How to Prevent the Common Cold

Avoid / Cure A Cold Fast

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Inhaled Corticosteroids For Asthma And Allergic Rhinitis

The following agents are also available in nasal inhalers for the treatment of allergic rhinitis. Details are provided below for the mode of metabolic inactivation involved for each of these products. Although all of these agents have much lower systemic effects than the oral steroids, some systemic effects, as measured by suppression of the hypo-thalamic-pituitary-adrenal (HPA) axis, have been observed for these products. Ciclesonide (2006) and fluticasone furoate (Veramyst, 2007), with a 17-furoate in place of the 17-propionate, were both also recently approved for treating allergic rhinitis.

Therapeutic Uses Of Muscarinic Receptor Antagonists

RESPIRATORY TRACT These drugs reduce secretion in both the upper and lower respiratory tracts. This effect in the nasopharynx may provide symptomatic relief of acute rhinitis associated with coryza or hay fever. The contribution of antihistamines employed in cold mixtures is likely due to their antimuscarinic properties, except in conditions with an allergic basis.

Respiratory complications

NSAIDs may aggravate asthma and reversible airway disease.54 Up to 10-20 percent of the general asthmatic population has hypersensitivity to aspirin and there is as much as 98 percent cross-reactivity with NSAIDs in those patients, but only 7 percent with paracetamol.55 This may cause severe exacerbation of asthma and naso-ocular reactions. Approximately half of this group is steroid dependent.56 This risk is highlighted in publications such as the British National Formulary.57 Other respiratory risk factors include nasal polyps and rhinitis.58 The NSAIDs

Asthmaas An Inflammatory Illness

Asthma is associated with inflammation of the airway wall. Increased numbers of various types of inflammatory cells, most notably eosinophils but also basophils, mast cells, macrophages, and certain types of lymphocytes, can be found in airway wall biopsies and in bronchoalveolar lavage fluid from asthmatic patients. Inflammatory mediators and various cytokines also are increased in the airways of asthmatic subjects compared with healthy control subjects. How bronchial inflammation contributes to the asthmatic condition remains poorly understood. Even asthmatics with normal baseline lung function and no recent exacerbations of their asthma have increased numbers of inflammatory cells in their airways. Conversely, many individuals allergic to inhaled allergens have evidence of lower airway inflammation but suffer only from the symptoms of allergic rhinitis. Many individuals with asthma are atopic and have clearly defined allergen exposures that are partially or substantially...

Nervous system vasculitis secondary to drugs and substance abuse

Recreational drug abusers are known to have higher incidences of coexisting infections, such as hepatitis B, HIV, and syphilis, all independently associated with nervous system vasculitides. However, CNS vasculitis secondary to drug and substance abuse has been histologically verified in users of cocaine, amphetamines and related drugs such as phenylpropanolamine, metamphetamine, and methylphenidate, as well as in abusers of multiple drugs unrelated to such infections.22,41,59 Phenyl-propanolamine, which was present in appetite suppressants and in some over-the-counter cough and cold remedies, was recently reported to be an independent risk factor for haemorrhagic stroke in women in a case-control study.60 Subsequently, the FDA issued a public health advisory concern on this risk, and many products containing phenyl-propanolamine were withdrawn from the market. However, the relationship between this vasoconstrictor drug and cerebrovascular events, including

Apnea Of Preterm Infants

Use of Asthma Drugs in Rhinitis Seasonal allergic rhinitis (hay fever) is caused by deposition of allergens on the nasal mucosa, resulting in an immediate hypersensitivity reaction. This reaction usually is not accompanied by asthma because the allergenic particles are too large to be inhaled into the lower airways (e.g., pollens). Treatment for allergic rhinitis is similar to that for asthma. Topical glucocorticoids, including beclomethasone (beconase), mometasone (nasonex), budesonide (rhinocort), flunisolide (nasarel), fluticasone (flonase), and triamcinolone (nasacort), can be highly effective with minimal side effects, particularly if treatment is instituted immediately prior to the allergy season. Topical glucocorticoids can be administered twice daily (beclomethasone and flunisolide) or even once daily (budesonide, mometasone, fluticasone, and triamcinolone). Cromolyn usually requires dosing three to six times daily for full effects. Rare instances of local candidiasis have...

Brain To Body Central Nervous System Effects On The Immune System

Although the relationship between stress and immunity is quite complex, more acute and or mild stressors, in general, tend to be associated with activation of immune responses, whereas more chronic and intense stressors tend to be associated with activated innate immune system elements and impaired acquired immune system responses. The health relevance of these stress-related immune changes has been demonstrated in studies that have shown an association between chronic stress and increased susceptibility to the common cold, reduced antibody responses to vaccination, and delayed wound healing (Cohen et al. 1991 Glaser et al. 1992 Kiecolt-Glaser et al. 1995). In addition, stress, as well as depression, has been linked to increased morbidity and mortality in infectious diseases (e.g., HIV infection), neoplastic diseases (including breast cancer and malignant melanoma), diabetes, and cardiovascular disease (Evans et al. 2005 Fenton and Stover 2006 Leserman et al. 1999 Raison and...

Uses of the PCR in research and clinical diagnosis

It is often important clinically to be able to detect incredibly low levels of a particular sequence of DNA in patient samples. An example of this is the detection of HIV, a virus that is not detectable by conventional methods in the circulation but which is detectable by the PCR using specific oligonucleotide primers to the viral DNA. This is now used on a regular basis as a rapid and sensitive method for HIV screening in genitourinary clinics and provides results more rapidly than the conventional method of immunological screening (Markham, 1993). The PCR also has been used to detect the measles virus RNA in brain biopsy specimens from patients with subacute sclerosing panencephalitis (Markham, 1993) and for the detection of herpesvirus DNA in the aqueous humour of uveitis patients, in whom it has been used for confirmation of the clinical diagnosis of viral uveitis (Yamamoto et al., 1996). The PCR has also been employed in the diagnosis of upper respiratory tract infections caused...

B aAdrenoceptor Agonists as Nasal Decongestants

Vasoconstriction of blood vessels in the nasal mucosa has long been recognized as an important approach to relieving nasal congestion accordingly, systemic or topical administration of a vasoconstrictor can produce nasal decongestion. Selective a1-adrenoceptor agonists, such as phenylephrine and naphazoline, nonselective (i.e., mixed a1- a2) a-adrenoceptor agonists, such as tetrahydrozoline, and even relatively selective a2-adrenoceptor agonists, such as oxymetazoline, are currently employed for this indication.

Antiallergic Benefit of Marine Algae in Medicinal Foods

Tis, and allergic rhinitis has increased during the past two decades and contributed a great deal to morbidity and an appreciable mortality in the world. Until now, few novel efficacious drugs have been discovered to treat, control, or even cure these disorders with a low adverse-effect profile. Meanwhile, glucocorticoids are still the mainstay for the treatment of allergic disease. Therefore, it is essential to isolate novel antiallergic therapeutics from natural resources. Recently, marine algae have received much attention as they are a valuable source of chemically diverse bioactive compounds with numerous health benefit effects.

Treatment of asthma with antileukotrienes

In addition to the effects of anti-leukotrienes on the lower airways, there is also evidence that cysteinyl leukotrienes are involved in some if not all manifestations of rhinitis. Accordingly, both when allergen has been applied topically or when subjects have been exposed to naturally occurring allergens, the nasal reactions have been attenuated by anti-leukotrienes 301-303 , Interestingly enough, in one study of aspirin-intolerant asthmatics, evidence was also provided that anti-leukotrienes caused a return of smell in subjects otherwise suffering from chronic loss of smell 296 ,

The Fc2 3PE40 chimeric protein a possible treatment for allergy responses

About 20 of the world population suffers from various allergic diseases such as asthma, allergic rhinitis, food allergies, atopic dermatitis and anaphylaxis. The alarming increase in the prevalence of these diseases over the past decade has led to a clear need for more effective therapeutic strategies.

Wegener Granulomatosis 3 Cases

Summary This article challenges readers with a series of three cases of Wegener granulomatosis, a form of necrotizing systemic vasculitis that commonly involves the upper airways, lungs, and kidneys. The pathogenesis of the disease resembles an infectious process, but no pathogen has been isolated. Wegener granulomatosis most likely occurs secondary to a hypersensitivity response to an exogenous or endogenous antigen that enters or resides in the airways. The authors describe diagnostic criteria, occurrence, treatment, and outcome before exploring the three illustrative cases. The kidney involvement is typically focal necrotizing glomerulitis. The extent of disease involvement dictates treatment the standard treatment is the cytotoxic drug cyclophosphamide and the glucocorticoid prednisone. High doses are initiated when the disease is diagnosed. After 4 weeks, the prednisone dose is slowly tapered and eventually discontinued after 3 to 4 months. The cytotoxic agent is continued for at...

Brief Mechanism About Asthma

FceRI is located on the surfaces of basophils and mast cells, which act as effector cells in IgE-mediated immune responses (Kinet, 1990). FceRI is composed of four subunits one p-chain, one a-chain, and two disulfide-linked g-chains. Most of the a-chain extends into the extracellular region, where it binds directly and with high-affinity to the Fc portion of IgE antibodies thus, the a-chain is the most important component of the FceRI molecule (Hakimi et al., 1990). The cross-linking of FceRI with allergen-IgE complexes causes the release of inflammatory mediators such as histamine, leukotrienes, and prostaglandins from activated basophils and mast cells, which contributes to the allergic responses in asthma, atopic dermatitis, allergic rhinitis, and food allergies (Drombrowicz et al., 1993 Gauchat et al, 1993 Metzer, 1991 Yanagihara et al., 1997).

Psychological Effects Of Immune Activation In Humans

Acute infectious illness, such as influenza, upper respiratory tract infections, gastroenteritis, Epstein-Barr virus, and cytomegalovirus, are associated with a range of depressive symptoms, including fatigue, psychomotor retardation, anorexia, somnolence, lethargy, muscle aches, cognitive disturbances, and depressed mood (Hickie & Lloyd, 1995). The evidence for these alterations is mainly anecdotal and only few studies examined these symptoms systematically. Experimentally-induced viral infections (e.g., common cold, influenza) are associated with decreased psychomotor performance of simple reaction-time tasks and memory impairments (Smith, Thomas, Brockman, Kent, & Nicholson 1993 Smith,Tyrrell, Al-Nakib, Coyle, Donovan, Higgins, & Wiliman, 1987 Smith,Tyrrell, Al-Nakib, Coyle, Donovan, Higgins, & Willman, 1988). In addition, they are often associated with long term psychiatric effects, particularly depression. Experimentally-induced influenza (but not infections with coronavirus or...

Clinical Studies of S5751

A proof-of-concept (POC) study (phase 2 study) of a first-in-class drug, S-5751, was carried out in patients with allergic rhinitis, because PGD2, through DP1, has been reported to be a potent elicitor of nasal congestions in humans, and S-5751, a DP1 antagonist showed excellent efficacy in an allergic rhinitis model. To evaluate the efficacy of this drug for treating allergic rhinitis, a double-blind, placebo-controlled phase 2 study was conducted in more than 600 patients with seasonal allergic rhinitis. However, clear efficacy was not seen in either the total nasal symptom score or other secondary endpoints such as nasal congestion and sneezing. It was considered that one of the reasons why efficacy was not shown may have been because the efficacy was masked by a high placebo effect due to a much lower pollen count in the year of the study than in a typical year. To minimize the placebo effect, we conducted a subanalysis of the clinical study by limiting the study population to...

Generalized Anxiety Disorder

Head-to-head comparisons between paroxetine and other medications in the treatment of GAD are sparse. One such study compared paroxetine 20-50 mg day with escitalopram 10-20 mg day (Bielski et al. 2005). Although there was no significant difference in efficacy between the two medications, as measured by the Ham-A, the authors noted considerably higher rates of adverse events, leading to withdrawal from the trial, in patients treated with paroxetine compared with those treated with escitalopram (22.6 vs. 6.6 ). Treatment-emergent side effects recorded more frequently with paroxetine therapy included insomnia, constipation, ejaculation disorder, anorgasmia, and decreased libido. Conversely, diarrhea and upper respiratory tract infection were more common with escitalopram than with paroxetine. One possible explanation for the divergence in dropout rates may be the seeming disparity in dose ranges between the two medications. Paroxetine was titrated to high-normal doses (between 30 and 50...

Development of Second Generation DPI Antagonist

Based on nonclinical and clinical studies with S-5751, we concluded that the failure to obtain clear efficacy with S-5751 was due to its inadequate DP1 antagonistic action, particularly in the presence of albumin, and insufficient plasma concentration to show a maximum effect in humans even at the highest dose used in clinical studies. To overcome the shortcomings of S-5751, a second-generation DP1 antagonist, S-555739, was successfully produced at Shionogi Research Laboratories through structure-activity relationship studies, using several lead compounds with nonprostanoid skeletons. Preclinical studies have demonstrated that S-555739 shows more potent and selective DP1 antagonistic activity, with a much better pharmacokinetics (PK) profile than S-5751. Pharmacological studies in several allergic disease models have shown that S-555739 is far superior to S-5751 in suppressing allergic symptoms such as nasal congestion and inflammatory cell migration. In addition, GLP toxicology...

Glucocorticoids With Very Little Or No Salt Retention

Beclomethasone dipropionate, (Beconase, QVAR), is used in nasal sprays and aerosol formulations to treat allergic rhinitis and asthma (see section on page 863). Mometasone Furoate, USP. Mometasone furoate, jS (Elocon), is a high-potency GC available in cream, lotion, or ointment formulations for topical use. In addition, mometasone furoate monohydrate is formulated for treating allergic rhinitis and asthma (see following section). Triamcinolone acetonide is approximately 8 times more potent than prednisone in animal inflammation models. Topically applied triamcinolone acetonide is a potent anti-inflammatory agent (see Table 25.7), about 10 times more so than triamcinolone. The plasma half-life is approximately 90 minutes, although the plasma half-life and biological half-lives for GCs do not correlate well. The hexacetonide is slowly converted to the acetonide in vivo and is given only by intra-articular injection. Only triamcinolone and the...

Endogenous Catecholamines

Midodrine And Desglymidodrine

The ability of epinephrine to stimulate jS2-receptors has led to its use by injection and by inhalation to relax bronchial smooth muscle in asthma and in anaphylactic reactions. Several OTC preparations (e.g., Primatene, Bron-kaid) used for treating bronchial asthma use E. It is also used in inhibiting uterine contraction. Because of its a-activity, E is used to treat hypotensive crises and nasal congestion, to enhance the activity of local anesthetics, and as a constrictor in hemorrhage.

Botanical Polysaccharides as Adjuvants

In contrast to the adjuvant properties described previously botanical polysaccharides have, in some cases, been reported to attenuate immune responses and have been proposed as promising agents for the treatment of IgE-dependent diseases (e.g., atopic dermatitis, asthma, atopic rhinitis, urticaria and food allergies). For example, Danilets and co-workers 297 studied the effects of water-soluble polysaccharides isolated from six different plants on anaphylactic shock and production of IgE and IgG1 by lymphocytes from mice immunised with OVA. They found that treatment with polysaccharides from coltsfoot, sweet flag, clover, Artemisia, marigold and elecampane reduced animal mortality after induction of anaphylactic shock. In addition, injection of these polysaccharides reduced serum concentrations of IgE and IgG1 297 . Likewise, pectins have been reported to exhibit antiallergic activity, resulting in a suppressed allergic asthmatic reaction in animals treated with doses of 5-12 mg kg...

Asthma GPCR Pharmacogenomics

The CysLT1 receptor has been associated with atopic asthma in at least one geographically isolated population resident on Tristan da Cunha. This is intriguing from the point of view of personalized medicine because drugs that act as high-affinity antagonist ligands of the CysLT1 receptor (e.g., montelu-kast, pranlukast, zafirlukast) (168-176) or allergic rhinitis (177) have been reported to be ineffective in approx. 20 of patients (178). The discovery that there are at least four CysLT1 transcripts generated by alternative splicing contributed further to the heterogeneity and should be examined in conjunction with the SNP data (179).

Chemical Structure Of Oxytetracycline

Oxytetracycline Molecule

Perhaps the most outstanding property of minocycline is its activity toward Gram-positive bacteria, especially staphylococci and streptococci. In fact, minocycline has been effective against staphylococcal strains that are resistant to methicillin and all other tetracyclines, including doxycycline.186 Although it is doubtful that minocycline will replace bactericidal agents for the treatment of life-threatening staphylococcal infections, it may become a useful alternative for the treatment of less serious tissue infections. Minocycline has been recommended for the treatment of chronic bronchitis and other upper respiratory tract infections. Despite its relatively low renal clearance, partially compensated for by high serum and tissue levels, it has been recommended for the treatment of

Dibenzocycloheptenes And Dibenzocycloheptanes

Cyproheptadine possesses both antihistamine and anti-serotonin activity and is used as an antipruritic agent. It is indicated for the treatment of hypersensitivity reactions, perennial, and seasonal allergic rhinitis vasomotor rhinitis allergic conjunctivitis, uncomplicated allergic skin manifestations of urticaria and angioedema amelioration of allergic reactions to blood or plasma and cold urticaria. It is also used off-label for nightmares associated with posttraumatic stress disorder (PTSD), prevention of migraine, suppression of vascular headaches, and appetite stimulation. Sedation is the most prominent side effect, and this is usually brief, disappearing after 3 or 4 days of treatment.

Clinical Use Of Vasopressin Peptides

V2 receptor-mediated therapeutic applications are based on the rationale that V2 receptors cause water conservation and release of blood coagulation factors. Central DI can be treated with V2 receptor agonists, and polyuria and polydipsia usually are well controlled. While some patients experience transient DI (e.g., in head injury or surgery in the area of the pituitary), therapy for most patients with DI is lifelong. Desmopressin is the drug of choice for the vast majority of patients and is efficacious and well-tolerated in both adults and children. A single intranasal dose lasts from 6 to 20 hours twice-daily administration is effective in most patients. There is considerable variability in the intranasal dose of desmopressin required to maintain normal urine volume, and the dosage must be tailored individually. The usual intranasal dosage in adults is 10-40 mg day, either as a single dose or divided into two or three doses. In view of the high cost of the drug and the importance...

Pharmaceutical Chemistry Of H2 Antagonist Drug

Evolution Antagonist

The recommended dose of ketotifen solution is 1 drop instilled into each affected eye every 8 to 12 hours. The most frequently reported adverse reactions are conjunctival infection, headaches, and rhinitis. This drug product is for ocular administration only and not for injection or oral use. Ketotifen solution should be used with caution during pregnancy or while nursing, because its safety has not been studied under these circumstances.58

Marine microalgae and their antiallergic properties

Microalgae are considered as the actual producers of some highly bioac-tive macromolecules in marine resources, including carotenoids, long-chain polyunsaturated fatty acids, proteins, chlorophylls, vitamins, and unique pigments (Kay, 1991). Thus, they have been used as additives in a variety of human foods and animal feeds. Ingestion of various edible microalgae not only supplies protein and other nutrients but also modulates both adaptive and innate aspects of immunity (Price et al., 2002). Indeed, Spirulina was determined to decrease IgE antibody level, and increased IgG1 and IgA antibody production in the serum of the mice immunized with crude shrimp extract as an antigen (Hayashi et al., 1998). In a clinical trial, Spirulina consumption resulted in the significant amelioration in symptoms and physical findings of allergic rhinitis patients compared with placebo (Cingi et al., 2008). The clinical effect of Spirulina on allergic rhinitis was determined due to inhibiting the...

Drug Discovery from the

The Spanish company PharmaMar (Madrid, Spain) has launched Yondelis (trabectedin ET-743), a three-fused tetrahydroisoquinoline ring member of the ecteinascidins isolated from the Caribbean tunicate Ecteinascidia turbinata, for the treatment of soft tissue sarcomas Marinomed (Vienna, Austria), an Austrian biotech company, has received market authorization for a marine biopolymer, Car-ragelose, to treat the common cold and the Israeli company Elan Pharmaceuticals (Dublin, Ireland) has received market authorization for Prialt (ziconotide) which, being a peptide, is a novel nonopioid, nonlocal analgesic, developed for the treatment of severe chronic pain (see Fig. 4 for chemical structures of these compounds).

Efficacy of S5751 in Allergic Diseases in Animal Models

First of all, we evaluated the effect of S-5751 on PGD2-induced increase in intranasal pressure in a guinea-pig model. Similar to reports in humans, in guinea pigs nasal airway resistance was immediately increased by PGD2 application to the nose, and this was almost completely suppressed by orally administered S-5751 at 1 mg kg, suggesting that PGD2-induced nasal blockage is mediated via DP1 10 . To clarify the role of PGD2 in the onset of allergic rhinitis and the potential of a DP1 antagonist to be developed as a drug for treating allergic rhinitis, the efficacy of S-5751 was evaluated in an allergic rhinitis model and compared with that of an antihistamine, terfenadine 9 . In patients with allergic rhinitis, nasal antigen challenge causes not only early-phase responses characterized by sneezing, rhinorrhea, and nasal blockage but also late-phase responses characterized by nasal blockage occurring several hours later in approximately 50 of the patients, with accompanying...

Scutellaria lateriflora L

Skullcap is one of the primary nerve tonics used in Western herbal medicine. A number of different species native to North America were used for various purposes by a large variety of tribes. In addition to its nervine properties, skullcap has also been used for colds, rabies, and as an antispasmodic. Different species of Scutellaria can be traded and sold as skullcap. A complete microscopic examination of these species is lacking. A different plant germander (Teucrium spp.), which is a potential hepato-toxin, is more readily found as an adulterant of skullcap. For a differentiation between Scutellaria lateriflora and Teucrium, see the table at the end of this section.

Antiviral Agents 6121 Viral Diseases

A number of diseases of man are of viral origin. These include poliomyelitis, common cold (rhinovirus), influenza, hepatitis A and B (liver disease), herpes simplex (cold sores), rubella and measles, papillomas (warts) and the human immunodeficiency virus (HIV-AIDS). A virus The immune system in the body may recognize the surface glycopro-teins on the virus. Antibodies are formed which encapsulate and expel the virus. Vaccination uses an attenuated or weakened form of the virus, which nevertheless stimulates the formation of the relevant antibodies. The immune system is then prepared to cope with an invasive attack from the 'wild-type' virus. The consequences of the immune reaction include the fever and rhinitis associated with viral infections.

Other Sympathomimetics

Several sympathomimetic drugs are used primarily as vasoconstrictors for local application to the nasal mucous membrane or the eye propylhexedrine (benzedrex, others), naphazoline (privine, naphcon, others), oxymetazoline (afrin, ocuclear, others), and xylometazoline (otrivin, others) see Table 10-1 . Ethylnorepinephrine (bronkephrine) is a b agonist that is used as a bron-chodilator the drug also has a agonist activity, which may cause local vasoconstriction and thereby reduce bronchial congestion. Phenylephrine (see above), pseudoephedrine (sudafed, others) (a stereoisomer of ephedrine), and phenylpropanolamine are sympathomimetics used most commonly in oral preparations for the relief of nasal congestion. Pseudoephedrine is available without a prescription in a variety of solid and liquid dosage forms. Phenylpropanolamine shares the pharmacological properties of ephedrine and is approximately equal in potency except that it causes less CNS stimulation. The drug has been available...

Macroalgae As Potential Antiasthmatic Agents

2,4 9-trihydroxydibenzo-1,4-dioxin were assessed by histamine release by human basophilic and rat basophilic leukemia cells and showed increased activities against them (Le et al., 2009). Eisenia arborea, edible brown seaweed, has been used as a folk medicine for allergic disease for centuries by Koreans and Japanese. In a study, several bioactive phlorotannin compounds have been isolated from E. arborea and evaluated for antiallergic activities (Sugiura et al., 2007). Phlorotannin compounds inhibited p-hex-osaminidase released from basophilic leukemia (RBL-2H3) cells in their study. Moreover, the compounds showed higher activity (IC50 7.8 p.M) than that of Tranilast (IC50 46.6 mM), a pharmaceutical agent used for the treatment of inflammation disorders including asthma, allergic rhinitis, and atopic dermatitis in Japan and Korea. Results revealed that they are potential agents to prevent the effect through various modes of actions. Further, preliminary investigation with the dried...


Berger et al.20 at Novartis reported optimization work on phenylethylamino quinazolines as inhibitors of human immunoglobulin E (IgE) synthesis. Based on the observation that high levels of IgE have been found in allergic diseases such as asthma and rhinitis, the authors focused on the development of compounds set to block the endogenous synthesis of IgE. This work began with 132, a hit produced during a high-throughput screening campaign.


Sometimes a tablet is coated with an 'enteric coating' such as cellulose acetate, which dissolves at a pH greater than 5.8. This prevents the tablet decomposing until after it has left the acidic regions of the stomach. The coating of a tablet may also provide a slow release form of the drug. Some drugs have a rapid onset of action and rapid excretion. Multiple doses over short time intervals may be required in order to maintain an effective concentration in the blood stream and yet avoid high toxic levels. This has been overcome by using a slow-release form of coating. For example, pseudoephedrine dries up the rhinitis in the symptoms of the common cold. However, too much taken at one time could have a serious effect on heart rate. Giving this drug in a slow-release capsule allows the effect on the rhinitis to last for upto 12 h while minimizing the harmful side effect.


Since the US government's ban on ephedra-based products, there has been an obvious decline in its prevalent use in that country. However, patients may still present for pain evaluation with a history of use of ephedra or be taking related compounds, many of which are readily available and possess potent dose-dependent increases in heart rate and in blood pressure. Ma huang, an ephedra-based alkaloid, is similar in structure to amphetamines and is traditionally indicated for the treatment of various respiratory disorders such as the flu, common cold, allergies, and bronchitis. Additionally, it is commonly used as an appetite suppressant (Hughes et al. 2004). Ma huang or ephedra acts as a sympathomimetic agent and exhibits potent positive inotropic and chronotropic responses. In addition to its antitussive actions, ephedra may also possess bacteriostatic properties (Kaye et al. 2000). As a cardiovascular and respiratory sympathomimetic, it utilizes an a-adrenergic or -adrenergic...


Echinacea, a genus of flowering plants including nine species that grow in the USA, is a member of the daisy family. Three species are found in common herbal preparations Echinacea angustifolia, Echinacea pallida and Enchinacea purpurea. Native-American Indians considered the plant a blood purifier. In the USA, echinacea is used in oral dosage as an immune stimulant that helps increase resistance to cold and influenza. Fresh herb, freeze-dried herb and the alcoholic extract of the herb are all commercially available. The ability of oral echinacea preparations to prolong the time of onset of an upper respiratory infection, was compared with placebo in 302 volunteers from an industrial plant and several military institutions. Although subjects felt better after taking echinacea, there was no statistically significant difference with regard to the time of onset of upper respiratory tract infection.76 Another study also examined the efficacy of echinacea in preventing colds and upper...

Diet Preparation

Access to a small kitchen on or near the inpatient unit is ideal for accommodating this process. Simple ketogenic meals should be taught initially to minimize food preparation and to facilitate learning. Ketogenic diet education should also include a session on appropriate vitamin and mineral supplementation and a list of carbohydrate-free health care products such as toothpastes, pain relievers, and cold remedies.


In a prospective, multicenter cohort study of 3981 patients in 103 primary care practices with additional specialization in homeopathy in Germany and Switzerland, Witt et al.61 III found that there were marked and sustained improvements in disease severity and quality of life during the two-year study period using homeopathic treatment. The most frequent diagnoses treated were allergic rhinitis in men, headache in women, and atopic

The Future

In the anti-infective area, increase in resistance to established antibiotics will require that new drugs be developed. The HIV pandemic and resulting AIDS syndrome have opened the door to a host of opportunistic infections. Exacerbated by HIV, tuberculosis is having a savage effect on the lives of millions of people, and new drugs are needed to combat resistant strains (Zhang et al., 1992). The incidence of malaria is increasing (Brown, 1992) and we badly need a new generation of drugs for this disease. We still have no drug at all to treat the common cold, and only a poor and limited therapy for influenza. Macromolecular targets have already been identified for all these diseases. In the developed countries, we are seeing a frightening increase in pulmonary disease asthma, bronchitis and rhinitis. Certain peptides (the tachykinins) are known to be involved as mediators of the inflammatory response in these conditions the primary structures of tachykinins are known, and some...

Oral zinc

The use of zinc lozenges within 24 h of the onset of cold symptoms and continued every 2-3 h while awake until symptoms resolve has been advocated for reducing the duration of the common cold. At least ten controlled trials of zinc gluconate lozenges for the treatment of common cold in adults have been published. Five trials found that zinc lozenges reduced the duration of cold symptoms,66 70 while five trials found no difference between zinc lozenges and placebo lozenges with respect to the duration or severity of cold symptoms.71 75 Of the two placebo-controlled trials that examined the effect of zinc acetate lozenges, one found that their use significantly shortened the duration of cold symptoms,76 while the other found no difference between zinc acetate and placebo lozenges.71 Despite numerous well-controlled clinical trials, evidence that zinc lozenges are effective in reducing the duration or severity of common cold symptoms is still lacking.77

Intranasal zinc

Intranasal zinc preparations designed to be applied directly to the nasal epithelium are also marketed as over-the-counter cold remedies. While two placebo-controlled trials found that intranasal zinc gluconate modestly shortened the duration of cold symptoms when started 24-48 h after the onset of symp-toms,78,79 two other placebo-controlled studies of intranasal zinc found it to be of no benefit.80,81 Of concern are several case reports of persistent loss of the sense of smell (anosmia) in individuals who used intranasal zinc as a cold remedy.82,83 Since zinc-associated anosmia may be irreversible, zinc nasal gels and nasal sprays should be avoided.

Local Delivery

Antihistamines and corticosteroids for allergic rhinitis (2), as well as decongestants for nasal cold symptoms. A few examples of low-molecular-weight drugs that have extensive use in this area include the anticholinergic agent ipratropium bromide (3), and steroidal anti-inflammatory agents such as mometasone furoate (4), budesonide (5), beclomethasone (6), and triamcinolone (6).


60 mL minute 1.73 m2 Pregnancy see notes above Breast-feeding see notes above Side-effects see notes above also flatulence, hyper-triglyceridaemia, arthralgia, rhinitis rarely headache, asthenia, anaemia, hypersensitivity reactions (including rash, pruritus, urticaria) very rarely nausea Dose

Therapeutic Uses

Except for adenovirus, IFN has broad-spectrum antiviral activity against respiratory viruses. However, prophylactic intranasal IFN-a is protective only against rhinovirus colds, and chronic use is limited by nasal side effects. Intranasal IFN is ineffective in established rhinovirus colds.

Vitamin C

As discussed previously, vitamin C or ascorbic acid is an essential water-soluble vitamin for all humans and functions as an antioxidant and cofactor in enzyme and hormonal reactions. It has been promoted as increasing immunity, thereby preventing and reducing colds. However, studies have yet to support this long-standing theory. It does play a major role in cartilage and collagen formation, in regulation of iron absorption and storage, and in immune system protection. Vitamin C scavenges free radicals (by donating electrons) and regenerates other biological antioxidants (such as glutathione and a-tocopherol vitamin E ). The body does not store vitamin C because it is water-soluble, although the body does have small tissue storage pools up to 2,000 mg. Excess intake is excreted and, in times of low dietary intake, the body will conserve vitamin C by minimizing excretion.7

Ch2cnhch2cooh O

From a clinical standpoint in using these Hi antagonists in the treatment of allergic rhinitis, urticaria in the early part of the pollen season (when the count is still low), these drugs seem highly effective with little or no adverse effects. As the pollen count rises and the period of exposure becomes protracted, symptoms are not as well controlled for instance, the rhinorrhea, nasal itching, nasal obstruction, and sinus congestion increase. The earlier low doses of antihistamines satisfactorily performed a balancing act between antagonizing the effects of moderate levels of released histamine and the unwanted drowsiness (and mucosal dryness). As the level of released histamine increases (due to greater allergic challenge), those low doses become inadequate. Simply increasing these doses is not satisfactory since the adverse anticholinergic and sedative effects may reach unacceptable levels the balance of effects achieved before is lost. A partially successful solution is the...



Propylhexedrine (Benzedrex) is another analog of amphetamine in which the aromatic ring has been replaced with a cyclohexane ring. This drug produces vasoconstriction and a decongestant effect on the nasal membranes, but it has only about one half the pressor effect of amphetamine and produces decidedly fewer effects on the CNS. Its major use is for a local vasoconstrictive effect on nasal mucosa in the symptomatic relief of nasal congestion caused by the common cold, allergic rhinitis, or sinusitis. Ephedrine decomposes gradually and darkens when exposed to light. The free alkaloid is a base, and an aqueous solution of the free alkaloid has a pH above 10. The salt form has a pKa of 9.6. Ephedrine and its salts are used orally, intravenously, intramuscularly, and topically for various conditions, such as allergic disorders, colds, hypotensive conditions, and narcolepsy. It is used locally to constrict the nasal mucosa and cause decongestion and to dilate the pupil or the bronchi....

Oseltamivir Tamiflu

Oseltamivir, a second-generation oral neuramidinase inhibitor, is widely used for the treatment and prevention of influenza A and B viral infections, including avian flu. Influenza is a serious respiratory illness that affects millions of people annually ( seasonal flu ) and results in many deaths as well as an estimated 10 billion in lost productivity. The symptoms of flu and the common cold are similar, but flu symptoms are generally more severe. Older people and those with a weakened immune system are especially at risk to develop complications such as bronchitis and pneumonia which are the main causes of influenza-related deaths. In recent years a more virulent influenza A type virus, the avian flu, has emerged. Certain strains of the avian flu (e.g., H5N1) are able to infect humans and cause high mortality. Since the effective treatment of the various flu infections has traditionally been difficult due to the lack of potent antiviral drugs, the possibility of a catastrophic...

Undecylenic Acid

For RNA viruses, replication in the host cell relies either on enzymes in the virion (the whole infective viral particle) to synthesize its mRNA or on the viral RNA serving as its own mRNA. The mRNA is translated into various viral proteins, including RNA polymerase, which directs the synthesis of more viral mRNA and genomic RNA (Figure 49-1B). Most RNA viruses complete their replication in the cytoplasm, but some, such as influenza, are transcribed in the host cell nucleus. RNA viruses include rubella virus (German measles), rhabdoviruses (rabies), picornaviruses (poliomyelitis, meningitis, colds, hepatitis A), arenaviruses (meningitis, Lassa fever), flaviviruses (West Nile meningoencephalitis, yellow fever, hepatitis C), orthomyxoviruses (influenza), paramyxoviruses (measles, mumps), and coronaviruses (colds, severe acute respiratory syndrome SARS ).

OTYPES of herbs

The medicinal herb that we call echinacea, or the purple coneflower, is indigenous to the Great Plains of the United States and, indeed, can be found in much of the Western Hemisphere. The plant gets its name (coneflower) from the narrow florets, which project downward in a conical array from a prominent center toward a substantial stem that bears one flower. Today, the herb is used as an immunostimulant,17 as a means of lessening the symptoms and duration of a cold or the flu, and sometimes as a wound healer. Recent reports show that echinacea is the best-selling herb in the United States.3 Folklore18 tells us that Native Americans used E. angustifolia to treat superficial wounds, snakebite, and the common cold. In the latter part of the 19th century, settlers exchanged information about medicines with the Indians and added echinacea to their own pharmacopoeia. Echinacea even became one of the first patent medicines, sold by a huckster in Missouri at midcentury. In the early 1900s,...


Adrenergic agents act on adrenergic receptors (adrenocep-tors, ARs) or affect the life cycle of adrenergic neurotransmit-ters (NTs), including norepinephrine (NE, noradrenaline), epinephrine (E, adrenaline), and dopamine (DA). These NTs modulate many vital functions, such as the rate and force of cardiac contraction, constriction, and dilation of blood vessels and bronchioles, the release of insulin, and the breakdown of fat. Therefore, adrenergic drugs constitute a broad class of agents, including albuterol (a bronchodilator), atenolol (an antihypertensive), and many common over-the-counter (OTC) cold remedies (Table 16.1). This chapter examines the biochemical basis for adrenergic action, adrenoceptors and then discusses the agents that affect the synthesis, storage, uptake, metabolism, or release of the adrenergic NTs and especially those that act directly on the various types of adrenoceptors.

Nonopiate Analgesics

Aspirin produces irreversible platelet aggregation, a concern if surgery is anticipated in the near future. Other salicylates (e.g., choline magnesium tri-salicylate, salsalate) have fewer GI side effects and less effect on bleeding time. Reye's syndrome is associated with aspirin use in children who have a viral illness (varicella). Aspirin hypersensitivity is of two types one involving respiratory reactions (observed in patients with rhinitis, asthma, or nasal polyps), and the second involving rapid development of urticaria, angioedema, hypotension, shock, or syncope.