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The cold war

The sneezing season is already upon us – but a little inside knowledge can reduce our chances of being laid low. Professor Ron Eccles explains how to fend off the winter chills

Tuesday October 07 2008 - Irish Independent

This is a golden age for the common cold. Densely populated cities provide ideal breeding grounds for the viruses that readily jump from one continent to another by jet.
The average adult gets two to five colds a year. Schoolchildren suffer worst, with seven to 10 colds a year. Young children, with undeveloped immune systems are the most vulnerable and form the main reservoir of infection. Most colds are transmitted at home or school and adults in regular contact with children are most at risk of infection.
Kissing is OK, but wash your hands
As I get older, I take more care to protect myself. I wash my hands a lot and I try not to touch my nose and eyes in public. Your fingers can easily become contaminated with viruses by touching door handles and by shaking hands. You may then touch your nose and eyes and infect yourself. Tears from the eye drain into the nasal cavity, passing viruses into the nose. Hand-washing can reduce the spread of colds within the family. Kissing is OK, though. The virus travels in the respiratory system, so is lodged at the back of the throat. Only if you have a bad cough and some of the respiratory mucus becomes mixed with your saliva is there a risk of the virus being transmitted in a kiss. Cold viruses appear to be spread by large particles expelled at close range by coughs and sneezes. The only guaranteed way to avoid a cold is to become a hermit.
Cold viruses are difficult to catch
Although few of us escape at least a couple of colds each year, common cold viruses are not very contagious. Under laboratory conditions with healthy volunteers, it has proved remarkably difficult to spread infection from one person to another. You are most infective when you have the early symptoms of sneezing, runny nose and cough. The virus replicates in the cells lining the nose and are coughed or sneezed out in droplets of mucus. The virus is also spread on fingers when we contaminate them with secretions from the nose.
Some people are more susceptibleto catching colds
I get letters from people saying they never get colds. They probably get the infection but not the symptoms. This is an interesting area of research. There may be genetic differences in our immune systems that make some people more vulnerable. Most viral infections produce no disease – this is the iceberg concept of infection. They do not cause symptoms and pass without notice. Or they may cause minor symptoms such as a throat irritation and a couple of sneezes which are not recognised as a cold. The "stinking colds" that cause severe symptoms represent the tip of the iceberg of infection. Genetic differences in the immune system may explain why the same virus causes severe symptoms in one person and mild or no symptoms in another.
Men get man flu – and women don't
I don't think there is any evidence that men respond more strongly to infection than women. But women's immune systems are different from men's because they have to support a foreign body when pregnant. So it may be that their immune systems are more tolerant. This could be important in a flu pandemic because it could affect its impact. It is obvious that if there are sex differences there could be differences affected by genetic make-up, too.
Stress can cause a cold
The pressure of everyday life can make you more susceptible to infection. Experiments on volunteers show they are more likely to become infected if they have recently suffered problems at work or home. Stress is associated with the suppression of general resistance to infection. It is not clear how it affects the immune system but there appears to be an increase in corticosteroid hormones, which are known to decrease resistance. The increased stress of modern city life may be one of the factors behind the very high incidence of common cold infections in our cities.
There are more colds in winter
As soon as the weather turns cold, I try to keep my nose warm. As winter comes, we put on our overcoats to protect our body temperature but we don't protect our nasal temperature. The nose dries out in low temperatures or in dry air-conditioning and respiratory viruses become trapped and start to reproduce. A study we did in Cardiff showed that when volunteers were chilled by sitting with their feet in icy water for 20 minutes, they were three times more likely to develop a cold in the next five days. We should all wind scarves round our necks and over our noses. I must admit, I am not good at following my own advice because in Cardiff you look like a bandit with a scarf wound round your face. It would be more acceptable in Canada.
There are 200 viruses that cause colds
Even if you have just had a cold you can get another straightaway caused by a different virus. The antibodies you develop against the first cold will only protect you against that virus. There are enough viruses to keep you having a couple of colds each year over a lifetime. Between a third and a half of colds are caused by rhinoviruses. Others are coronaviruses, respiratory syncytial virus, adenovirus and influenza virus. All the viruses have very similar effects and there is no way of identifying them from the symptoms alone.
Feed a cold, starve a fever?
This old saying is part of folklore. Its origin lies with the fact that any feverish illness is likely to be associated with loss of appetite. Most colds in adults are not associated with fever and so there is not much loss of appetite. It is the release of chemicals from the white blood cells called cytokines that fight infection and cause fever, tiredness and loss of appetite. In general, common cold viruses do not trigger a large response from the white cells but severe cold infections can, like flu, cause a lot of cytokine release and give us the typical flu-like symptoms of fever and tiredness and loss of appetite.
The cause of cold symptoms
When I was a PhD student in the 1970s, I did some work on bradykinin – I demonstrated its presence in nasal secretions from people with colds. The symptoms of a cold – sneezing, coughing, runny or blocked nose – are caused by a complex soup of chemicals triggered by the immune system which act on blood vessels, glands and nervous tissue. They are part of the inflammatory response to infection. Bradykinin, a peptide, is one of these chemicals and has been proposed to play a dominant role in colds. As well as being identified in nasal secretions, if administered to the nose in healthy volunteers it causes nasal congestion and irritation, throat irritation and stimulates nasal secretions.
The best hope for a treatment
There is a lot of interest in developing a medication that would act as a bradykinin antagonist. It would work in the same way as antihistamine against hay fever, reducing the symptoms. But no one has come up with one and it is a long time since bradykinin was discovered. If such a development is to take place, it is likely to come from arthritis research as bradykinin is also implicated in the pain and swelling associated with joint inflammation.
Vitamin c and echinacea
There is no good evidence either can prevent a cold. The Nobel Prize winner Linus Pauling popularised the idea of taking daily doses of vitamin C to ward off colds. Sales of the vitamin soared. However, only a very small proportion of the population in the West are likely to have any deficiency of vitamin C and it is unlikely a daily dose will provide any benefit. Echinacea is the most popular preventive treatment for colds and helps to prevent infection by boosting the immune system. It could, in theory, abort a common cold infection and prevent the development of symptoms, but there is no evidence of this.
The best remedy for a cold
Only the immune system can cure a cold. In most cases, it will take four to seven days and will not require any other treatment. If you want relief from severe symptoms, aspirin, paracetamol and ibuprofen are very effective for relieving headache, sinus pain, sore throat and aches and pains. A nasal spray containing xylometazoline or oxyetazoline to clear a blocked nose can be very helpful before sleep. Any hot drink will relieve a cough and sore throat – but standard cough medicines are no better than placebo. Spicy foods and hot soups are also beneficial.
Cold or flu? How to tell the difference
A simple rule of thumb is that genuine flu is characterised by an irresistible, and often sudden, desire to lie down. It is accompanied by fever muscle aches and pains and a general feeling of malaise. It's nasty.
People tend to claim they are suffering from flu to maximise sympathy. If a member of your family tries this, clamp a hand on their forehead and then on your own to check if they have a temperature. Amazingly, you will find they rarely do – compared with colds, flu is uncommon.
The complicating factor is that the symptoms of fever, aches and malaise can also occur with a heavy cold, though this is unusual. In both cases the best treatment is hot drinks, paracetamol and doses of TLC.