Conventional Treatment of common Upper Respiratory Disorders
Treatment of uncomplicated cases of common upper respiratory disorders includes: bed rest, plenty of fluids, gargling with warm salt water, petroleum jelly for a raw nose, and aspirin or acetaminophen to relieve headache or fever (16). However any medication used for the elderly should be monitored carefully, as over-the-counter drugs are more likely to cause adverse effects in elderly individuals.
Symptomatic treatment include:
|•||Decongestants (Alpha adrenergic agonists): These substances are potent decongestants and have been long used for treating the common cold. Both oral and nasal forms proved effective in natural and experimental cold models. These drugs are not without hazards, as prolonged use can lead to a rebound effect (rhinitis medicamentosa) (17,18).
They may relieve some cold symptoms but does not prevent, cure, or even shorten the duration of illness. Care needs to be taken in patients with hypertension because of the sympathomimetic effect of these drugs.
|•||Cough suppressants (codeine and dextromethorphan), Codeine is contraindicated in pregnancy as it may pose a risk to the fetus. Doctor should be consulted before taking any medication while pregnant.
Moreover, most have some side effects, such as drowsiness, dizziness, insomnia, or upset stomach, and should be taken with care.
|•||Antihistamines: They may have some effect in relieving inflammatory responses such as runny nose and watery eyes that are commonly associated with colds.
Antihistamines are H1 and H2 receptor antagonists. They prevent antigens acting on the membranes of basophil cells. This prevents the release of histamine, which causes the symptoms typical of allergies, and similar to those of the common cold. However, it has been shown that histamine is not present in increased concentrations in people with upper respiratory tract infection (cf. allergic rhinitis). It is suggested that if antihistamines do alleviate cold symptoms, the effect may be due to their atropine-like action on the nasal mucous membranes rather than the antagonism of histamine receptors (19).
|•||Analgesics: Acetaminophen (Tylenol), ibuprofen (Advil) and (aspirin) may be used to reduce fever. Do not give aspirin to anyone under 18 years age during a viral infection due to an increased risk of Reye's syndrome, a potentially life-threatening disorder.
Reye's syndrome is a rare but serious illness that usually occurs in children between the ages of three and 12 years. It can affect all organs of the body, but most often injures the brain and liver. While most children who survive an episode of Reye's syndrome do not suffer any lasting consequences, the illness can lead to permanent brain damage or death.
Aspirin as well as other non-steroidal anti-inflammatory drugs has been suggested to increase nasal symptoms and virus shedding and decrease serum neutralizing antibody response in volunteers infected with rhinovirus (20,21).
|Cyclo-oxygenase inhibitor: Naproxen was found to reduce headache, malaise, and cough without altering virus shedding or antibody responses in experimentally induced rhinovirus colds (22).|
|•||Steam inhalation: Recent studies found that this approach had no effect on the symptoms or amount of viral shedding in individuals with rhinovirus colds. But steam may temporarily relieve symptoms of congestion associated with colds. Breathing in steam from a bowl or jug is widely believed to ease the soreness and discomfort of a cold. Nasal hyperthermia (420-440C) administered for natural or experimental common colds resulted in subjective improvement of symptoms and objective increased nasal patency in some patients (23,24,25,26).|
|•||Antibiotics: These prescription drugs do not have antiviral effect. People receiving antibiotics did not do better in terms of cure or improvement than those on placebo There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics and there is a significant increase in adverse effects associated with antibiotic use and should be used only for bacterial complications, as intensive antibiotic therapy might be indicated in acute and chronic sinusitis after culture and sensitivity test of the post -nasal discharge to choose the proper antibiotic. Antibiotic solution irrigations are used when purulent drainage begins in cases of atrophic rhinitis. Mucosal moisturizers are indicated to prevent crusting (27,28).|
|•||Interferon-alpha has been studied extensively for the treatment of the common cold. Investigators have shown interferon, given in daily doses by nasal spray, can prevent infection and illness. Interferon, however, causes unacceptable side effects such as nosebleeds and does not appear useful in treating established colds (29).|
|•||Cold vaccine: The development of a vaccine that could prevent the common cold has reached an impasse because of the discovery of many different cold viruses. Each virus carries its own specific antigens (substances that induce the formation of specific protective proteins "antibodies" produced by the body). Until ways are found to combine many viral antigens in one vaccine, or take advantage of the antigenic cross-relationships that exist, prospects for a vaccine are dim. Evidence that changes occur in common-cold virus antigens further complicates development of a vaccine. Such changes occur in some influenza virus antigens and make it necessary to alter the influenza vaccine each year. The vaccine may, sometimes cause side effects, especially in children who previously have not been exposed to the flu virus. The most common side effect in children and adults is soreness at the site of the vaccination. Others include fever, tiredness and sore muscles that may begin 6 to 12 hours after vaccination and may last for up to 2 days. Viruses for vaccine production are grown in chicken eggs and then inactivated with a chemical so that they are no longer infectious. People who are allergic to eggs should not receive flu vaccine since some egg protein may be present in the vaccine.|
|•||Antiviral treatment: Some influenza virus infections have been successfully treated with drugs such as amantadine, rimantadine, and zanamivir. On the other hand, several studies using antiviral drugs against rhinovirus colds showed no appreciable clinical benefit. 10% of people on amantadine experience side effects like depression, dizziness, nausea, and insomnia and rapid development of resistance during treatment (30,31,32,33).|
|•||Vitamin C: The vitamin may reduce the severity or duration of symptoms, but there is no definitive evidence (34).|
Alternative Treatment of Common Upper Respiratory Disorders
The use of and search for drugs and dietary supplements derived from plants have accelerated in recent years. Ethnopharmacologists, botanists, microbiologists, and natural-products chemists are combing the different phytochemicals that could be of help for the treatment of immunodeficiency and infectious diseases. Drugs derived from plants are used to treat conditions ranging from arthritis to leukemia and ovarian cancer. Some of today's treatments use herbs directly. Researchers also are studying a variety of foods for their potential medicinal benefits. More and more consumers are buying herbal medications in the form of food supplements to use as analgesics, sedatives, or immune system stimulants. Although a few plants may cause serious adverse reactions, many herbal preparations are considered to be safe and effective in moderation (39).
Extensive study on the present state of herbal medicine in Germany showed that phytotherapeutic drugs (herbal remedies) are of considerable importance in Germany, both in self-medication and in medical prescriptions. The Federal Health Office of the German Ministry of Health has officially evaluated the efficacy and safety of approx. 300 medicinal plants used in Germany; their evaluations are used as criteria for the permission to market phytotherapeutic drugs (40).
The American Association of Poison Control Centre, Toxic Exposure Surveillance System was manually and computer searched over a ten-year period (1983-92) to prioritize plant exposures by frequency. The data were analyzed using descriptive statistics and it has been concluded that the most common plant exposures are not significant morbidity or mortality (41).
Studies showed that temporary weakening of the immune defense system lowers the body resistance to common cold and influenza viruses and cause most upper respiratory tract infections. Similarities in symptom presentation for upper respiratory tract infection of different viral etiology reflect a generalized profile of proinflammatory cytokine elaboration.
The local immune response to different viral infection causing common upper respiratory tract infection was studied through determining the cytokines and chemokines levels in serial nasal lavage fluid samples, from volunteers experimentally infected with influenza virus. It has been found that Interleukin (IL-6), tumor necrosis factor alpha (TNF- ), interferon gamma (IFN- ), and proinflammatory chemokines are increased in response to influenza viruses. These cytokines are responsible for inducing inflammation, recruiting and stimulating other immune components, and generally induce an inhospitable environment for the virus.
IL 10 has been also found to be increased in the nasal lavage and is responsible for the balance of the immune response to stop inflammatory fulmination. The cytokine and chemokine level correlated statistically with the magnitude and time course of symptoms. It was concluded that there is a complex interplay of cytokines and chemokines in the development of symptoms and resolution of influenza.
The fact that IL-10 inhibits macrophage production of TNF- and IL-6, establishes IL-10 as a major anti-inflammatory cytokine and suggests that its production early in influenza virus infection is an important mechanism by which the body controls and limits inflammation induced by such infection. It is also able to act as a terminal differentiation factor for B cells. This leads to the suggestion that IL-10 plays a role in the B cell response to influenza antigen and thus helps drive the protective antibodies that evolve during and after infection (42).
Recent studies have documented a link between respiratory viral infections and the expression of asthma and other allergic disorders. Results from other studies have suggested that diminished production of IL-10, an anti-inflammatory cytokine, may contribute to the patho-physiologic features of these diseases.
IL-10 production was significantly diminished in subjects with allergy, as compared with subjects with no allergy, after experimental infection with influenza A virus. It has been concluded that subjects with allergy have an intrinsic inability to up-regulate IL-10 production in response to inflammatory stimuli and extend this observation to include respiratory viral infections (43).
Thus cell-mediated immunity (CMI) has been shown, over many decades of clinical observation and bench research, to be central to the outcome of invasive infections. In recent years, understanding the role of messenger molecules (cytokines) in coordinating and augmenting cellular immunity has been ascendant. These studies have made it possible to use herbal remedies that stimulate the natural production of cytokines by the patient's blood monocytes and thus augment the cellular immunity of the body to fight various types of infections. This function of some herbal ingredient made it possible to be used in treating infections in humans, even for immunocompromised (immunodefecient) patients. Recent experimental work has lead to a better understanding of the role of cytokines and importance in therapy (44).
Cytokines also play a role in treating patient with upper respiratory allergic reactions. Experimental laboratory work showed an increase in IL-10 and IFN-gamma expression in the bronchial lavage of allergic patients with asthma treated with cortisone was corresponding to the degree of improvement of their allergic state. It has been concluded that cortisone relieves the bronchial allergic reaction through their stimulatory effect on cytokine expression such as IL-10 and IFN-gamma. This observation made it essential to consider the herbs that simulate the action of cortisone regarding the production of such cytokines in treating patients with allergy (45). Experimental studies showed data that support the role of IL-10 as a key modulator in the inhibition of the contact hypersensitivity response by whole body (46).
The Scientists of Dermamed Pharmaceutical Company, being always enthusiastic, about finding a solution for the common health problems that affect most of the people, they formulated their unique completely natural medication for the prophylactic and therapeutic treatment of common upper respiratory tract infections. The prophylactic or therapeutic use of this formulation enhances the specific and non-specific immune system (immunomodulatory) in a mode that makes it capable of enhancing the natural body defence against various types of infections. In addition to its immunomodulatory function it helps the protection of the respiratory tract against infection through its marked inhibitory effect on viral, bacterial and fungal infection by adding the herbal extracts that are considered to be the most abundant source of a wide variety of secondary metabolites, such as tannins, terpenoids, alkaloids, and flavonoids, which have been found in vitro and in vivo to have antimicrobial properties (47).
Dermamed formulation for cold and sinusitis is the only medication, in the drug market, that can act both as immunomodulatory and antimicrobial in the same time. It is a combination of plant extract preparations that can act synergistically in different directions i.e. enhancing the specific and non- specific immune system and in the mean time inhibit the replication of any viral, bacterial or fungal infection.
The efficacy of the herbal extract preparations used for this formulation has been assessed by many immunological in vitro- and in vivo-experiments that were done by investigators at many sites of the world. The existing controlled studies on humans and in vitro experimental studies have shown positive results. Adverse effects and possible health risk of the active natural ingredients used in this medication have not been reported so far.
The most noteworthy features observed after using dermamed formulation are:
|•||Diminution of recurrent infections.|
|•||Reduction of the duration of a disease.|
|•||Significant reduction of the seriousness of most of the symptoms associated with the upper respiratory tract disorders whether infectious or allergic.|
The Goal of PhytoCort Cold and Sinus Treatment:
|1.||Stimulates the natural production of cytokines by the patient's blood monocytes and thus augment the cellular immunity of the body to fight various types of infections and in the same time keep the body's immunobalancing state through the production of the immunoregulatory cytokines such as IL-10 and IL-4 which stops any inflammatory fulmination even for immunocompromised patients.|
|2.||Stimulates the production of cytokines, IL-10 and IFN-gamma, which helps relieving the allergic reactions and thus exhibits quick, long lasting effect in relieving seasonal allergic rhinitis symptoms|
|3.||Exhibits antiviral effect via stimulation of the interferon alpha, beta-production|
|4.||Enhances the production of specific antibodies against the viral infection and activates the complement system.|
|5.||Inhibits viral, bacterial and fungal replication with secondary broad-spectrum effect on the upper respiratory tract infections and thus stops complications such as sinusitis, tonsillitis, otitis media and bronchitis.|
|6.||Reduces the common symptoms associated with upper respiratory tract infection through its anti-inflammatory, analgesic and antipyretic activity as well as its relaxing effect on the tracheal smooth muscles. It also relieves the sinusitis symptoms such as headache, pressure pain at nerve exit points, and irritating cough through its secretolytics effect.|
|7.||Exhibit muscle and mental relaxing effect without interfering with the cognitive performance.|
|8.||Exhibits free-radical scavenging property.|
|9.||Inhibits the cytopathogenic effects induced by human immunodeficiency virus and thus considered helpful as alternative treatment for AIDS patients with oropharyngeal Candidiasis refractory to conventional anti-fungal treatment.|
|10.||It is well tolerated, showing absence of any adverse side effect.|
|11.||It is cost effective and has long shelf life.|
The strategy of Dermamed Scientists in formulating their completely natural medications is:
|1.||The use of a combination of active herbal ingredients that proved by different experimental and clinical studies to be safe and effective in correcting the different aspect of the pathological factors involved in causing the corresponding disease.|
|2.||The use of the minimum effective dose of each active ingredient to avoid the side effects of any of them if ever exists.|
|3.||Each active ingredient acts on one or more of the pathological factors by the same or different mechanism but without interfering with each other's mode of action (act synergistically) and thus augment the benefit of each ingredient without using unnecessary high dose of any of them.|
|4.||The final development of new therapeutic interventions for the common upper respiratory tract disorders based on the increasing patho-physiological knowledge about the role of viruses and the antiviral immune response in common respiratory infection and the role of immune system in allergic disorders.|
The herbal active ingredients include: Echinacea, Luffa Operculata, Eucalyptus, Solidago Virgaurea, Gnaphalium Viscosum, Mentha Piperita, Linden, Lavandula Vera, Maritime Pine, Rosemary, Melaleuca alternifolia, Ocimum basilicum, Atropa belladonna, Phytolacca Americana, Populus Tremula, Melissa Officinalis and Chamomile.
Echinacea Purpurea is a plant that was originally used by Native Americans to treat respiratory infections and is now widely used in some European countries and the USA for upper respiratory tract infections. On the German market there are at present more than 200 preparations obtainable which contain extracts of Echinacea alone or in combination with other plant extracts (48).
Purified root extracts from Echinacea Purpurea has revealed biological activity in different immunological and virological test systems. It exhibits different activity on immunological parameters, such enhancing the specific and non-specific immune system. An antiviral activity to influenza virus was also observed. The Echinacea Purpurea extracts have shown an indirect antiviral effect via stimulation of the interferon alpha, beta-production (49). It contains many Immunologically active constituents such as: polysaccharides, glycoproteins, caffeic acid derivatives (cichoric acid) and alkamides (50).
The analysis of alkamides in the roots of Echinacea Purpurea (L.) showed nine major alkamides in addition to other minor alkamides (51). Roots are distinguished from other plant parts by higher levels of the C12 diene-diyne alkamides (52).
Many studies have been done to evaluate its ability to stimulate the production of cytokines by normal human peripheral blood macrophages in vitro. Different concentrations of Echinacea were tested. Macrophages cultured in concentrations of Echinacea as low as 0.012 mug/ ml produced significantly higher levels of IL- 1, TNF-alpha, IL-6 and IL-10 (P < 0.05) than un-stimulated cells. The high levels of IL-1, TNF-alpha, and IL-10 induced by very low levels of Echinacea are consistent with an immune activated antiviral effect. These results demonstrate the immune stimulatory ability of the Echinacea Purpurea extract and offer some insight into the nature of the resulting immune response (53,54).
Various investigators have postulated that the Echinacea extract is capable of stimulating cytokine production that can bind to specific receptors on the microbial target cells, and call into play many other cells and substances, including the elements of the inflammatory response and thus it can direct cellular traffic to destroy the microbial target cells, and stimulate the phagocytosis of the disintegrated viral particles by the activated macrophage. In the same time it stimulate the production of IL-10 which has immunoregulatory (immunobalancing) function as it is vital for orchestrating the whole immune system by suppressing the immune response after reaching the desirable effect and keeping it from going out of control by turning the helper T cells off and thus can stop any fulminating inflammatory response (55). It is also a potent modulator of monocyte / macrophage function as it significantly enhances the natural killer (NK) -function of peripheral blood mononuclear cells both from normal individuals and patients with depressed cellular immunity (56).
Studies also showed antifungal effect for Echinacea extract as it has been found to increase the in vitro phagocytosis of Candida albicans by granulocytes and monocytes from healthy donors by 30-45% (57).
The Echinacea extract has also significant ability to enhance the antibody response to antigenic stimulation (58). The previous study has been confirmed by clinical trial, which has showed that the Echinacea-treated patients have significant augmentation of their primary and secondary IgG response to the antigen. The results suggested that medicinal plants like Echinacea might enhance immune function by increasing antigen-specific immunoglobulin production (59).
A recent clinical trial on 108 patients has been done to investigate the effect of using Echinacea in cold and respiratory infection, 54 patients were taking the Echinacea extract and 54 patients were taking placebo. The average number of colds and respiratory infections per patient was 0.78 in the Echinacea group, and 0.93 in the placebo group. Median duration of colds and respiratory infections was 4.5 days in the Echinacea group and 6.5 days in the placebo group. The study showed more incidence and severity of the cold and the respiratory infections in the placebo group than in the Echinacea group, despite reporting the result as statistically non- significant which may be due to the small number of patients (60).
Another recent double blind, placebo controlled study was done to investigate the efficacy and safety of different doses and preparations of Echinacea Purpurea in the treatment of common cold. 246 recruited healthy, adult volunteers caught a common cold. The primary endpoint was the relative reduction of the complaint index defined by 12 symptoms during common cold according to the doctor's record. All treatments were significantly effective and well tolerated. It has been concluded that it is low-risk and effective alternative to the standard symptomatic medicines in the acute treatment of common cold (61).
The efficacy of Echinacea in the treatment of Rhinorrhea has been proved by many other experimental studies and clinical trials and it has been concluded that they demonstrated high efficacy in acute viral respiratory tract infections and infections requiring antibiotics therapy and Echinacea containing preparation demonstrated therapeutic superiority over placebo (62).
Clinical trial has been done to test the effect of the Echinacea extract on children with chronic decompensated tonsillitis due to immunodeficiency diseases. Positive effect has been found on the clinical and immune indices and also on state of microcirculation, which gives ground to advise the formulation containing the extract for the treatment of children with this disorder (63).
In one systemic review some investigators searched the Cochran Acute Respiratory Infections Group and Complementary Medicine Field's trials registers, MEDLINE, EMBASE, PHYTODOK and reference lists of articles. They also contacted researchers and manufacturers. The results suggested that the majority of the available studies reported positive results (64).
Animal experiments proved that the extract is non-toxic and tests for mutagenicity carried out in microorganisms and mammalian cells in vitro and in mice all gave negative results (65).
Luffa Operculata (Cucurbitaceae)
The names Luffa operculata (L.) is applied to the Central American indigenous species of Luffa. Bryonolic acid is a pentacyclic triterpene isolated from Luffa genus (Cucurbitaceae) and has been found to have anti-allergic activity that is comparable to other known antiallergic components. It has been tested in experimental animals and has demonstrated high ability to inhibit passive cutaneous anaphylaxis and delayed hypersensitivity more strongly than other compounds. In addition it showed not only little toxicity but also no visible side effects on mice, without impairment of the activity of the hepatic enzymes involved in steroid catabolism (66). Intracellular localization of bryonolic acid was investigated with reference to the sites of its biosynthesis and accumulation. The results of cell fractionation showed that bryonolic acid was mostly located in the cell wall fraction (67).
Experimental studies showed that bryonolic acid (3-beta-hydroxy-D: C-friedo-olean-8-en-29-oic acid) is found exclusively in the roots of the intact plants and it has been postulated that it could be a potential source of pharmacologically active compounds (68).
More than 150 volatile components were separated and thirty-seven components were identified and quantified. The contents of essential oil were 0.05%, 0.05%, and 0.08% on a dried weight base in leaves, stem, and seeds respectively. Seed oils obtained from Luffa genus are widely abundant in palmitic (C16: 0), oleic (C18: 1) and linoleic (C18: 2) acids (69).
However linoleic acid has been found to be the major component of most of the oils and has marked anti-inflammatory activity due to arachidonate inhibition (70).
Twenty-six components of normal hydrocarbons in leaves, stem, seed, and unripe fruit were separated (71).
Luffa ribosomal inhibitory protein isolated from Luffa genus has been studied and found to show moderate but significant antiviral activity. Studies showed that HIV replication was inhibited at doses in which they were non-toxic to uninfected peripheral blood mononuclear cells (72,73).
The therapeutic success of medication containing Luffa operculata has been demonstrated in a controlled randomized double blind trial, carried out by 47 physicians in private practice with in total 152 patients with acute and chronic sinusitis. Criteria for the therapeutic result were headache, blocked nasal breathing, trigeminal tenderness, reddening and swelling of nasal mucosa and postnasal secretion. Averaged over all four groups 81% of the patients with acute sinusitis and 67% of the patients with chronic sinusitis recovered (74).
Recently the efficacy and safety of homeopathic medication, containing Luffa operculata has been confirmed by other investigator in another open study of 119 male and female patients, 12 to 57 years of age, with the clinical sings of acute sinusitis not previously treated. At the first visit, after a mean of 4.1 days of treatment, secretolysis had increased significantly and typical sinusitis symptoms, such as headache, pressure pain at nerve exit points, and irritating cough, were reduced. Ninety-nine patients received only the test medication. Twenty patients were able to discontinue concomitant medication at the first visit. Only one patient needed an antibiotic. The average treatment duration was 2 weeks. At the end of treatment, 81.5% of patients described themselves as symptom free or significantly improved. Adverse drug effects were not reported (75,76,77).
A clinical study to investigate the efficacy and tolerance of a homeopathic nasal spray containing Luffa operculata in cases of hay fever (seasonal allergic rhinitis) in comparison with the conventional intranasal cromolyn sodium therapy has been made on 146 outpatients with symptoms of hay fever. The results of the study demonstrated a quick and lasting effect of the homeopathic treatment, which produced a nearly complete remission of the hay fever. Adverse systemic effects did not occur. It has been concluded that, for the treatment of hay fever, the homeopathic nasal spray is as efficient and well tolerated as the conventional therapy with cromolyn sodium (78).
Eucalyptus sp. is considered among the most frequently used medicinal plants in Mexico and many other countries (79). It is considered a rich source of biologically active compounds. Among these, are the phloroglucinol compounds such as sideroxylonals, macrocarpals, euglobals, and robustadials, which are unique to Eucalyptus species. Macrocarpals, which consist of phrologlucinol and sesquiterpene, shows very strong antibacterial activity against gram -positive bacteria. Both Macrocarpals and euglobals have also antiviral activity (80,81).
The essential oils of Eucalyptus globules were also tested on bacteria that could cause secondary infection of viral upper respiratory tract infection and can also cause complications such as acute bronchitis, pneumonia, sinusitis, otitis media and conjunctivitis (ascending infection of the lachrymal canals) e.g. Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, Streptococcus pyogenes. The study showed that these oils presented antimicrobial activity and produced inhibition zone larger than 12 mm diameter. These results proved that eucalyptus extract exhibits strong in vitro antibacterial activity against the tested microorganisms (82,83,84).
The essential oils of eucalyptus have been found to have broad-spectrum antifungal activity against many human pathogenic fungi (Microsporum nanum, Trichophyton mentagrophytes and T. rubrum. On comparing the minimum effective concentration of the oil with those of prevalent synthetic antifungal drugs, the oil was found to be more effective. These oils, showed maximum effect, and were found to be cost effective, had long shelf life, and showed absence of any adverse side effects (85).
Eucalyptus extract exhibits anti-inflammatory effects, which is dose dependent and this, affirm its traditional use in inflammatory conditions (86). It has the ability to ameliorate the inflammatory processes of various infectious diseases by interacting with aggressive oxygen free radicals that accompany or initiate the pathogenesis of inflammatory processes. These activities partially allow attenuation of oxidative attack and damage introduced by infections or environmental impacts (87).
Polycyclic aromatic hydrocarbons and phenolic fractions were isolated from eucalyptus extract was tested for genotoxicity evaluation, the results achieved showed no genotoxic effects (88). Eucalyptus oil poisoning through oral oil ingestion has been also studied in childhood and it has been concluded that eucalyptus oil was less toxic compound than it was previously believed (89)
Eucalyptus-based drugs have been tried successfully in the treatment of common cold and flue-like symptoms (90).
It has been also tried in children with acute maxillary sinusitis, exacerbation of chronic purulent maxillary sinusitis and paratonsillar abscess. The findings indicate a good anti-inflammatory effect and it has been concluded that it can be used as a treatment of choice in children with ENT diseases (91).
Solidago Virgaurea L
The common golden rod, Solidago virgaurea L., has been used in European phytotherapy for 700 years as an antiphlogistic remedy (92,93).
The steam-distilled essential oil of Solidago virgaurea L. was investigated by Gas chromatography. Sixty components were identified. The main constituents are alpha-pinene, myrcene, beta-pinene, limonene, sabinene and germacrene-D (94).
Genuine saponins of Solidago virgaurea have been investigated in view of their immunomodulating effect. It has been found that it increases TNF alpha concentration in blood when compared to the control group (95). Experimental work has been done on aqueous-ethanolic extracts from Solidago virgaurea and it demonstrated that it has also the ability to regulate the biochemical reactions involved in various inflammatory processes (96).
S. Virgaurea extract could be useful as antifungal preparation against dermatophytes, especially against Trichophyton mentagrophytes, Microsporum gypseum and Microsporum canis (97).
Aqueous/alcoholic extracts of Solidago virgaurea were tested on experimental animals and found to be capable of reducing the inflammation and secondary edema (98). It has been found to produce dose-dependent anti-inflammatory, analgesic and antipyretic effects, which simulates the efficacy of non-steroidal anti-inflammatory drugs (99).
A methanol extract of the flowers of Gnaphalium showed significant anti-inflammatory activity. Caffeoylquinic acid derivatives and flavonol glycosides were isolated as the compounds responsible for this activity (100).
Gnaphalium viscosum of American origin, have been used for the treatment of respiratory ailments. Preliminary in vitro results provide scientific basis for the use of this plant against bacterial respiratory infections (101).
Laboratory studies showed that it exhibited antibacterial activity. Gnaphalium viscosum was screened for activity against 3 bacteria, which cause respiratory infection (Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes). The results proved the antibacterial activity of the extract (102,103).
Mentha Piperita L
Mentha x Piperita L. (Lamiaceae) has been known for a long period as a medical plant, and its therapeutic effects were mostly attributed to the composition of its essential oil. In addition to the essential oil, it is known that M. x Piperita contains some other pharmacologically active ingredients as well, such as tannins, bitter substances, caffeic acid and flavonoids (104).
Peppermint leaves contained 2.4% essential oil, total polyphenolic compounds 19% and total flavonoid compounds 12% (105). The volatile oil of mature Mentha Piperita (peppermint) leaves contains as major components the oxygenated p-menthane monoterpenes l-menthol (47%) and l-menthone (24%) as well as very low levels of the monoterpene olefins limonene (1%) and terpinolene (0.1%), which are considered to be probable precursors of the oxygenated derivatives (106).
Mentha Piperita leaves is considered also as an inexpensive and easily obtained sources of provitamin A, which is a precursor of vitamin A which is known of its protective effect on the various mucous membrane, including that of the respiratory tract, against infection with various microbes (107).
Earlier studies proved that Oils of, Mentha Piperita, have fungistatic or fungicidal effect, depending upon the concentrations (108).
Many animal experimental studies have been done on Mentha Piperita and investigators concluded that it possess an anti-nociceptive (reduces the sensitivity of the nerve endings to pain sensation) and anti-inflammatory property. Both effects were dose dependent. These data affirm the traditional use of some of these plants for painful and inflammatory conditions (109).
Compared to the application of placebo, 10 % peppermint oil in ethanol solution significantly reduced the clinical headache intensity after 15 minutes (p < 0.01). The clinical trial showed no significant difference between the efficacy of 1000 mg of acetaminophen and 10% peppermint oil in ethanol solution. The patients reported no adverse events. Peppermint oil thus proved to be a well-tolerated and cost-effective alternative to usual therapies (110,111).
Clinical trial on the combined effect of peppermint oil in ethanol and eucalyptus oil preparations has been conducted. Studying their effect on both physiological and neuro-physiological parameters has been evaluated in 32 healthy subjects in a double blind, placebo-controlled, randomized crossover design. It has been found that the combination can increase cognitive performance while having a muscle relaxing, mentally relaxing effect and significant analgesic effect with reduction in sensitivity to headache. It has been concluded that these essential plant oil preparations often used in empirical medicine can thus be shown by laboratory tests to exert significant effects on mechanisms associated with the patho-physiology of clinical headache syndromes (112).
Another study has also proved the efficacy of the same combination of Eucalyptus and peppermint oils in reducing the symptoms of upper respiratory tract infection (113).