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Essential oils and contraindications in palliative care
In addition to the normal local and general contraindications for the use of essential oils and massage, the following cautions have been compiled from the resources listed below.
IMPORTANT: This does not mean that Therapists cannot use these oils, but extra care and a good rationale for treatment and an appropriate level of skill and route of delivery is required.
Cancer
Balacs and Tisserand (1995) suggest avoiding the following essential oils for cancer:
 | Anise |
| Basil |
| Fennel (bitter and sweet) |
| Ho leaf (ct. camphor and safrole) |
| Laurel |
| Myrtle |
| Nutmeg (East Indian) |
| Star anise |
(p229)
Oestrogen-dependent cancers
avoid anethole-high oils (Zondek 1938 p645, Albert-Puelo 1980 p344)
| Anise |
| Fennel Star anise |
and citral high oils (Geldof 1992 p144) such as:
| Lemongrass |
| Melissa |
| Verbena |
| Citronella |
| Eucalyptus |
(Buckle 1997 p78 and 135)
Melanomas
Avoid:
| Bergamot |
(Buckle 1997 p86)
Oils high in d-limonene (citrus oils such as sweet orange, lime, lemon and grapefruit) have been shown to stimulate tumerous growths in mice on the site of topical application (Roe 1959 p92-93; Roe et al. 1960, p1403; Peirce 1961 p497-498; Elegbede 1986 p2049).
Renal diseases
Avoid:
| Bay (West Indian) |
| Cinnamon leaf |
| Clove (bud, stem and leaf) |
(Balacs et al. 1995 p231)
| Juniper |
(Price et al. 1999 p328)
Hepatic disease
Avoid:
| Anise |
| Basil |
| Bay |
| Cinnamon leaf |
| Clove (bud, stem, leaf) |
| Star anise |
(Balacs et al.1995 p231) and
|
Fennel |
(Buckle 1997 p84)
Cardiac disease
Avoid:
| Peppermint |
(Balacs et al. 1995 p234)
Interactions with medication
Most adverse interactions with conventional medications are associated with the oral use of essential oils. However, Sweet birch and wintergreen are contraindicated for Warfarin (Balacs et al. 1995, p43).
Poor storage and degrading oils
d-limonene high oils (citrus oils) in particular will quickly degrade after opening to produce weak carcinogenic chemicals (Homberger et al. 1968 p2372) or will increase risk of sensitisation and skin irritation. Therefore the shelf life of opened bottles if stored correctly is recommended to be 1 year, or 2 years of stored in a fridge. Citrus oils will last 6 months if stored correctly.
Contraindications for massage
There is no evidence to suggest that massage is contraindicated for cancer patients (Price et al. 1999 p247) except for the following circumstances in addition to normal local and general contraindications for massage:
Avoid:
| Area of the skin exposed to radiation treatment (McNamara 1993 p48) |
| On or close to tumour sites |
| Oedema without instruction in appropriate massage techniques |
Damaged skin (including eczema and psoriasis)
| Anise |
| Citronella |
| Clove (leaf, bud and stem) |
| Lemon gum (Eucalyptus citriodora) |
| Laurel |
| Lemongrass |
| May chang |
| Melissa |
| Oregano |
| Star anise |
| Thyme (ct. unknown) |
Balacs et al. 1995 p229
Purchasing, supply and labelling
Oils should not be used unless purchased form an Aromatherapy Trade Council (ATC - the UK regulatory body for the essential oil trade) approved supplier to ensure quality and to ensure against adulteration.
Essential oils come under UK Health and Safety legislation - COSHH (Control of Substances Hazardous to health) and CHIP (Chemicals: Hazardous Information and Packaging for Supply) therefore should be stored properly with controlled access with appropriate risk assessments in place (Buckle 1997 p95).
The above regulations will enable Clinical Managers to make informed decisions about the appropriate use of particular essential oils and to identify potential for risk.
Essential oil dealers should provide Material Data Sheets listing the chemical CAS number, chemical data, toxicity and other hazardous information.
Correct labelling should conform to CHIP 1994 regulations, include include the name of the supplier, essential oil common name, botanical name, expiry date, batch number and CHIP hazardous warnings.
Practitioners
The advice given to Primary care practitioners wishing to refer their patients to a Complementary Therapist recommend that they seek a Therapist with an Aromatherapy Organisations Council (AOC) recognised qualification (Department of Health 7:1).
Individual practitioners have an obligation of a duty of care according to their own code of practice.
Managers
Clinical managers are responsible for introducing and implementing an Aromatherapy and Essential Oil Policy with appropriate regard to Health and Safety legislation with protocols for staff training (Buckle 1997 p95).
Restricted essential Oils
The following are oils which are on (International Fragrance Accociation (IFRA) restricted list and should be used with caution:
Angelica root oil Angelica archangelica (phototoxic)
0.78%
Bergamot oil expressed Citrus aurantium ssp. bergamia (phototoxic) 0.4%
Bitter Orange oil Citrus aurantium (phototoxic) 1.4%
Cassia oil Cinnamomum cassia (sensitiser) 0.2%
Cinnamon bark Cinnamomum zeylanicum (sensitiser) 0.2%
Cumin oil Cuminum cyminum (phototoxic) 0.4%
Grapefruit expressed Citrus paradisi (phototoxic) 4%
Lemon oil cold pressed Citrus limonum (phototoxic) 2%
Lime oil expressed Citrus aurantifolia (phototoxic) 0.7%
Tagete oil & absolute Tagetes minuta (phototoxic) 0.05%
Oakmoss absolute & Resinoid Evernia prunastri (sensitiser) 0.1%
Pinaceae oils to have a peroxide value of less than 10 millimoles peroxide
per litre (sensitiser)
Rue oil Ruta graveolens limit (phototoxic) 0.78%
Verbena absolute Lippia citriodora (sensitiser) 0.2%
Treemoss absolute Evernia furfuracea (sensitiser) 0.6%
Banned IFRA essential oil list
Cade oil crude Juniperus oxycedrus (carcinogen)
Calamus oil Acorus calamus (some forms contain high levels of the
carcinogen
b-asarone)
Chenopodium ambroisoides oil (acute oral toxicity)
Costus root oil, absolute & concrete Saussurea costus (sensitiser)
Elecampane oil Inula helenium (sensitiser)
Fig leaf absolute Ficus carica (sensitiser) (Horseradish oil)
Armoracia rusticana (toxic, irritant) (IFRA has banned
allyl isothiocynate therefore effectively prohibiting use of Horseradish)
Mustard oil Brassica nigra (toxic; irritant)
Peru balsam Myroxylon pereirae (sensitiser) distilled oil is allowable
Sade tree oil ? (further details not to hand)
Savin oil (Juniperus sabina). (J. phoenicea oil allowable).
Verbena oil Lippia citriodora (sensitiser)
Tea absolute Thea sinensis (sensitiser)
(Sassafras oil) Sassafras albidum (carcinogen) - effectively banned by
imposing a limit on the carcinogen safrole limit of 0.01% in perfumes.
Stryax gum Liquidamber orientalis and other L. spp. Only Liquidambar
styraciflua var. macrophylla products produced by methods which give products
not showing a potential for sensitisation should be used.(e.g. steam distillation,
vacuum distillation, extraction with ethanol or hexane, neutralisation with
aqueous alkali followed by solvent extraction.
Wormwood oil Artemisia absinthium (neurotoxic)
Additional list for discussion: the following oils
are also under discussion for safety:
Laurel leaf oil Laurus nobilis: many fragrance houses have internally
imposed lists restricting or banning this product.
Thuja occidentalis oil (neurotoxic)
Tansy Tanacetum vulgare (neurotoxic)
Pennyroyal Mentha pulegium/Hedeoma pulegioides and other high Pulegone
oils
(e.g. Micromeria
Parsley seed oil Petroselinum crispum (hepatoxic)
Parsley leaf Petroselinum crispum (hepatoxic)
Boldo oil Pneumus boldus (acute oral toxicity)
Massoia oil (Cryptocaria massoia) Powerful irritant.
Melaleuca bracteata oil. Methyl eugenol is a suspected carcinogen.
(Burfield 2001 RQA Conference)
Safe oils
Below is a list of essential oils which are safe to use in normal dilution with no known contraindications compiled from using all the literature included in the references below:
| Basil (European) |
| Cajaput |
| Catnep |
| Clary Sage |
| Cypress |
| Eucalyptus Smithii (Gully Gum) |
| Everlasting |
| German Chamomile |
| Ginger |
| Frankincense |
| Lavender (Angustifolia) |
| Lavandin |
| Marjoram (Sweet and Spanish) |
| Myrrh |
| Niaouli |
| Neroli |
| Petitgrain |
| Pine |
| Roman Chamomile |
| Rose Otto |
| Rosewood |
| Sandalwood |
| Spikenard |
| Summer savory |
| Sweet marjoram |
| Sweet thyme (ct. geraniol and ct. linalool) |
| Tea tree |
| Vetiver |
| Ylang ylang |
References
Albert-Puelo M (1980) Fennel and anise as estrogenic agents. Journal of Ethnopharmacology 2: 337-344
Balacs T, Tisserand R (1995) Essential Oil Safety: A Guide for Health Care Professionals. London: Churchill Livingstone
Buckle J (1997) Clinical Aromatherapy in Nursing. London: Arnold Publishers
Burfield T (2001) RQA AGM 11th March 2001 London : Safety address
Elegbede J A (1986) Mouse skin tumour activity of orange peel oil and d-limonene: a re-evaluation. Carcinogenesis 7:12 2047-2049
Department of Health (2000) Complementary medicine: Information pack for Primary Care Groups June 2000 7:1
Geldof A A (1992) Estrogenic action of commonly used fragrant agent citral induces prostatic hyperplasia. Urological Research 20: 139-144
Homberger F, Boger E (1968) The carcinogenicity of essential oils, flavours and spices: a review. Cancer Research 28: 2372-2374
McNamara P (1993) Massage for people with cancer: a working paper. London: Wansdworth cancer Support Centre Publication
Peirce W (1961) Tumour-promotion by lime oil in the mouse forestomach. Nature 189: 497-498
Roe F (1959) Oil of sweet orange: a possible role in carcinogenesis. British Journal of Cancer 13:92-93
Roe F, Peirce W (1960) Tumour promotion by citrus oils. Journal of the National Cancer Institute 24: 1389-1403
Zondek B (1938) Phenol methyl esters as estrogenic agents. Biochemical Journal 32: 641-645
Information
Aromatherapy Organisations Council - AOC (the major umbrella
organisation to ensure quality in training and practice.
PO Box 19834,
London,
SE25 6WF
Tel 020 82517912
AOC membership organisations
| Aromatherapy and Allied Practitioner's Association (AAPA) |
| Association of Holistic Practitioners (International) Ltd |
| Association of Medical Aromatherapists (AMA) |
| Association of Natural Medicine (ANM) |
| Association of Physical & Natural Therapists (APNT) |
| English Societe de L'Institute Pierre Franchomme (ESIPF) |
| Guild of Complementary Practitioners (GCP) |
| Holistic Aromatherapy Foundation (IHAF) |
| International Federation of Aromatherapists (IFA) |
| International Society for Professional Aromatherapists (ISPA) |
| International Therapy Examination Council - ITEC |
| Register of Qualified Aromatherapists (RQA) |
| Renbardou Institute (RI) |
Aromatherapy Trade Council (the regulatory body
for the UK essential oil trade)
PO Box 387,
Ipswich,
IP2 9AN.
Tel 01473 603630