After looking at the available peer-reviewed science focused on the effects of over-the-counter (OTC) cold medicines, a group of researchers from the medical schools of Ghent University in Belgium and the University of Brisbane, Australia, have concluded that these products offer little to no relief from symptoms of viral respiratory infections, and may, in fact, cause more harm than good – particularly in children.

The group’s report, published in BMJ was written to help guide physicians on how to advise patients bothered by nasal symptoms from the common cold, yet is equally handy for any layperson unsure of how to navigate the upcoming winter cold and flu season.

“The common cold is self-limiting and symptoms usually clear within 7 to 10 days,” they wrote. “Explain to patients that there are no ‘magic bullets’ to relieve their symptoms and that very few OTC treatments are supported by evidence.”

Adults

According to their examinations of the latest Cochrane reviews on OTC cold medicines for adults, only a small handful of quality studies have been conducted to assess whether decongestants, antihistamines, analgesics, intranasal corticosteroids (like Afrin), herbal remedies, and vitamins and minerals (zinc) have any impact on the infection’s nasal manifestations; ie congestion, sneezing, or rhinorrhea – the medical term for a runny nose.

Several of these investigations have revealed that sedating antihistamines – the likes of Benadryl, aka diphenhydramine – can reduce rhinorrhea and sneezing compared with placebo, but don’t improve congestion. Products marketed as decongestants can help congestion a bit, either alone or in combination with antihistamines and/or analgesics, but carry the potential side effects of insomnia, drowsiness, headache, or gastrointestinal upset. Ironically, long-term use is known to lead to chronic nasal congestion. Lead author Mieke van Driel and her colleagues recommend that nasal decongestants should only be taken for a maximum 7-10 days.

Children

Colds are far more common in children under 12 than they are in adults – an average of six to eight mild to moderate viral respiratory infections per year vs two to four per year – but even fewer studies have been conducted on OTC treatments for this age group. Making the issue even more confusing, the scant findings we do have are contradictory.

The authors found that there is low-quality evidence supporting the use of saline irrigations, but they may not provide adequate relief. And because the safety of using antihistamines and decongestants in young children remains unclear, the authors believe they should be avoided for now.

“We do not recommend decongestants or formulations containing antihistamine in children under 6 and advise caution between 6 and 12 years. There is no evidence that these treatments alleviate nasal symptoms and they can cause adverse effects such as drowsiness or gastrointestinal upset. Serious harm, such as convulsions, rapid heart rate and death, has been linked to decongestant use in very young children,” they added.

“None of the other commonly used OTC and home treatments, such as heated humidified air, eucalyptus oil, or echinacea, are supported by adequate evidence [for adults or children].”