Interferon works against colds
To beat the cold
Coldsby Sabine Schellerer, Munich
With the onset of the cool, rainy autumn weather, sniffling and coughing pharmacy customers give each other the handle every day. They are looking for advice and help on how to tackle the annoying symptoms. In 2001, Germans spent 866 million euros on their cough and cold medicines; not to forget the 289 million euros that they spent on phytopharmaceuticals.
An average of two to four times a year, colds paralyze an adult. It is an age-old, almost universal wisdom that the cold increases the risk of a cold. The German word "Kaltung" and the Italian word "raffreddore" reflect who is to be responsible for the evil. The Hindi word "sardi" stands for "to cool down" as well as for "cold". However, the connection between the cold and the common cold has never been scientifically substantiated.
The fact that the wave of illnesses peaked in winter cannot be explained by the low temperatures. People simply spend more time in closed rooms and move closer together. In addition, the dreary autumn weather and the low humidity in heated rooms strain the body's defenses, especially the bastions that protect the airways.
The real culprits who tie people to bed for an average of about a year over the course of their life are viruses. Today more than 200 types are known, including parainfluenza, corona, and respiratory syncytial (RS), more rarely adeno and rheoviruses. Enteroviruses strike more often in summer. Unknown pathogens are behind a good third of the commonplace infections (22). Time and again, scientists track down previously undiscovered strains; Dutch researchers brought metapneumoviruses from the paramyxovirus family to light (1).
The rhinoviruses undoubtedly have the greatest impact in the cough and runny nose sector. Almost half of all colds are caused by them. They belong to the picornavirus family and occur in more than 100 genetic variants. Specialists divide them into two main groups, which differ in terms of their receptors (2).
But other causes, such as the use of certain medications, can trigger symptoms that make laypeople think of a cold. The pharmacist's instinct is required here (Table 1).
Table 1: Differentiation of possible self-medication and required doctor's visit; after (11)
Medicines that reduce cold symptoms
A doctor's visit is recommended
Doxepin, clonidine, dihydralazine, and methyldopa have been reported to complain of nasal congestion in patients.
- Suspected bacterial infection (fever, purulent secretion)
- Sinusitis (symptoms are slightest in the morning and evening, worst at noon; increase when bending and pressing)
- Children under 7 years
often observed side effects of ACE inhibitors;
Inhaling aerosols can cause coughing
- Serious illnesses can be concealed behind a cough: bacterial infection, influenza, asthma / allergy, tuberculosis, bronchitis, carcinoma, heart failure.
Anticholinergics such as tricyclic antidepressants and neuroleptics
- Suspected bacterial infection: fever, purulent tonsils, purulent sputum, bad breath, unilateral pain
Antihypertensive agents such as nitrates, calcium antagonists, molsidomine, clonidine;
Hormones in contraceptives, remedies for menopausal symptoms;
Caffeine, ergotamine, triptans for withdrawal
- Patients with cold-related headache who are pregnant or breastfeeding
- Children under 7 years
Virus time - suffering time
When a cold patient sneezes, like a shotgun, thousands of infected droplets shoot several meters from the nose at a speed of 150 km / h. These droplets float in the air for minutes, the ejected microparticles even for days. The assumption that patients pass on their cold through the air is therefore obvious. But far from it.
Although the pathogens are also distributed via coughing and sneezing, scientists have discovered the hands as the actual carriers (3). From various experiments they concluded that viruses mainly spread via hand contact - not necessarily skin contact. Because the pathogens, enclosed in secretion droplets, stay on almost all smooth surfaces, including the skin, for several hours. In contrast, they only survive for a relatively short time in cotton handkerchiefs.
As soon as the tiny culprits implant themselves in the epithelia of the nasopharynx and bronchial tree and begin to replicate, the body pulls out all the stops to destroy the enemy as quickly as possible. If the intruder wins, the typical symptoms appear after an incubation period of a few hours to days - all of a sudden. The viruses themselves do less damage than the permanent attacks of the immune system. The infected cells send out a signal that attracts white blood cells. As a result, numerous messenger substances such as cytokines, histamine, prostaglandins and leukotrienes cavort in the mucous membranes of the airways. The consequences: inflammation, swelling and secretion production.
Usually the common cold starts with a scratchy throat and sore throat. On the second and third days, the mucous membranes of the nose and sinuses swell and become blocked. At the same time, they secrete copious amounts of clear fluid made of water, proteins, dead cells and a lot of viruses. In the further course, the secretion thickens and becomes stickier, until after four or five days the mucous membranes swell again on their own. Some patients are plagued by an annoying, persistent cough caused by inflammation of the upper respiratory tract. Headache and body aches or conjunctivitis can also occur. Fever and chills rarely tie the patient to bed.
The symptoms can appear either individually or together - depending on which part of the respiratory tract the virus colonizes. Doctors differentiate between catarrhs of the nasal mucosa (rhinitis), the throat (pharyngitis), the larynx (laryngitis) or the deep respiratory tract (bronchitis, tracheitis). Usually the suffering peaks on the third day; after about a week the ghost is over. In a third of those affected, however, a cold can drag on for up to 14 days (4, 10).
Escaped the immune system
The organism has to deal with cold viruses for a lifetime. After overcoming the period of suffering, an immunity against specific individual types develops, but this does not protect against the attack of the remaining cold viruses. In addition, the acquired immunity decreases with age. Now known pathogens get a new chance.
In addition, many are able to change their surface structure. In this way they fool the immune system and let tailor-made antibodies run wild. It is logical that it is almost impossible to develop broadly effective vaccines against the many quick-change artists. It has recently been possible to develop antibodies that are directed against glycoprotein F of both subtypes of the RS virus (5).
In the field of antiviral therapy, not too much is happening for cold patients in practice. Capsid-binding agents are new hope for the future (2, 8). Pleconaril prevents rhinoviruses from docking with the ICAM-1 receptor. In addition, the substance inhibits the replication of most rhinoviruses and enteroviruses in vitro by preventing the pathogen from being uncoated. Pleconaril is currently in phase II clinical trials. Tremacamra - a bioengineered ICAM-1 receptor in soluble form - also blocks the receptor binding sites of rhinoviruses. The preparation is applied directly into the nose. Further studies have yet to confirm whether this approach can hold its own in practice (23).
Other antiviral approaches, for example with protease inhibitors, which are supposed to stop the multiplication of the cold viruses, are still in the experimental stage.
Scientists have long tried to stop the pathogens with intranasally applied alpha-2 interferon (6, 7). An American researcher has high hopes for the combination of intranasally applied alpha-2 interferon, peroral chlorpheniramine and ibuprofen (9). While the interferon keeps the pathogens in check, the antihistamine and anti-inflammatory drugs get the inflammation mediators under control.
Free path for the air you breathe
So far, there is nothing left but to treat a cold symptomatically and thus shorten the duration of the illness or at least make it more bearable (10, 11). In addition to allopathic drugs, numerous homeopathic drugs are also available (Table 2).
Table 2: Help from homeopathy (20, 21)Symptoms, moodMeans, dosage * beginning flu-like infection with sneezing, sore throat, shivering, cold feet or hands
Attention: Not suitable for babies and toddlers! Camphora D3,
3 drops every half hour at the beginning of a cold with a high fever without sweat (cold is due to cold drafts); Difficulties swallowing; Sudden, nocturnal cough Aconitum D4 - D6,
5 drops of sweat every quarter to half hour (skin is hot and damp); Common cold begins to localize; barking, dry, convulsive cough Belladonna D4 - D6,
5 drops of infection 5 times a day with a dull headache (head flu); "Summer flu"; moderate fever; Patient dazed as if stupefied; Sore throat (radiating to the ear when swallowing) Gelsemium D4 - D6,
5 drops 5 times a day, moderate fever, unstable circulation; respiratory tract affected in particular: nosebleeds, runny nose, dry cough; Ferrum phosphoricum D6 is particularly effective in children,
acute 1 tablet per hour slowly developing, febrile infection; Patient tired, weary, wants rest; A headache; first runny nose and sneeze, then cough; dry painful tickling cough that worsens when entering rooms Bryonia D4 - D6,
acute 5 drops of fever every hour increases in the morning between 7 and 9 o'clock; severe bruised feeling; Bone and limb pain; inner unrest; severe runny nose Eupatorium D4 - D6,
5 drops of infection 5 times a day with severe pain in the limbs as a result of wetness and cold; Restlessness; Fever with chills, cold sores Rhus toxicodendron D6,
5 drops 5 times a day
*) Give or discontinue remedies less often when they improve
The treatment of a runny nose requires the restoration of ventilation and drainage of the paranasal sinuses as the most important therapeutic principle. Especially nasal drops or sprays with sympathomimetics, ideally the long-acting imidazoline derivatives oxymetazoline and xylometazoline, swell the mucous membranes and allow the patient to breathe freely again. Important: Sympathomimetics must not be instilled in the nose for more than a week. Used orally, they have a considerable range of contraindications. Patients with CHD, hypertension and hyperthyroidism have to keep their hands off it.
Anti-inflammatory drugs such as acetylsalicylic acid and ibuprofen also allow more air to flow through the main and paranasal sinuses. Presumably, their anti-edematous effect ensures freer breathing. Scientifically proven knowledge is still missing. According to the monograph, phenylephrine has only been proven to be effective for local, but not for oral use. Antihistamines are to be viewed critically and are only indicated in the case of a runny nose that cannot be stopped. Ephedrine judges a monograph negatively.
Isotonic saline or sea water showers help dry mucous membranes to regenerate. Lipophilic agents such as nasal oils are less suitable.
Secretolytics such as ambroxol and bromhexine probably improve the viscosity of the mucus and increase the transport of secretions. They should also have an anti-inflammatory and antiviral effect, because they increase the transfer of immunoglobulin A from the blood into the bronchial secretion and in this way stimulate the local immune response. However, there is a lack of current scientific knowledge. For acetylcysteine, the mucus-liquefying effect is also more likely to be demonstrated in vitro than in vivo.
Antitussives help against dry, irritating coughs. Here a monograph evaluates the active ingredients clobutinol, pentoxyverine and dropropizine positively. The literature also shows the effectiveness of pipacetate and dextromethorphan. Codeine, dihydrocodeine and noscapine require a prescription, hydrocodone is subject to the Narcotics Ordinance. In principle, cough blockers are intended to ensure a peaceful night's sleep. If a pregnant or breastfeeding woman coughs her heart out, she must seek medical advice and not self-medicate - just like patients who cough chronically.
All centrally active antitussives can have a negative effect on the ability to concentrate and react. Patients who still want to drive a car should therefore listen carefully to themselves when they are taking the medication for the first time.
Sore throats are relatively difficult to treat. The literature characterizes chlorhexidine and dequalinium chloride as antimicrobial, lidocaine and polidocanol as locally anesthetic. Lozenges help against the agony in the throat; Sprays are mainly used for complaints in the anterior throat. According to recent studies, ambroxol is also said to have a local anesthetic and antioxidant effect. It blocks the neural sodium channels in the sensory nerve endings. This is why lozenges that release the active ingredient locally in the mouth and throat are also suitable for sore throats.
ASA, paracetamol and ibuprofen are effective against headaches and pain in the limbs. Phenazone and propyphenazone are second-choice drugs because of their side effects. In a smaller study, high-dose zinc had a clearly positive effect on the duration and severity of cold symptoms (18).
In principle, monopreparations should be preferred and tablets should be taken with 250 ml of water. In order for suppositories to slide better, it is enough to moisten them slightly; whoever "creams" them makes it difficult to absorb the active ingredient.
Experts still rate multi-component mixtures in expensive flu drugs as very critical. According to the motto “less is more”, a limited number of selected drugs that target individual symptoms are more useful than shotgun therapy with a rich mix of active ingredients (11).
What plant power creates
According to a survey by the Institute for Demoscopy in Allensbach in 2002, 70 percent of those questioned said that natural remedies would help them with colds.
As natural multi-substance mixtures, plant extracts offer the advantage of a broad spectrum of activity. Well-chosen herbal combinations have a beneficial effect on the course of cold symptoms due to their synergistic and complementary effects. Phytopharmaceuticals are generally well tolerated; essential oils can sometimes be a problem for sensitive stomachs. If you only want to use tried and tested preparations in your recommendation, it is best to use standardized finished products that have proven their quality in clinical studies.
A wide range of drugs are available against coughs that have antitussive, secretolytic, secretomotor, bronchospasmolytic, anti-inflammatory, antiviral or antibacterial effects. Mucus drugs such as mallow, sundew, marshmallow roots or Icelandic moss, as well as thyme, alleviate the agonizing urge to cough. Mucilaginosa draw a protective film over the mucous membrane of the mouth and throat and thus shield the sensitive cough receptors from exogenous stimuli.
Home remedies - physical help (after 4, 17)Inhalations for coughs and runny nose
In a large bowl, pour one tablespoon each of chamomile flowers, thyme, and sage or peppermint leaves with plenty of hot water. Pull for a few minutes and allow to cool (caution, risk of burns!), Then bend your head over the vapors and inhale.
In the case of bronchitis, steam inhalation via a nebulizer is more suitable, as finer droplets penetrate into the deep bronchi.
Neck wrap In case of inflammation, congested airways in the throat, swollen lymph nodes: Dip the linen cloth in cold water, wring it out and wrap it around the neck. Wrap a dry linen cloth over it and finish with a woolen cloth. Leave the wrap for 60 minutes. In the case of acute inflammation, up to six times a day. Warning: heat only in the case of chronic inflammation.
Chest wrap for coughs: dip linen cloth in cold (for convulsive coughs in warm) water, wring out and wrap / wrap around the chest. The wrap should extend from the armpit to the costal arches. Cover it with a dry linen cloth and finish with a dry woolen cloth. Caution: do not wrap too tightly! After about 90 minutes, when you sweat, remove it. Then rest in bed for another hour.Use: once or twice a day.
Calf wrap If you have a fever: Dip two linen or towels in cold water, wring them out and wrap them around both lower legs. The wraps should extend from the hollow of the knee to the ankle. Lay a dry linen cloth over it (not a woolen cloth because it is too warm). The wipes stay on the skin until they have warmed up (now they no longer dissipate heat).
Onion wrap for sore throats and ears: Chop five large vegetable onions and heat them in a pan without oil. Wrap the dried, lukewarm vegetables in a cloth, wrap around the neck / ears and secure with a scarf.
Foot bath for the onset of a cold
Put your feet in a tub of 39 ° C water; Immerse in cold water for 3 seconds after 8 to 12 minutes. Dry off well, put on warm socks and lie in bed for 20 minutes.
Essential oils from star anise, anise, fennel, eucalyptus and thyme or sapon drugs such as ivy, primrose and senega root act as expectorants for acute, productive coughs. Saponin drugs also increase the activity of the ciliated epithelium and stimulate the movement of the cilia by stimulating the vagus nerve. If you sweeten your cough tea, you stimulate parasympatholytic receptors in the oral mucosa and thereby additionally stimulate bronchial secretion.
Standardized Myrtol takes away the horror of colds. Camphor, cineole, menthol and eucalyptus oil are also well documented in the specialist literature. The fixed combination of the extracts from gentian root, primrose blossoms, verbena, elderflower and dock herb gets the secretolysis going when the nose is blocked.
In some patients, enzymes of plant origin have proven their worth: bromelain and papain promote the proteolysis of protein debris and microthrombi in the inflamed tissue and are intended to defeat the inflammation of the nasal mucosa in this way. Marshmallow root, chamomile blossoms, field horsetail, yarrow, walnut leaves, oak bark and dandelion are good for a battered neck. Chamomile, sage, mint or thyme oil help with hoarseness, sore feelings and difficulty swallowing (15).
Umckaloabo extract from the South African plant Pelargonium reniforme / sidoides is relatively new to the Central European range of therapies. The ingredients are intended to coat the mucous membrane cells with a protective film and thereby prevent pests from attaching themselves. Allegedly they also mobilize immune cells, have a direct antibacterial effect against a number of germs and loosen tough mucus. However, there is a lack of randomized, controlled studies. Some experts even warn against the use of this "miracle cure" because the coumarins contained in the extract carry the risk of bleeding (16).
Cold patient number one
With small children it is hardly worthwhile to put away the handkerchiefs. The offspring have to deal with colds and the like 10 to 12 times a year. This begins around six months, when babies start crawling and the maternal nest protection fades. The incidence of the disease peaks at the age of three to five - probably due to the close social contact in kindergarten.
The reason for the constant snotty nose: the child's immune system lacks the necessary maturity to be able to fend off permanent attacks. The newborn is born with a low level of T helper cells of subtype 1 (Th1), while Th2 cells, which are involved in the allergy, predominate. In order to win the fight against viruses, bacteria and fungi, however, the body needs enough Th1 cells (14, 13). A child acquires this Th1 competence when they train their immune system hard at an early age - with infections of the upper respiratory tract.
In principle, it is the same symptoms that afflict children as in adults - only that they are often more pronounced and usually more severe. The mercury column of the clinical thermometer rises rapidly, while adults have little or no fever.
If you have a cold, it is advisable to shoo the little patient out into the fresh air as much as possible. For example, with children who do not have a fever, it is out of place to be afraid of long walks. When the outside temperature is over 7 degrees Celsius, the windows can also remain open at night.
Common cold in babies
A cold in children is a nuisance, but not entirely unproblematic in babies. For example, a blocked nose prevents many babies from drinking or eating enough. Here, age-appropriate, decongestant nasal drops or isotonic saline solution keep the olfactory organ free. Because of the risk of aspiration, oily preparations are less recommended in the first year of life.
Herbal preparations are particularly suitable for coughing in childhood. Synthetic blockers such as pentoxyverine or clobutinol guarantee babies from four months of age a quiet night. Ambroxol or bromhexine, as well as herbal secretolytics, loosen tough mucus. In pediatrics, primrose flowers rather than roots are recommended because of their lower saponin content (15). Guaifenesin should be avoided because of possible gastric intolerance and the risk of bronchoconstriction.
Caution when using essential oils: The mucus in the bronchi can liquefy so much that the little ones often cannot cough it up. Camphor, menthol, mint oil and other strongly smelling oils also harbor the risk of reflex glottic spasm or bronchospasm up to respiratory arrest and are therefore contraindicated in infants and young children. Experts also report hypersensitivity reactions in connection with essential oils.
Whether it actually helps the little patients who cough badly to drink a lot remains a matter of dispute among experts. Opponents note that only the urine flow would increase and no more secretion would flow. In addition, especially young children who drink constantly, would vomit while coughing.
Because babies and toddlers cannot suck candy, difficulty swallowing causes particular problems - mainly because the food torments them. The mother has to try out whether her sick darling prefers a hot soup or whether she prefers ice cream and yogurt. Older children can suck on ribwort or Iceland moss lozenges for sore throats or gargle with sage tea. Icelandic moss also slightly stimulates the appetite and brings one or the other little food refusher to eat again.
Because fever is generally a sensible response of the body, it should not be lowered immediately - except in children who are prone to convulsions. Paracetamol or ibuprofen are ideal against the heat in the body; Those who prefer the gentle tour can try linden blossoms, elderberries and meadowsweet blossoms. Under the age of 12, hands off ASA as the dreaded Reye's syndrome threatens.
Serious complications are rare
Although a cold is one of the benign infections that usually proceed without complications, it cannot be completely ruled out. The rare problems occur predominantly in the airways. The typical consequences include sinusitis and severe bronchitis, and less often pneumonia and pleurisy. It can also lead to otitis media. It is important to distinguish a banal infection from a real flu (influenza) (Table 3).
Table 3: Differentiation of influenza and flu-like infection; after (11)characteristicfluGripal infect Pathogen Influenza viruses of types A, B and C more than 200 different pathogens, for example rhino, corona, RS and enteroviruses Infested organ Respiratory tract Respiratory tract Symptoms Cold, cough, hoarseness, headache and body aches, high fever Cold, cough , Hoarseness, headache and body aches Disease progression sudden onset of a severe feeling of illness with exhaustion, weakness, drowsiness
severe headache, joint pain and pain in the limbs
Initially chills, then rapid rise in body temperature up to 40 ° C mild course immunity none none prophylaxis vaccination strengthening of the immune system incubation time 1 to 3 days a few hours to 3 days lethality high low therapy symptomatic symptomatic doctor's visit absolutely necessary; Evidence is notifiable conditional transmission droplets droplets
Athletes shouldn't take flu-like infections lightly: because some viruses tamper with the heart muscle and trigger myocarditis, which young people in particular often fail to notice. You will feel fit again after the cold and continue to train as before. Some pay for their zeal with their lives.
As a rule, parents don't have to worry about their constantly sniffing offspring. Nevertheless, you should definitely seek medical advice in the event of a protracted course. The professional diagnosis rules out that the supposedly banal infection is caused by influenza, infectious mononucleosis or a pseudovirus infection (psittacosis, Mycoplasma pneumoniae). If the larynx becomes inflamed, life-threatening epiglottitis could be present. In the case of pseudo croup, the advice of the doctor is also imperative. In both cases, the mucous membranes swell so much that the children are in acute danger of suffocation.
RS viruses - a strain that is harmless to older children and adults - often causes severe bronchiolitis or bronchopneumonia in infants. Constant infections by rhinoviruses can lead to acute exacerbation of bronchial asthma (19). In principle, bacterial infections belong in the hands of the pediatrician (12). Otherwise some postponed streptococcal angina ends with rheumatic fever, cardiac problems or a nephritic syndrome. Recurrent otitis media due to a pneumococcal infection is not infrequently paid for by children with permanent hearing damage or even hearing loss.
Only the doctor can decide whether antibiotics help. In principle, they are indicated for otitis media in small children, complicated sinusitis and bacterial, diagnostically confirmed pneumonia (laboratory, chest X-ray). In contrast, the prophylactic administration of an antibiotic rarely prevents complications of the deep airways. High-risk patients with chronic obstructive pulmonary and cardiovascular diseases or immunodeficiency as well as people on immunosuppressive therapy require antibacterial treatment at an early stage (22).
Colds are widespread and accompany people from cradle to grave. Viruses are the cause in 95 percent of cases. Since medicine, on the other hand, can still hardly do anything, only the symptoms can be treated effectively. Coughs, runny nose or hoarseness should be specifically treated. Well-stocked combination preparations that "aim in the dark" are not recommended.
Despite its banality, a flu-like infection should not be taken too lightly. Threatening complications are rare, but we shouldn't turn a blind eye to them.
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- Higgins, P.G., et al., The efficacy of intranasal interferon alpha-2a in respiratory syncytial virus infections in volunteers. Antiviral Res. 14, No. 1 (1990) 3-10.
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- Gwaltney, J. M. Jr., et al., Combined antiviral-antimediator treatment for the common cold. J. Infect. Dis. 186, No. 2 (2002) 147 - 154.
- Steimann, H., Zerfaß, A., Self-medication for colds. Basics and results of a dialogue program. Knowledge Verlagsges. Stuttgart 1991.
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- Brunner, C, Timmermann, C, home remedies and teas under the microscope. Govi-Verlag, Eschborn 2001.
- Prasad Ananda, S., et al., Duration of Symptoms and Plasma Cytokine Levels in Patients with the Common Cold Treated with Zinc Acetate. Ann. Intern. Med. 131, No. 4 (2000) 245-252.
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- Turner, R., et al., Efficacy of Tremacamra, a soluble intercellular adhesion molecule 1, for experimental rhinovirus infection. JAMA 281, No. 19 (1999) 1797-1804.
Sabine Schellerer studied pharmacy in Munich and received her license to practice medicine in 1993. From 1995 to 2000 she worked at the Institute for Forensic Medicine at the University of Munich on her doctorate and during this time also worked in public pharmacies. She then completed an apprenticeship as a trade magazine editor as well as internships in several publishing houses. Since the middle of last year, Dr. Schellerer works as a freelance science and medical journalist.
Dr. Sabine Schellerer
© 2003 GOVI-Verlag
Email: [email protected]
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