Allergenic flora of Thessaloniki Perfecture, Makedonia, Greece

Tsakiropoulou Evangkelia [Dr], Τσακιροπούλου Ευαγγελία

MD, Otorhinolaryngologist, PhD, Member of the Greek Association of ENT Allergy, lmmunology and Ronchopathies, Scientific Collaborator of the 2nd ENT Clinic of Papayeoryiou General Hospital, Thessaloniki

Konstantinidis Iordanis, Κωνσταντινίδης Ιορδάνης

MD, PhD, Otorhinolaryngologist, Rhinologist

Gelis N.Dimitrios, MD, PhD, DDS, Otorhinolaryngologist

MD, PhD, DDS, Otorhinolaryngologist , Organ oriented Allergist

By Tsakiropoulou Evangkelia, MD, ORL, Organ oriented Allergist Thessaloniki,

Dr Konstantinidis Iordanis, MD ORL, PhD, Organ oriented Allergist, Thessaloniki,
Dr Gelis N. Dimitrios MD, PhD, DDS, ORL, Organ oriented Allergist, Korinthos Greece

Chamomile [Matricaria chamomilla  (synonym: Matricaria recutita, C mahomiílla recutita).


   Common names: Camomile, German chamomile, Ground Apple, Whig Plant, White Stars,  chamomile,  Hungarian chamomile, wild chamomile,  scented mayweed, Χαμομήλι, Χαμαίμηλον, Χαμόμηλο].
The term chamomiles is used to mean a large group of annual plant species belonging to the Compositae family Asteraceae.
The term  chamomile has Greek origin χαμαίμηλον (chamaimēlon)  which means "earth-apple", χαμαί (chamai) meaning "on the ground" and μῆλον (mēlon) meaning "apple". Chamomile has been used in herbal remedies for thousands of years, known in ancient Egypt, Greece, and Rome  [1]

Wild M. chamomilla is found all over Europe, temperate areas ofAsia, North America and Australia. It usually grows best in clay, poor and mountain soils. roads, around landfills, and in cultivated fields as a weed, because the seeds require open soil to survive. Chamomile is distributed all over Greece and Albania, and the rest Balkan peninsula . Pollination season: April-May.

Description: Chamomile is an annual plant low-growing,. It has a smooth, erect and hairy stems which grow up 5 to 50 cm. Leaves are white long and narrow, bipinnate to tripinnate. Flowers appear solitary on long, erect stalks. They have white ray florets and hollow, conical center, yellow in color. 

The fruit is small and dry. The dried flower of Matricaria Chamomilla heads (chamomile tea) has been available commercially and is now a common drink worldwide.

   Chemical components: volatile oil, coumarin, valerianic acid, cyanogenic glycosides, flavonoids, sailcylates, tannins. It has a strong, aromatic scent.

Chamomile has been used for centuries for a variety of medical conditions.. Chamomile is used mainly as an anti-inflammatory, antispasmodic, anodyne and antiseptic, also antispasmodic laxative, stomachic, sedative and tonic properties and mildly sudorific [2] and it is  familiar remedy for treating insomnia, indigestion, and menstrual disorders, as well as other afflictions and recently has been used in treating migraine [3]. Due to its calming and soothing properties it is used for nervousness, headaches, anxiety, hysteria, several digestive problems such as abdominal pain, indigestion, gastritis, excessive gas, abdominal bloating, colic, hernia, peptic ulcer.  Chamomile tea is also used externally, it soothes the skin, it can help in cases of various allergies, sore skin and eczema but it is also strong allergen for some persons who develop atopic dermatitis after external use of chamomile tea. 

Chamomile has a mild antiphlogistic and bacteriostatic property. It has been used in treating epidermolysis bulosa, eczema, eye irritation, throat discomfort, and hemorrhoids. Several shampoo, hair rinses, and vegetable hair dyes contain chamomile.
Eye washing with chamomile tea is a folk remedy used by the general public to treat conjunctivitis and other ocular reactions. Many cosmetic products contain chamomile. Some cases of contact dermatitis (but not reactions of type I) were reported following its topical applications [9].

Chamomile tea eye washing can induce allergic conjunctivitis. Pollen of M. chamomilla contained in these infusions are the allergens responsible for these reactions [3] . 

Although German chamomile (Chamomilla recutita) is considered a weak sensitizer, recent studies have shown several possible non-sesquiterpene lactone allergens in tea (infusions) from the plant.

Mechanisms of Action: Several pharmacological actions have been documented for German chamomile, based primarily on in vitro and animal studies. Such actions include anti-inflammatory, antispasmodic,antibacterial, antifungal, anti-ulcer, antiviral, and sedative effects.

Chamomile allergens: Camomile has been reported to induce of severe anaphylaxis.  Reider N. et al (2000) reported that Ten of 14 patients with allergy to chamomile had a clinical history of immediate-type reactions to chamomile, in some cases life threatening.
Eleven subjects demonstrated also sensitivity to mugwort in prick or RAST and  eight to birch tree pollen. They detected a homologue of the major birch pollen allergen Bet v 1 using a polyclonal rabbit anti-Bet v 1 antibody, in two chamomile blots.
In four cases a group of higher molecular weight allergens (23-50 kDa) showed IgE-binding to chamomile. All allergens proved heat stable. Binding was inhibited in variable degrees by extracts from celery roots, anize seeds and pollen from mugwort, birch and timothy grass.
Deglycosylation experiments proved the presence of carbohydrate determinants in chamomile which were not responsible for IgE-binding, though. Profilins (Bet v 2) were not detected in their  camomile extracts [11].

Although German chamomile (Chamomilla recutita) is considered a weak sensitizer, recent studies have shown several possible non-sesquiterpene lactone allergens in tea (infusions) from the plant like herniarin. The  sensitization may occur through, for example, external use [4].

There are reports describing cases of anaphylaxis following ingestion of Chamomile or after an enema [5], through a type I immunologic mechanism. It has been reported IgE activity against Matricaria chamomilla pollens.

Atopic dermatitis is an immunologic disease induced from an imbalance favoring type-2 helper T (Th2) cell [6]. Also, allergic contact dermatitis (type-IV-allergic reaction) has occurred is subjects who have handled this plant or who have used compresses of chamomile or chamomile ointment. However, only a few cases of anaphylactic reaction to camomile have been described in the literature [7].

Incidence and risk of type I allergy to camomile may be underestimated. Concurrent sensitization to mugwort and birch pollen is not infrequent. Bet v 1 and noncarbohydrate higher molecular weight proteins were found to be eliciting allergens and are responsible for cross-reactivity with other foods and pollen [8].

Subiza J,  et al (1990)  presented seven hay fever patients that suffered from conjunctivitis; two of them also had lid angioedema after eye washing with chamomile tea. All seven patients had positive skin prick tests to the chamomile tea extract, Matricaria chamomilla pollen and Artemisia vulgaris pollen extracts. Positive conjunctival provocations were also observed in all the patients with the chamomile tea extract.

In contrast, no symptoms were observed after oral challenges with this infusion. IgE activity against chamomile tea and Matricaria and Artemisia extracts (composite pollens) was detected by ELISA in the seven patients' sera. A cross reactivity among the above extracts was observed by an ELISA inhibition study.
In all cases, the IgE activity to chamomile tea could fully be absorbed by Matricaria pollen extract. Skin prick tests and conjunctival provocation tests also performed in 100 hay fever controls revealed a positive immediate skin response to Artemisia in 15 patients, eight of them also to Matricaria pollen and five of them to Chamomile tea as well.
Only two of the last patients had a positive conjunctival response. The results were negative in the rest of the controls. It was concluded that the chamomile tea eye washing can induce allergic conjunctivitis. Matricaria chamomilla pollens contained in these infusions are the allergens responsible for these reactions [9].

The allergens responsible for camomile allergy have not been characterized as yet [8].

Additional response to mugwort and pollen-derived food allergens should be evaluated in patients sensitised to camomile due to a higher incidence of allergic cross-reactivity[7].

de la Torre Morín F, et al (2001) in their study confirms a high degree of in vivo cross-reactivity between A. vulgaris and M. chamomilla. Sensitization to A. vulgaris seems to be a primary risk factor for experiencing symptoms after the ingestion of chamomile infusions. Based on the results of bronchial provocation tests, M. chamomilla pollen could be a relevant inhalant allergen [3].

Individuals with known hypersensitivity to  members of Asteraceae/Compositae family (ragweed, chrysanthemum, marigold, daisy, etc.), should avoid use
of chamomile-containing products to reduce the likelihood of of cross allergenicity .

References
1. Issac O. 1st ed. Czecho-Slovakia: Prague press; 1989. Recent progress in chamomile research- medicines of plant origin in modern therapy.
2. Mericli AH. The lipophilic compounds of a Turkish Matricaria chamomilla variety with no chamazuline in the volatile oil. Int J Crude Drug Res. 1990;28:145–7.
3. Subiza J. et al: Allergic conjunctivitis to chamomile tea. Ann. Allergy 65;127-132, 1990.
4. Paulsen E, Otkjaer A, Andersen KE. The coumarin herniarin as a sensitizer in German chamomile [Chamomilla recutita (L.) Rauschert, Compositae]. Contact Dermatitis. 2010 Jun;62(6):338-42. doi: 10.1111/j.1600-0536.2010.01730.x.
5. Thien FC. Chamomile tea enema anaphylaxis. Med J Aust. 2001 Jul 2;175(1):54.
6. Pastar Z, Lipozencić J, Ljubojević S. Etiopathogenesis of atopic dermatitis--an overview. Acta Dermatovenerol Croat. 2005;13(1):54-62.
7. Andres C, Chen WC, Ollert M, Mempel M, Darsow U, Ring J. Anaphylactic reaction to camomile tea. Allergol Int. 2009 Mar;58(1):135-6. Epub 2008 Dec 1.
8. Reider N, Sepp N, Fritsch P, Weinlich G, Jensen-Jarolim E.Anaphylaxis to camomile: clinical features and allergen cross-reactivity. Clin Exp Allergy. 2000 Oct;30(10):1436-43.
9. Subiza J, Subiza JL, Alonso M, Hinojosa M, Garcia R, Jerez M, Subiza E. Allergic conjunctivitis to chamomile tea. Ann Allergy. 1990 Aug;65(2):127-32.
10. de la Torre Morín F, Sánchez Machín I, García Robaina JC, Fernández-Caldas E, Sánchez Triviño M. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol. 2001;11(2):118-22.