Cold Comfort . . . Not!

No doubt about it: We’re in the throes of cold and flu season. Sniffles, coughs, sneezes, headaches, scratchy throats, loss of appetite, stuffy heads, and occasional vomiting can leave us feeling wretched for days to weeks on end. The youngest sufferers are especially miserable.

In any year, the average child will develop six to eight colds. Although young children can run fevers and become seriously dehydrated during such infections, they frequently fight parents trying to administer palliatives in the form of liquids, mentholated vapors, and chicken soup. Further frustrating parents, over-the-counter medicines show little efficacy for children under 12.

Indeed, James A. Taylor at the University of Washington’s Child Health Institute is frustrated by the lack of drugs available to the preschool set. He’s coauthored two studies investigating the value of over-the-counter and prescription cough suppressants and cold medicines in young children. “And in neither study could we show any efficacy,” he says.

For instance, his team’s March 1997 paper in the Journal of Pediatrics showed that in children 5 and under, a popular antihistamine-decongestant combo (brompheniramine maleate and phenylpropanolamine hydrochloride) proved no better than an inert placebo in reducing runny nose, nasal congestion, and cough.

No wonder parents panic when a child’s cold gets bad. During the winter, some 40 percent of pediatrician visits for children 5 and younger are for coughs and colds, Taylor and his colleagues observe. Roughly one-third of upper-respiratory infections eventually develop complications, from earaches to pneumonia, they point out.

The inability of conventional medicine to prevent dangerous complications probably explains why parents of some 11 to 21 percent of U.S. and Canadian children explore alternative therapies, Taylor’s team points out.

The researchers decided to investigate one class of herbal medicine touted as a cold treatment–commercial preparations made from plants in the Echinacea family, which appear to reduce the length and severity of colds in adults. The University of Washington group used a sweet syrup containing Echinacea purpurea, a native coneflower species. Says Taylor, “We really thought we had a pretty good chance of showing a positive effect [with echinacea].”

However, the product proved no better at curtailing or reducing the severity of a child’s symptoms than did just sweet syrup containing no medication, his team reports in the Dec. 3 Journal of the American Medical Association. The researchers conclude: “Our results do not support the use of echinacea for treatment of upper-respiratory infections in children 2 to 11 years old.”

Immune to treatment

Taylor’s team recruited some 500 children–all 11 or younger–from Seattle-area pediatricians’ practices and from Bastyr University in suburban Kenmore, Wash., an alternative-medicine center. Parents were given bottles of medicine during the winter and then asked to notify the researchers during the next 4 months whenever their child developed at least two head cold symptoms. The medical professionals also regularly contacted each family to inquire about possible symptoms.

Whenever a child was sick, the researchers authorized parents to start administering syrup at a prescribed dose. Neither the researchers nor the parents knew during the trial which families had received the echinacea-laced syrup.

The researchers had asked parents not to give their children any additional medication for colds except acetaminophen, unless a child’s physician specifically prescribed something else. Nevertheless, parents did use additional cold remedies–usually over-the-counter decongestants and antihistamines–for about 35 percent of the infections.

When a cold developed, parents logged the symptoms and severity of a child’s illness every day that it lasted. Overall, the Washington team collected full data for 707 upper-respiratory infections that occurred among 407 of the youngsters. Later analyses would show that 370 of the infections had been treated with plain syrup and the rest with the Echinacea formulation.

Prior to the start of the study, the researchers calculated that their study had at least an 80 percent chance of detecting notable benefits from echinacea, if they exist. However, they now report: “Despite multiple subanalyses, we did not find any group of children in whom echinacea appeared to have a positive effect.” There was no significant difference between the two groups of children even in the length of their fevers or number of days for which their colds were most severe.

Moreover, 7 percent of the kids receiving echinacea developed a rash–more than twice the rash incidence within the plain-syrup group. This, the researchers say, suggests that rash “was actually an adverse effect of treatment with echinacea.” Two children getting the echinacea syrup also developed stridor–a harsh vibratory sound during breathing–that required a trip to an emergency room and treatment with oral steroids. Both individuals were excused from further participation in the trial.

Aside from that

The study’s authors say that it’s possible the echinacea syrup didn’t work simply because it was given too long after a cold set in or the amount administered was too small.

In the past, other researchers have shown that many herbal products don’t even deliver the ingredients promised by the label. For instance, earlier this year, Christine M. Gilroy of the University of Colorado Health Sciences Center reported an analysis of 59 commercial echinacea products from Denver-area stores. None, it turned out, contained quite what was printed on the label. For instance, six products contained no echinacea, 28 lacked the particular species listed, and some products included quantities of the herbal ingredient that fell substantially below what was promised.

That was not the case here, Taylor told Science News Online. “We did an analysis to make sure that the product was a reasonably pure preparation of Echinacea purpurea.”

However, research has shown that even when an herbal ingredient is present, it’s precise chemical constituents can vary widely owing to how and where the herb grew, weather while it grew, and even aspects of how a plant was harvested and processed into a commercial product (see SN: 6/7/03, p. 359: Herbal Lottery). Taylor’s group concedes that since no one knows which of the plant’s constituents might be active against colds, the study couldn’t verify whether the echinacea syrup contained any anti–head cold ingredient in an optimal amount.

The University of Washington researchers did uncover one “intriguing” sign of an echinacea benefit: The chance of contracting a subsequent cold appeared somewhat diminished among children getting the herbal syrup for their first cold during the study. Only about half of kids getting echinacea syrup came down with a second cold, whereas 64 percent of children getting the plain syrup did.

It’s conceivable, Taylor notes, that echinacea stimulated an infection-fighting immune response that revved up too late to make a difference in the youngsters’ first head cold but conferred some protection against a future infection. In fact, his team cites a study showing that an 8-week course of echinacea prevented head colds in a mostly adult group.

To follow up on this aspect of the new study, Taylor says the team is looking for funding for a study of cold prevention in kids.

For now, the pediatrician says, when worried parents come in asking how to treat babies with serious head colds, “we don’t have anything to offer them other than what their grandmothers told them to use.” Pull out those vaporizers and start cooking up some chicken broth.