Zinc is a well-known mineral supplement used to treat URI symptoms and is available OTC at most pharmacies. In a small cohort study by Hemilä et al, use of zinc acetate lozenges in the treatment of the common cold did not significantly alter recovery time when used for 5 days after symptom onset compared with control.11 However, findings from other studies suggest that zinc may decrease the duration of URI symptoms by approximately 33%.12 Safety associated with taking zinc supplements is varied. Intranasal zinc use has been associated with decreased ability to smell, and oral zinc can lead to gastrointestinal issues such as indigestion, nausea, vomiting, and diarrhea.13
Echinacea purpurea (purple coneflower) is a popular OTC herbal supplement that is native to North America. Echinacea has a long-standing history of use, first discovered by Native Americans and used in European medicine in the late 1800s.14 Native Americans first used Echinacea as an antiseptic for treating toothaches and snakebites and as an analgesic. In a recent meta-analysis, David and Cunningham found that Echinacea might have a preventative effect on URIs, although it is unclear whether the effect size is clinically meaningful. The study authors did not find evidence for an effect on the duration of URIs.14
In a meta-analysis by Rondanelli et al, prophylactic treatment with Echinacea over 4 months (2400mg/day for prevention and 4000mg/day during acute stages of cold) appeared to be effective for preventing and treating the common cold.12
Black elderberry (Sambucus nigra) contains chemicals that have been shown to boost immune functioning and have antiviral effects, although research is limited.15 In a meta-analysis, Hawkins et al found that “supplementation with a standardized elderberry extract is significantly effective at reducing the total duration and severity of upper respiratory symptoms,” as compared with placebo.15
Essential Oils and Aromatherapy
The use of essential oils and aromatherapy has gained popularity among patients looking for natural alternatives to conventional therapies for cold and flu symptoms (Table 2).16-19 Essential oils may have anti-inflammatory, antiviral, antimicrobial, or astringent properties. These oils come in many different formulations including topical and vaporized in a diffuser. Concentrated essential oils are highly potent. Thus, is important to educated patients on appropriate use. The oil should not be applied directly to the skin in most circumstances due to the high concentration. Instead, essential oils may be used topically in conjunction with a carrier oil such as coconut, olive, or grapeseed oil. Sometimes these preparations come combined in a rollerball device to aid topical application.
Recently, researchers have investigated the potential use of essential oils in the treatment of COVID-19.20-21 Limited data is available.
Table. Common Essential Oils Used for Cold and Flu Symptoms16-19
|Essential Oil||Reported Effects|
|Black pepper (Piper nigrum)||Analgesic, anti-inflammatory|
|Cinnamon (Cinnamomum zeylancium)||Antifungal, antioxidant, helps boost immune system|
|Clove (Eugenia caryophyllata)||Antimicrobial, anti-inflammatory, oral health|
|Eucalyptus (Eucalyptus globulus)||Antibacterial and antiviral properties, decongestant|
|Lavender (Lavandula intermedia)||Antimicrobial, relaxation, sleep aid|
With the use of complementary and alternative medicine practices growing in the United States and Europe, homeopathic medicines used to treat the common cold should be considered. Schmiedel and Klein compared a complex homeopathic therapy called Engystol® to common OTC traditional symptomatic care such as antihistamines and antitussives.22 Engystol was considered not significantly inferior to traditional therapies, and the study authors concluded that this homeopathic treatment may be helpful in the symptomatic treatment of URIs.22
Neti pots were originally used in the Indian health practice called Ayurveda (emphasis on massage, meditation, yoga, and dietary changes) and use of neti pots in the US has grown in the past 2 decades.23 The neti pot comes in a variety of types and is used to irrigate the nasal passages by rinsing saline solution into 1 nostril and out the other. A multicenter study showed that regular use of nasal irrigation was effective at improving nasal congestion, decreasing postnasal drip, and improving sinus pain.24
Saline Nasal Spray
Saline nasal spray is similar to the neti pot; it is a form of nasal irrigation and is derived from Ayurvedic medicine. This therapy coats the nasal mucosa with liquid saline. The side effects are minimal and limited in duration. The breakdown of the nasal mucosa is known to play a role in viral upper respiratory tract infections taking hold. Thus, protecting the nasal mucosa with irrigation is believed to improve mucociliary function and removes inflammatory mediators.20 This is a practical and safe complementary therapy to recommend to patients interested in symptom treatment of the common URI.
Limitations of Research
Upper respiratory tract infections are mostly viral in nature and antibiotics are not indicated for these infections. Of the studies on alternative therapies reviewed in this article, many were inconclusive in terms of the preventative effect of alternative therapy vs placebo. However, some studies showed a decreased duration of symptoms with alternative therapies. There is potential bias and subjectivity with the results of this data as patients’ symptoms are measured subjectively and their attitude toward alternative therapies may have an effect on outcomes. Initiating treatment with supplements of vitamin C, zinc, Echinacea, and elderberry at the time of symptom onset may be beneficial. Therapies such as aromatherapy, neti pots, and saline nasal spray also may beneficial for symptom control and have few if any side effects.
A limitation of the literature reviewed was the size of the studies. Even though many of the studies were meta-analyses, the cohorts included were small; therefore, conclusions are sometimes difficult to fully decipher. This demonstrates a need for continued research on complementary and alternative therapies with larger cohorts and randomized controlled trials.
Ultimately, patient education plays an important role in the future treatment of URIs. Healthcare providers should evaluate URIs fully and determine if antibiotic therapy is indicated. If it is not, they should educate their patients on reasons antibiotics are not indicated, and recommend safe OTC medications for symptom control and possibly alternative therapies. Complementary and alternative medicine practices continue to merge with traditional-based practice as patients continue to seek more natural solutions to their illnesses.
Nicole Drake, MSM, PA-C, is a physician assistant at AdventHealth Medical Group Family Medicine at Biltmore Park in Asheville North Carolina.
Disclosure: Nicole Drake, MSM, PA-C, is enrolled in a nutrition outreach fellowship that is sponsored by Abbott Nutrition.
- Finley CR, Chan DS, Garrison S, et al. What are the most common conditions in primary care? Can Fam Physician. 2018;64(11):832.
- Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States. 2019. US Department of Health and Human Services. Accessed February 22, 2021. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf
- Centers for Disease Control and Prevention. Antibiotic Resistance Threatens Everyone. Centers for Disease Control and Prevention. Published December 6, 2019. Accessed February 22, 2021. https://www.cdc.gov/drugresistance/about.html
- Sanchez GV, Fleming-Dutra KE, Roberts, RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016;65(No. RR-6):1-12. doi:10.15585/mmwr.rr6506a1
- Thomas M, Bomar PA. Upper respiratory tract infection. In: StatPearls. StatPearls Publishing: 2020. Accessed February 22, 2021. https://www.ncbi.nlm.nih.gov/books/NBK532961/
- Johnsen M. Consumer use of natural OTCs increases. Drug Store News. 2016;38(9):56-56.
- Jackson Allen P, Simenson S. Management of common cold symptoms with over-the-counter medications: clearing the confusion. Postgraduate Medicine. 2013;125(1):73-81. doi:10.3810/pgm.2013.01.2607.
- Bucher A, White N. Vitamin C in the prevention and treatment of the common cold. Am J Lifestyle Med. 2016;10(3):181-183. doi:10.1177/1559827616629092
- Vorilhon P, Arpajou B, Vaillant Roussel H, Merlin É, Pereira B, Cabaillot A. Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children. Eur J Clin Pharmacol. 2019;75(3):303-311. doi:10.1007/s00228-018-2601-7
- Hamishehkar H, Ranjdoost F, Asgharian P, Mahmoodpoor A, Sanaie S. Vitamins, Are They Safe? Adv Pharm Bull. 2016;6(4):467-477. doi:10.15171/apb.2016.061
- Hemilä H, Haukka J, Alho M, Vahtera J, Kivimäki M. Zinc acetate lozenges for the treatment of the common cold: a randomised controlled trial. BMJ Open 2020;10:e031662. doi:10.1136/ bmjopen-2019-031662
- Rondanelli M, Miccono A, Lamburghini S, et al. Self-care for common colds: the pivotal role of vitamin D, vitamin C, zinc, and echinacea in three main immune interactive clusters (physical barriers, innate and adaptive immunity) involved during an episode of common colds — practical advice on dosages and on the time to take these nutrients/botanicals in order to prevent or treat common colds. Evid Based Complement Alternat Med. 2018 Apr 29;2018:5813095. doi:10.1155/2018/5813095
- National Institutes of Health. Zinc: fact sheet for health professionals. Updated July 15, 2020. Accessed February 22, 2021. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
- David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complement Ther Med. 2019;44:18-26. doi:10.1016/j.ctim.2019.03.011
- Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: a meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-365. doi:10.1016/j.ctim.2018.12.004
- Sharifi-Rad J, Sureda A, Tenore GC, et al. Biological activities of essential oils: from plant chemoecology to traditional healing systems. Molecules. 2017;22(1):70. doi:10.3390/molecules22010070
- Swamy MK, Akhtar MS, Sinniah UR. Antimicrobial properties of plant essential oils against human pathogens and their mode of action: an updated review. Evid Based Complement Alternat Med. 2016;2016:3012462. doi:10.1155/2016/3012462
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- Meghwal M, Goswami TK. Piper nigrum and piperine: an update. Phytother Res. 2013;27(8):1121-1130. doi:10.1002/ptr.4972
- Senthil Kumar KJ, Gokila Vani M, Wang CS, et al. Geranium and lemon essential oils and their active compounds downregulate angiotensin-converting enzyme 2 (ACE2), a SARS-CoV-2 spike receptor-binding domain, in epithelial cells. Plants (Basel). 2020;9(6):770. doi:10.3390/plants9060770
- Raimundo E, Silva JP, Acevedo CAH, et al. Natural products as potential agents against SARS-CoV and SARS-CoV-2. Curr Med Chem. 2021 Jan 24. doi:10.2174/0929867328666210125113938
- Schmiedel V, Klein P. A complex homeopathic preparation for the symptomatic treatment of upper respiratory infections associated with the common cold: an observational study. Explore. 2006;2(2):109-114
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This article originally appeared on Clinical Advisor