/?searchTxt=chamomile" TARGET="_blank" [4]</a> The essential oil (scented liquid taken from plants) of chamomile is used in perfumes, shampoos, lotions, and aromatherapy.<a href="http://www.cancer.gov/dictionary/?searchTxt=chamomile" TARGET="_blank" [4]</a>

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<a name="hdng3"></a>A type of chamomile plant with daisy-like white flowers that is found in Europe, North America, and Argentina. <a href="http://www.cancer.gov/templates/db_alpha.aspx?CdrID=462682" TARGET="_blank" [5]</a> During the last decades, plant extracts were widely used against phytophagous pests and mosquitoes (Arnason et al., 1987 1987 ; Balandrin et al., 1985 1985 ; Chavan and Nikam, 1988 1988 ). It has been shown that the extract of flower heads of chamomile ( Matricaria chamomile ) contains angelic acid (2-meyhyl-2-butenoic acid), azolen, chamazulene (1,4-dimethyl-7-etazulene), α-bisablol, sineol, maricarin and matricin as major constituents (Franz, 1980 1980 ).<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Recently, Macchioni et al. ( 2004 2004 2004 ) showed the antagonistic activity of chamomile ( Matricaria chamomile ) flowers’ extract against mite Psoroptes caniculi. In the present study, we examined the acaricidal potential of the extract obtained from the flowers of chamomile ( M. chamomile ) against the females of Rhipicephalus annulatus to elucidate its ability as a cattle fever tick biocontrol agent.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> The present works imply that chamomile may be a promising candidate for considering as a preventing agent in control of cattle fever tick, Rhipicephalus annulatus, in field condition. In order to substantiate this hypothesis, tests are currently being performed using larger recipient and larger doses than tested in the present study in our laboratory.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Macroscopic observations indicated that in effective concentrations of plant (4.0% and 8.0%), patchy hemorrhagic swelling appeared on the skin of treated ticks. The results presented for the first time in this study imply that chamomile may be considered as a promising plant for biocontrol of cattle fever tick disease in the field condition.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Chamomile has been used in traditional medicine for thousands of years, and it has been widely used in Europe. It is a popular treatment for numerous ailments, including sleep disorders, anxiety, digestion/intestinal conditions, skin infections/inflammation (including eczema), wound healing, infantile colic, teething pains, and diaper rash.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

In another study, the acaricidal activity of Chamomile roman essential oil obtained from Anthemis nobilis was reported against Dermanyssus gallinae (red mite) (Kim et al., 2004 2004 ). The results by these researchers showed that Chamomile roman essential oil might be good candidates for naturally occurring D. gallinae control.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> There are only reports of the acaricidal properties of decoctions, infusions and macerates of dried flower heads of chamomile in vitro against the mite Psoroptes caniculi in which all the extracts tested showed highly significant acaricidal activity when compared with controls.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Based on the morphological observation of ticks treated and/or non-treated with chamomile flower’s extract, mortality rate and also egg laying inhibition were noted (Fig. 1 ). The cuticle of dead ticks was dark with these ticks becoming immotile.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

In the U.S., chamomile is best known as an ingredient in herbal tea preparations advertised for mild sedating effects.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> According statistical analysis chamomile flowers’ extract caused low to moderate acaricidal effect which occurred in first 24 h post inoculation and was dose-dependent.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Fig. 2 shows low to moderate acaricidal effect caused by different concentrations of chamomile flowers’ extract.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

The chamomile flowers’ extract in highest concentration used (8.0%) caused 46.67% failure in egg laying in engorged females while no failure was observed for non-treated control group.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> The mortality rate caused by different dilutions of chamomile flowers’ extract ranged from 6.67% to 26.7%, whereas no mortality was recorded for non-treated control group.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> The acaricidal activity of the chamomile flowers’ extract against cattle fever tick, Rhipicephalus annulatus, had not been previously reported.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Chamomile flowers’ extract showed a low to moderate effect against Rhipicephalus annulatus.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

The acaricidal efficacies of different concentrations of chamomile flowers’ extract are reported in Table 1 that shows average failure in egg laying (%) and mass of produced eggs (g) compared with non-treated control.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

Macchioni F, Perrucci S, Cecchi F, Cioni PL, Morelli I, Pampiglione S. Acaricidal activity of aqueous extracts of chamomile flowers, Marticaria chamomilla, against the mite Psoroptes caniculi.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a> Extract form chamomile flowers was prepared by Barij Essence Co. Kashan, Iran.<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank" [6]</a>

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<a name="sources"><a href="#" onclick="toggle_visibility('srcs'); return false;" title="Most Informative Documents, used in preparation of this report.">
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1. <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank">MedlinePlus Herbs and Supplements: Chamomile (Matricaria recutita, Chamaemelum nobile)</a>
<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html" TARGET="_blank">http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-chamomile.html</a>

2. <a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank">Chamomile [NCCAM Herbs at a Glance]</a>
<a href="http://nccam.nih.gov/health/chamomile/" TARGET="_blank">http://nccam.nih.gov/health/chamomile/</a>

3. <a href="http://clinicaltrials.gov/ct2/show/NCT00645983?term=Chamomile&spons=NCCAM&rank=1" TARGET="_blank">Chamomile Therapy for Generalized Anxiety - Full Text View - ClinicalTrials.gov</a>
<a href="http://clinicaltrials.gov/ct2/show/NCT00645983?term=Chamomile&spons=NCCAM&rank=1" TARGET="_blank">http://clinicaltrials.gov/ct2/show/NCT00645983?term=Chamomile&spons=NCCAM&rank=1</a>

4. <a href="http://www.cancer.gov/dictionary/?searchTxt=chamomile" TARGET="_blank">Definition of chamomile - NCI Dictionary of Cancer Terms</a>
<a href="http://www.cancer.gov/dictionary/?searchTxt=chamomile" TARGET="_blank">http://www.cancer.gov/dictionary/?searchTxt=chamomile</a>

5. <a href="http://www.cancer.gov/templates/db_alpha.aspx?CdrID=462682" TARGET="_blank">Definition of Roman chamomile - NCI Dictionary of Cancer Terms</a>
<a href="http://www.cancer.gov/templates/db_alpha.aspx?CdrID=462682" TARGET="_blank">http://www.cancer.gov/templates/db_alpha.aspx?CdrID=462682</a>

6. <a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank">Biological activities of chamomile (Matricaria chamomile) flowers’ extract against the survival and egg laying of the cattle fever tick (Acari Ixodidae)</a>
<a href="http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437" TARGET="_blank">http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1963437</a>

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