Diseases

Cold, Flu, Allergy Information

Cough

A cough is a common symptom of viral respiratory infections and allergies. A cough can also be caused by other conditions, some of them serious. For example, a cough can be a symptom of asthma, acid reflux into the esophagus (gastroesophageal reflux disease or GERD), sinusitis, postnasal drip, bronchitis, cigarette smoking, pneumonia, tuberculosis, hypersensitivity pneumonia (inflammation of the lung from exposure to certain environmental chemicals), and even lung cancer. Therefore, a persistent cough or a cough that is associated with chest pain, fever, weight loss, or blood-tinged or discolored sputum should be evaluated by a doctor.There are three types of cough medications available OTC for the temporary relief of cough due to a cold. They are oral cough suppressants, oral expectorants, and topical (externally applied) medicines.Oral cough suppressantsCodeine and hydrocodone are narcotic oral cough suppressants that require a doctor's prescription. Dextromethorphan is an oral cough suppressant that is available OTC. Dextromethorphan is chemically related to codeine and acts on the brain to suppress cough, but it does not have the pain-relieving and addictive properties of codeine. Diphenhydramine is another non-narcotic medication that acts on the brain to suppress cough. It is also an antihistamine.Dextromethorphan and diphenhydramine can be used to relieve a dry, hacking cough. They are not generally used to suppress a productive cough (when sputum is coughed up). Suppressing a productive cough impairs the clearing of secretions and mucous from the airways, which is generally undesirable. However, cough suppressants are sometimes used to suppress even productive coughs if they are especially bothersome and prevent restful sleep.Oral expectorantsGuaifenesin is an oral expectorant that is believed to increase the leaking of fluid out of the lung tissue and into the airways. This action thins (liquefies) the thick mucus in the airways and facilitates the clearing of the mucous by coughing. Clearing of mucous from the airways decreases cough.Topical medicationsCamphor and menthol are topical cough medications. Camphor and menthol ointments are rubbed on the throat and the chest as a thick layer. The anesthetic action of their vapors is believed to relieve cough. They are also available as products for steam inhalation. Menthol is also available as lozenges and compressed tablets.Examples of products in the cough category include the following:Cough suppressants: Buckley's Mixture, Diabe-Tuss DM, and St Joseph Cough Suppressant for Children and Delsym (effective for 12 hours)Expectorant: Hytuss, Robitussin, Mucinex, Duratuss G, Muco-FenTopical cough medicines: Hall's Mentho-Lyptus Cough Suppressant Drops, Mentholatum, Vick's VapoRub, and Vick's VapoSteamCough suppressant plus an expectorant and other cold/flu/allergy ingredients: Alka-Seltzer Plus Cold and Cough, Alka-Seltzer Plus Cold and Flu, Comtrex Deep Chest Cold & Congestion Relief, Coricidin HBP Cough and Cold Tablets, Dimetapp Cold and Cough Liqui-Gels Maximum Strength, PediaCare Cough-Cold Liquid and Chewable Tablets, Robitussin Maximum Strength Cough and Cold, TheraFlu Flu Cold and Cough Medicine, and Triaminic AM Cough and Decongestant formulaSince many of these combinations also contain an antihistamine, a decongestant, and an analgesic in addition to the cough suppressant and expectorant, they also provide relief of nasal congestion, sneezing, fever, and aches.In October 2000, an advisory panel of the U.S. Food and Drug Administration (FDA) recommended that phenylpropanolamine (PPA), an ingredient contained in many OTC and prescription cold medications as well as weight-loss products, be classified as unsafe because of reports of stroke associated with the ingredient. It was removed from OTC sale in 2005 in the U.S.

Facts about cold, flu, and allergy treatments

• The three classes of pain and fever treatments available over the counter (OTC) are aspirin, acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Antibiotics have no effect on viruses, which are the cause of colds and the flu. However, bacterial infections that can follow viral infections, for example, infections of the ears and sinuses, may be treated with antibiotics.
• Nasal decongestants (for example, pseudoephedrine, oxymetazoline, etc.) narrow the blood vessels in the nose, thereby preventing fluid from leaking and the lining from swelling. These can be used for short-term relief in older children and adults.
• Analgesic/antipyretic medications are often sold in combination with other ingredient(s) to treat cold/flu/allergy symptoms.
• Antihistamines are commonly used to block the histamine effect that causes the symptoms of an allergic reaction, including swelling, congestion, irritation, and itching. "First generation" antihistamines such as diphenhydramine (Benadryl) have been in use longer, are less expensive, and are more sedating (prone to cause drowsiness) than the newer, "second generation" antihistamines (fexofenadine [Allegra], loratadine [Claritin], etc.), which have minimal sedative effects.
• OTC antihistamines frequently are combined with a nasal decongestant and sometimes also with a cough suppressant or an analgesic. Generally, antihistamine preparations are not effective for cold symptoms.
• Codeine and hydrocodone are narcotic oral cough suppressants that require a doctor's prescription. Dextromethorphan (Tussin P) is an oral cough suppressant that is available OTC.
• Guaifenesin (Robitussin, Mucinex) is an oral expectorant that is used to increase the leaking of fluid out of the lung tissue and into the airways.
• There is no conclusive evidence that mega-doses of vitamin C prevent colds or decrease the severity and duration of cold symptoms.
• Aspirin-containing medicines should never be used for children and teenagers with influenza, chickenpox, or other viral illnesses.

Introduction to cold, flu, and allergy treatments

Millions of people use over-the-counter (OTC) products to relieve symptoms of cold, flu, and allergy, including nasal stuffiness and congestion, sneezing, runny noses, sore throat, and cough. The common causes of these symptoms include the viruses that cause the common cold, influenza virus, allergic rhinitis (hay fever), and sinus infections (sinusitis). Viral infections can also cause headache, body aches, fatigue, and sometimes fever. Hay fever symptoms can also include itchy eyes, nose, and throat, and watery eyes.To benefit from OTC products for cold, flu, and allergy, it is important to understand (1) the condition causing the symptoms, (2) the predominant symptom(s) one wishes to relieve, and (3) the active ingredient(s) in the product. Some OTC products contain a single active ingredient medication to relieve one symptom. Many others contain a combination of two, three, and even four active ingredient medications to treat several symptoms at once. Selecting the right product can be difficult at times.Here we have categorized products for cold/flu/allergy according to the predominant symptoms they relieve:

• Headaches, body aches, fever, and flu-like symptoms
• Nasal congestion, runny nose, and sneezing
• Cough
• Sore throat

Nasal congestion, sneezing, and runny nose

Nasal congestion, sneezing, and runny nose are common symptoms of a cold caused by a virus. The viruses that cause colds induce inflammation that increases the leakage of fluid from the blood vessels into the lining of the nose and even into the nose. This causes swelling of the lining of the nose, obstructing the flow of air, and a runny nose.Symptoms of hay fever, or allergic rhinitis, are caused by allergens. Allergens are tiny particles that cause cells in the lining of the nose and the airways of the lungs to release histamine and other chemicals. Histamine and these other chemicals are responsible for the leakage of fluid, runny nose, sneezing, and nasal congestion, as well as the itching of the eyes.Cold symptoms usually resolve in one to two weeks whether treated or not. Antibiotics have no effect on viruses, which are the cause of colds. However, bacterial infections that can follow viral infections, for example, infections of the ears and sinuses, may be treated with antibiotics. For the temporary relief of cold symptoms, plenty of oral fluids such as broth, chicken soup, and tea with lemon and honey and humidification of room air are safe remedies for people of all ages. Saline (salt and water) sprays and mists can also safely provide soothing moisture to dry, irritated nasal passages. In infants and young children, saline nose drops and clearing the nose with a nasal syringe can temporarily relieve nasal obstruction. Allowing infants and young children to sleep upright in car seats also improves the drainage of nasal secretions.For short-term relief of nasal congestion in older children and adults, nasal decongestants can be used. Nasal decongestants are chemicals (for example, pseudoephedrine, oxymetazoline, etc.) that narrow the blood vessels in the nose, thereby preventing fluid from leaking and the lining from swelling. As a result, the lining shrinks and the nasal passages open. Nasal decongestants can be used topically within the nose (nasal spray, solution, or mist) or can be taken orally (tablets, caplets, or gelcaps). Topical nasal decongestants act faster than the oral decongestants but have a shorter duration of action. Thus, more frequent dosing will be necessary. Oral nasal decongestants frequently are combined with an antihistamine, a cough suppressant, or an analgesic in treating cold/flu/allergy symptoms.The first step in preventing and relieving symptoms of allergy is to avoid the allergens, the particular substance that stimulates the allergic reaction. If avoiding allergens is not feasible or does not adequately control the allergic symptoms, antihistamines are commonly used to block the effect of histamines. Some of the antihistamines that are available OTC (diphenhydramine, chlorpheniramine, etc.) are called "first generation" antihistamines. These antihistamines have been in use longer, are less expensive, and are more sedating (more prone to cause drowsiness) than the newer "second generation" antihistamines (fexofenadine, loratadine, etc.), which have minimal sedative effects. OTC antihistamines frequently are combined with a nasal decongestant and sometimes also with a cough suppressant or an analgesic. Generally, antihistamine preparations are not effective for cold symptoms.The following are some examples of products in the nasal congestion, sneezing, and runny nose category:

• Saline solutions as nose sprays or mists: Nasal Moist Solution, Pediamist, Afrin Moisturizing Saline Mist, and Afrin Menthol Moisturizing Saline Mist
• Topical nasal decongestants as nasal sprays, mists and drops: Afrin Regular Nasal Spray, Afrin Nose Drops, Duration 12 Hour Nasal Spray, Neo-Synephrine Nasal Sprays, and Vicks Vapor Inhaler. Note: Decongestant nasal sprays can lead to a rebound worsening of nasal congestion and become habit-forming, especially if overused.
• Oral nasal decongestant: The only OTC decongestants available in oral form are phenylephrine (such as Sudafed PE) and pseudoephedrine (Contac Non-Drowsy, Sudafed, and Neo-Synephrine). Medicines that contain pseudoephedrine are limited to being sold behind the counter, even though you may not need a prescription to buy them.
• Oral antihistamine: Benadryl Allergy Chewables, Dramamine, Alavert, Claritin, Zyrtec, and Chlor-Trimeton Allergy Tablets
• Oral nasal decongestant combined with an oral antihistamine (may also contain an analgesic): Actifed Tablet, Chlor-Trimeton Allergy/Decongestant Tablets, Coricidin "D" Decongestant Tablets, Contac Continuous Action Nasal Decongestant/Antihistamine 12 Hour Capsules, Dimetapp Tablets and Liqui-Gels, Sinutab Sinus Allergy Medication Maximum Strength Formula Tablets and Caplets, Sudafed Cold and Allergy Tablets, Tylenol Flu Nighttime Medication Gelcaps, Allegra Tablets and oral suspension, Claritin Tablets and RediTabs, Claritin-D, and Vick's NyQuil Hot Therapy

Sore throat and other symptoms

Viruses are the most common cause of sore throat. A sore throat caused by a cold virus usually resolves in one to two weeks without treatment. On the other hand, a sore throat caused by the Streptococcus bacterium (strep throat) should be treated with antibiotics to prevent damage to the heart valves and other complications of strep infection. Generally, Streptococcus bacteria cause a more severe sore throat and a higher fever than viral sore throats, but it is not always possible to distinguish the two without laboratory testing. Sneezing, runny nose, and cough more frequently accompany sore throats due to a cold virus, rather than Streptococcus infections. Sometimes, a throat culture or other lab test is necessary to establish the cause of the sore throat.Medications that are available OTC for the temporary relief of sore throat due to the common cold usually contain anesthetics such as benzocaine and dyclonine or menthol and come in the form of lozenges, gargles, and sprays. Children often prefer popsicles, ice cream, yogurt, pudding, smoothies, or other cool/soft foods in lieu of traditional medications. Aside from their analgesic effects, these foods also provide some nutritional benefit.Examples of sore throat medications include Cepacol Sore Throat Maximum Strength and Sucrets sore throat lozenges.