The Runny Nose Conundrum

This fall, just before cold season when they are most often used, the FDA completed and publicized a review of the over the counter cold medicines that are commonly used to stop a child’s runny nose. These drugs are made up of a variety of decongestants and antihistamines that have been around for over fifty years and available without prescription for over thirty. Researchers reported to the FDA that between 1969, when they went over-the-counter, and the fall of 2006, there were 54 reported child deaths from decongestants and 69 from antihistamines. The FDA told the pharmaceutical industry that they were going to review the use of these drugs in children, but before the review was done the major pharmaceutical companies pulled these drugs from the market.

Parents across the country are wondering what is wrong here and what to do when their child has this problem. When the drug industry voluntarily withdrew these products they insisted that when used as directed, the drugs are safe, and they work. “Parents can continue to trust over-the-counter cough and cold remedies for their children,” said Linda A. Suydam, president of the Consumer Healthcare Products Association. CNN quotes her: “We strongly encourage parents to adhere to the recommended dosing instructions for all medicines, recognizing that the vast majority of adverse events associated with their use are due to inadvertent overdosing and misuse.”

If that is true and the deaths were caused by parental overdosing, as the industry is implying, why was the industry so willing to pull these products without more discussion.

The American Academy of Pediatrics supports removing saying that there are better ways to treat the condition. According to the report at CNN, they recommend:

• Moisturizing the air with a vaporizer or hydrator
• Using saltwater nose drops to moisten the nose
• Using a rubber nose bulb to clear up congestion
• Feeding the child chicken soup
• If the problem continues consult a pediatrician

As usual there is more to this story and it involves how we see and treat problems in our healthcare system. Whenever a person goes to the doctor they present a complaint for the doctor to fix. Most of the time the bothersome symptom is treated with drugs designed to make it less bothersome; so an ache is treated with pain medicine and a runny nose is treated with antihistamines that block the effect of histamine, or with decongestants that close down the leaky blood vessels that histamine has opened. But there is a different way of looking at this.

Biologists and forward looking doctors are asking why these bothersome symptoms are there. Why does your nose run? Why do we get fevers? Why. . .? The answer they come up with in almost all cases is that there is a survival benefit somewhere. In the case of a fever we know that every warm blooded animal is capable of developing a fever when they are infected. Cold blooded animals commonly move to the sun when they need a fever. Blocking the fever in infected animals, either in the warm blooded ones with the drugs we use to treat fevers in our children, or by preventing the cold blooded ones from moving into the sun, results in more of them dying. There is a survival benefit in the ability to fever and when we block the symptom of fever we lose the benefit.

Common sense tells us that the runny nose is trying to wash out irritants from the nose. In most cases a child’s nose doesn’t run all the time, but just when it is cold season and they have a bug. In some children it runs all of the time as it tries to deal with allergens that irritate it. In both cases it is a defense; it is trying to protect the child from the bacteria, viruses, allergens, or whatever threats the immune system senses to be present in the back of the nose.

Like a fever a runny nose is a defense that works to help us better deal with environmental challenges. Like the defensive players on your favorite football team these defenses help us better play the game we are constantly playing with bacteria, viruses, and other irritants in our environments. If we hobble the defensive players the team is likely to lose the game. If we hobble our child’s runny nose they too are more likely to lose the game and this is far more likely to be the reason behind the deaths that the pharmaceutical industry puts off to overdoses.

In 2001, I wrote an article, published in the Journal Medical Hypotheses, proposing that the increases we have seen in this country in both ear infections and asthma are related to our use of these drugs. Ear infections begin with viruses or bacteria in the back of the nose that get into the middle ear, and allergens or infections in the back of the nose are the primary triggers for asthma. Beginning around the time these drugs were made available over the counter, their advertisement on television and their wholesale sampling through physician’s offices to patients with problems, the incidence of ear infections and asthma have increased by 5 to 10% every year. While after this therefore because of this does not satisfy the logic of causality it should at least raise some questions. Perhaps someone at the FDA did read it.

The recommendations of the pediatricians are beneficial because they address one of the major problems that result in colds. Cold season is generally in the fall and early winter when we turn on the heater. In order to be most effective the runny nose needs lots of water. The mucus the nose makes absorbs almost 200 times its volume of water and it is most effective at both holding on to irritants and bacteria and being washed out, when it is wettest. Dry heated air and the decreased thirst in winter work against this defense. All of the AAP recommendations address this aspect of the problem. In addition there is also a very good way to stimulate the washing.

Researchers at Johns Hopkins found out almost thirty years ago that putting the sugar alcohol mannitol in the noses of normal people would increase the flow of liquid into the nose, reproducing what histamine does as it turns on the taps, as well as stimulating some histamine release as well. At that time only a few were questioning the hobbling of this defense so no one picked up on the research. Mannitol does this by working osmotically to pull fluid into the nose. Other sugar alcohols will do the same thing and there are nasal washes on the market that use other agents to do this. Concentrated saline works like this as well as other sugar alcohols. By far the best and most useful of these is xylitol.

Xylitol not only works osmotically to increase the flow of water into the nose, it also decreases the ability of the major problem causing bacteria to hold on inside the nose. As long as children share germs on their toys and rub their noses bacteria will have no problem getting around. But if they can’t hold on inside the nose they are easily washed out if the washing is effective. A nasal spray with xylitol not only stimulates the water that makes the washing effective, it unhooks the bacteria; it’s like soap for the nose.

Some of the nasal washes using sugar alcohols advertise xylitol on the label, but the amount is not sufficient to affect the adherence. Only sufficient amounts of xylitol provide the soap; make sure it is second, after water, on the ingredients list.

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