Scant attention has been given to the actual chemical composition of the EOs used and even the exact botanical origin type of the oil was ignored, for example, there are many main commercial types of 'lavender oil', all differing in both genus and composition! There are a large number of chemotypes of Lavandula EOs, and of these, often vague chemotypes are preferentially used by some aromatherapists (Lis-Balchin, 1999). The danger here is that little is known about them, the composition is very variable and no toxicity tests have been carried out on most of them. Only commercially-used EOs have been tested for toxicity, as these are mainly used in the food and cosmetics industries; however large-scale admixing, deterpenation, dilution and adulteration also occurs giving rise to a multitude of different lavender oils.
Many studies in Italy and France, have offered very little in the way of scientific evidence on the efficacy of EOs on patients and were reported in a rather unscientific way. There may well have been some success in the treatment of depressed patients (Rovesti and Colombo, 1973), but there is little data supplied as to the precise diagnosis of the patients, their symptoms, which symptoms were relieved, the number of patients involved and the statistical significance or otherwise of the results. Under such circumstances, the evidence is at best anecdotal. Most of the recent work has never been published in peer-reviewed journals but has been quoted as gospel, for example, Franchomme and Penoel (1990) and only single case studies are presented on the efficacy of treatment, which were used mostly internally.
There is also long-standing evidence for the benefits of inhaling certain EOs to relieve coughs, congestion etc. in the respiratory tract using mixtures of Eucalyptus globulus, pineneedle and camphor (Martindale, 1992) which could also alleviate sleeplessness and save on diapezams.
Lavender oil has been used in one trial relatively successfully, however, only four geriatrics were involved in the study (Hardy et al., 1995).
More clinical and toxicological research is needed, in order to extend the use of aromatherapy. From the toxicological aspect, there is the danger of causing dermatitis in sensitive people (Rudzki et al., 1976): lavender oil is not implicated greatly, but there was a report of occupational allergy to a lavender shampoo used by a female hairdresser (Brandao, 1986). The hairdresser had allergy problems on her hands due to a variety of products, but reacted more strongly to a lavender shampoo and lavender oil itself. Menard (1961) reported a similar case, but this time the hairdresser was allergic to the eau de Cologne containing lavender, rather than to the lavender alone. Patch tests have shown a few allergies due to photosensitization and also pigmentation was reported (Brandao, 1986; Nakayama et al., 1976).
There is also the danger of airborne contact allergic dermatitis through overuse of EOs and their storage (Schaller and Corting, 1995), which produced a severe response in a man who had been active with EOs, and proved long-lasting due to the sequestering of the odorants in the house even after the removal of all the bottles.
There may also be danger in the overuse of EOs during pregnancy and childbirth. Studies during childbirth in particular should take into account the baby's health, as there is always the danger of over-sedation of the infant and the subsequent lack of breathing reflex (personal communication). Clinical studies should include EOs which are not generally employed in order to assess the efficacy of frequently used EOs and eliminate aromatherapist's bias, as well as indicate whether the effect is actually due to any EO in particular. Studies using case notes of past clients could also be of help in assessing the efficacy of usage of certain EOs for different clinical conditions.
What could be achieved by using aromatherapy as an adjunct to clinical medicine especially in hospitals and general practice? So far there have been many 'successes' in various areas, notably hospices. There are no miracle cures, but an alleviation of suffering and possibly pain, mainly through touch, relaxation due to gentle massage and the presence of someone who cares and listens to the patient. This is probably also the case in geriatric wards, in general wards, in the treatment of severely physically and mentally-challenged children and adults.
There is a need for this kind of healing contact, and aromatherapy with its added power of odour, fits this niche. Future studies may reveal the individual benefits of different EOs for different ailments, but, in practice this may not be of the greatest importance as aromatherapy (especially when combined with massage) offers relief from stress and this in itself is of the greatest benefit for most people.
Nurses and other healthcare professionals have expressed the wish to learn and train in the use of aromatherapy, in favour of all the other alternative therapies (Trevelyan, 1996). The medical profession is also turning towards this branch of alternative medicine, as it seems to be useful in the treatment of patients whose symptoms are largely based on stress, and who do not respond to conventional medicine. The future of aromatherapy may, however, be in doubt, if there is no scientific verification of its efficacy forthcoming and if there is a clamp-down on the EO industry (which includes aromatherapists selling or just using EOs) as to the safety and standard of the
EOs. EOs are hazardous in the wrong hands and in the United Kingdom there are no restrictions on who can practise with them, regardless of their qualifications and knowledge of their potential dangers, despite some regulatory bodies (like the Aromatherapy Organisation Council, AOC and the individual organisations to which aromatherapists can belong, for example, International Federation of Aromatherapist, IFA); in the rest of Europe, there are more stringent regulations, with EOs being sold mainly by pharmacists, and aromatherapy practised by medically qualified practitioners or herbalists, and these are probably to be implemented in the United Kingdom in the near future. The regulations round the world will then doubtlessly be amended.
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