Mallow

FEB 2009

Althaea officinalis L. Malva sylvestris L., Malva neglecta Wallr. Family: Malvaceae (mallows)

Common marshmallow ( Althaea officinalis ), common mallow ( Malva sylvestris , Malva neglecta ), malva . ^1, , ^2, , ³

Uses

Limited clinical trial data consist mostly of studies on the anti-inflammatory properties of the plant for skin, oral, and pharyngeal conditions. Despite the lack of clinical data, the German Commission E approved mallow for treating irritation of oral and pharyngeal mucosa, as well as for dry cough.

Dosing

Commercial tea products are the primary dosage forms of mallow.

Contraindications

Avoid use if allergic or hypersensitive to any components of the plant species. Animal studies document that the plant may lower blood sugar levels; thus, use with caution in patients with diabetes or in those sensitive to changes in blood glucose levels. ⁴

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

No serious adverse reactions were reported in 2 clinical trials.

Toxicology

No toxicity studies could be found.

The Malvaceae family is represented by the genera Althaea , Malva , and Lavatiera , and the mallow plants are members of this family. ^2, Mallows are perennial plants native to Europe, North Africa, and southwestern Asia. The plants have been naturalized in North America and are cultivated from western Europe to Russia. They prefer damp areas, such as the ocean, salt marshes, meadows, sides of ditches, and banks of tidal rivers. They grow from 1 to 2 m tall, and the leaves, flowers, and roots have been used for medicinal purposes. The flowers bloom in late spring, and the roots must be at least 2 years old before harvesting. ^1, , ^3, , ⁴

Mallow has a rich ethnomedicinal history and has been used since ancient Greece and Roman times. The leaves and shoots of common mallow have been used as food sources since the 8th century BC. ^1, The aboveground portions of the plant have been used in pancakes and salads, cooked as greens, and used as stuffing. ^5, The immature fruits may be consumed raw as a snack. ⁶

Ethnomedicinal references document the plant's efficacy as an anti-inflammatory for the respiratory tract, GI tract, and the skin. ^7, , ^8, , ^9, , ^10, , ^11, , ^12, The plant can be used topically or in a bath to treat abscesses, bruises, burns, dermatitis, swellings, and varicose ulcers. ^4, , ^7, A decoction may be chewed, gargled, or used as a wash to treat sore throat as well as mouth, throat, and gingival inflammations. ^9, , ^12, Respiratory conditions, such as bronchitis and whooping cough, can also be treated with a decoction. ^3, , ^10, It may be used as a compress on the stomach to help heal abdominal pains. ^11, Mallow may be taken as food to treat constipation or similar GI discomfort. ^4, , ^12, Other uses have been documented. ⁴

The mucous compounds in the plant species are of commercial interest, particularly in dermatology and cosmetic preparations. The plant species has been used to treat acne. ^4, , ^9, , ^12, , ¹³

The active components of the plant species are found in the leaves, flowers, and roots. Several studies document the mucilaginous polysaccharide content in the plant; the primary components are composed of rhamnose, galactose, galacturonic acid, and glucuronic acid. ^14, , ^15, , ^16, , ^17, Flavonoids, phenolic acids, tannins, and volatile oils have also been isolated. ^3, , ^18, , ^19, , ^20, Malonated anthycyanins have been isolated from the flowers. ^21, , ^22, , ²³

Pharmaceutical-grade marshmallow leaf must have a swelling index of at least 12 and pass macroscopic and microscopic authentication for botanical identification. The British Herbal Pharmacopoeia requires marshmallow leaf to be harvested before the flowering period and identified by thin-layer chromatography (TLC). The water-soluble extract must be at least 15%. Pharmaceutical-grade marshmallow root also must pass macroscopic and microscopic authentication tests and have a swelling index of at least 10 with the pulverized root. The British Herbal Pharmacopoeia requires botanical identification by TLC and additional quantitative standards for marshmallow root. A swelling index of at least 15 is required by The Swiss Pharmacopoeia . ^3, , ^24, , ²⁵

Limited clinical trial data mainly focuses on the anti-inflammatory properties of the plant for dermal, oral, and pharyngeal conditions. Commission E approves mallow for treating irritation of oral and pharyngeal mucosa, as well as dry cough.

Antitussive activity

Animal data A 100 mg/kg complex extract and 50 mg/kg polysaccharide dosage form isolated from the roots of A. officinalis were effective as antitussive agents in cats. The cough suppressant activity of the polysaccharide was more effective than prenoxidiazine but not dropropizine. ²⁶

Clinical data A multicenter, prospective, randomized, double-blind, placebo-controlled study examined the efficacy and safety of Throat Coat in 60 patients with acute pharyngitis. Throat Coat is an herbal tea containing 4 herbs, including marshmallow root ( A. officinalis ). Patients were randomly assigned and administered Throat Coat 5 to 8 oz (n = 30) or placebo (n = 30), 4 to 6 times daily. The study period was 2 to 7 days and a follow-up visit was scheduled 2 to 10 days later. Outcome measures included intensity differences for pain in throat upon swallowing and total pain relief. Results document Throat Coat as superior to placebo in providing relief of sore throat pain in patients with pharyngitis. No serious adverse reactions were reported during the trial. ²⁷

An open clinical trial examined a combination herbal cough syrup containing marshmallow root in 62 patients 16 to 89 years of age. Patients with irritating cough were diagnosed with a common cold (n = 29), bronchitis (n = 20), or respiratory tract diseases with formation of viscous mucus (n = 15). Patients were administered 7.5 to 15 mL of syrup over 3 to 23 days. The product was considered effective based on subjective symptom scores and treatment data assessing changes in cough and expectoration. ^28, , ²⁹

Other pharmacologic activity In vitro studies document antioxidant properties in the plant. ^30, , ^31, , ³² A. officinalis has antibacterial activity and may be useful in periodontal prophylaxis. ^19, , ^33, , ³⁴ Histopathological results document that M. neglecta extracts protected rats from gastric lesions induced by ethanol. ³⁵ Antiulcerogenic activity may be associated with the high mucilage content from the plant species.

A. officinalis inhibited intracellular calcium mobilization in normal human melanocytes (NHMC) activated by endothelin-1 (ET-1). ET-1 expression increased in the epidermis after ultraviolet (light) B (UVB) irradiation, which is likely to contribute to UVB-induced pigmentation. ET-1 also is involved with inducing NHMC. The results of the study suggest the extracts from A. officinalis inhibit the physiological effect of ET-1 on NHMC after UVB irradiation and may be useful when used in combination with other preparations in treating hyperpigmentary conditions or disorders. ³⁶

One study in rats investigated the effects of anthocyanin from M. sylvestris on plasma lipids. Decreases in total cholesterol (20%) and triglycerides (34%) were found. ³⁷

A carbohydrate in mallow has anticomplementary activity on the immune system. In vitro analysis of an acidic polysaccharride from the seeds of a related mallow stimulated the reticuloendothelial system. In vitro analysis of a crude powder from another mallow species showed antitumor activity. ^16, , ^38, , ³⁹

Commercial tea products are the primary dosage forms of mallow. ^3, , ²⁹

There is no clinical evidence to support the safe use of the herb during pregnancy and lactation.

None well documented.

No serious adverse reactions were reported in 2 clinical trials.

No toxicity studies could be found.

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