Flu symptoms include:*
Swift, severe onset.
Prominent Prostration.
Flushed, hot moist skin.
102-104 degree temp.
Chills, body aches.
Extreme fatigue,
can last 2-3 weeks.
Cough, sore throat.

Sinus infection symptoms:*
Facial pains.
Tenderness of the sinus areas.
Headaches.
Nasal drainage that is thick and colored.
Cough (may be itchy).
Postnasal drip.
Bad breath.
Upper jaw pain.
Sore throat.
Eyes are sensitive to light.
General fatigue.
Eye lids swell.

Sinus Infection Symptoms - What is Sinusitis?

by the National Institute of Health (NIH)

You're coughing and sneezing and tired and achy. You think that you might be getting a cold. Later, when the medicines you've been taking to relieve the symptoms of the common cold are not working and you've now got a terrible headache, you finally drag yourself to the doctor. After listening to your history of symptoms, examining your face and forehead, and perhaps doing a sinus X-ray, the doctor says you have sinusitis.

Sinusitis simply means your sinuses are infected or inflamed, but this gives little indication of the misery and pain this condition can cause. Health care experts usually divide sinusitis cases into

• Acute, which lasts for 3 weeks or less
• Chronic, which usually lasts for 3 to 8 weeks but can continue for months or even years
• Recurrent, which is several acute attacks within a year

Health care experts estimate that 37 million Americans are affected by sinusitis every year. Health care workers report 33 million cases of chronic sinusitis to the U.S. Centers for Disease Control and Prevention annually. Americans spend millions of dollars each year for medications that promise relief from their sinus symptoms.

Sinus Infection - Quick Menu:

Use your browser's "back" button to navigate the sinus infection menu.

Sinus Infection Symptoms
Sinus Cold Causes
Chronic Sinusitis
Diagnosis
Sinus Treatment
Prevention
Research
Sinus Resource Information

What are sinuses?

Sinuses are hollow air spaces in the human body. When people say, "I'm having a sinus attack," they usually are referring to symptoms in one or more of four pairs of cavities, or sinuses, known as paranasal sinuses. These cavities, located within the skull or bones of the head surrounding the nose, include the:

• Frontal sinuses over the eyes in the brow area
• Maxillary sinuses inside each cheekbone
• Ethmoid sinuses just behind the bridge of the nose and between the eyes
• Sphenoid sinuses behind the ethmoids in the upper region of the nose and behind the eyes

Each sinus has an opening into the nose for the free exchange of air and mucus, and each is joined with the nasal passages by a continuous mucous membrane lining. Therefore, anything that causes a swelling in the nose-an infection, an allergic reaction, or an immune reaction-also can affect the sinuses. Air trapped within a blocked sinus, along with pus or other secretions, may cause pressure on the sinus wall. The result is the sometimes intense pain of a sinus attack. Similarly, when air is prevented from entering a paranasal sinus by a swollen membrane at the opening, a vacuum can be created that also causes pain.

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Sinus Infection Symptoms

The location of your sinus pain depends on which sinus is affected.

• Headache when you wake up in the morning is typical of a sinus problem.
• Pain when your forehead over the frontal sinuses is touched may indicate that your frontal sinuses are inflammed.
• Infection in the maxillary sinuses can cause your upper jaw and teeth to ache and your cheeks to become tender to the touch.
• Since the ethmoid sinuses are near the tear ducts in the corner of the eyes, inflammation of these cavities often causes swelling of the eyelids and tissues around your eyes, and pain between your eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell, and a stuffy nose.
• Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head.

Most people with sinusitis, however, have pain or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.

Other symptoms of sinusitis can include

• Fever
• Weakness
• Tiredness
• A cough that may be more severe at night
• Runny nose (rhinitis) or nasal congestion

In addition, the drainage of mucus from the sphenoids or other sinuses down the back of your throat (postnasal drip) can cause you to have a sore throat. Mucus drainage also can irritate the membranes lining your larynx (upper windpipe). Not everyone with these symptoms, however, has sinusitis.

On rare occasions, acute sinusitis can result in brain infection and other serious complications.

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What are some causes of acute sinusitis?

Most cases of acute sinusitis start with a common cold, which is caused by a virus. These viral colds do not cause symptoms of sinusitis, but they do inflame the sinuses. Both the cold and the sinus inflammation usually go away without treatment in 2 weeks. The inflammation, however, might explain why having a cold increases your likelihood of developing acute sinusitis. For example, your nose reacts to an invasion by viruses that cause infections such as the common cold or flu by producing mucus and sending white blood cells to the lining of the nose, which congest and swell the nasal passages.

When this swelling involves the adjacent mucous membranes of your sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. When your sinus openings become too narrow, mucus cannot drain properly. This increase in mucus sets up prime conditions for bacteria to multiply.

Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no problems until the body's defenses are weakened or drainage from the sinuses is blocked by a cold or other viral infection. Thus, bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute sinus infection.

Sometimes, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people, indicating that the human body has a natural resistance to them. Fungi, such as Aspergillus, can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi.

Chronic inflammation of the nasal passages also can lead to sinusitis. If you have allergic rhinitis or hay fever, you can develop episodes of acute sinusitis. Vasomotor rhinitis, caused by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.

Acute sinusitis is much more common in some people than in the general population. For example, sinusitis occurs more often in people who have reduced immune function (such as those with immune deficiency diseases or HIV infection) and with abnormality of mucus secretion or mucus movement (such as those with cystic fibrosis).

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What causes chronic sinusitis?

If you have asthma, an allergic disease, you may have frequent episodes of chronic sinusitis.

If you are allergic to airborne allergens, such as dust, mold, and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis. In addition, people who are allergic to fungi can develop a condition called "allergic fungal sinusitis."

If you are subject to getting chronic sinusitis, damp weather, especially in northern temperate climates, or pollutants in the air and in buildings also can affect you.

Like acute sinusitis, you might develop chronic sinusitis if you have an immune deficiency disease or an abnormality in the way mucus moves through and from your respiratory system (e.g., immune deficiency, HIV infection, and cystic fibrosis). In addition, if you have severe asthma, nasal polyps (small growths in the nose), or a severe asthmatic response to aspirin and aspirin-like medicines such as ibuprofen, you might have chronic sinusitis often.

How is sinusitis diagnosed?

Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.

Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, and taking X-rays, and if necessary, an MRI or CT scan (magnetic resonance imaging and computed tomography).

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How is sinusitis treated?

After diagnosing sinusitis and identifying a possible cause, a doctor can suggest treatments that will reduce your inflammation and relieve your symptoms.

Acute sinusitis - Sinus Infection

If you have acute sinusitis, your doctor may recommend

• Decongestants to reduce congestion
• Antibiotics to control a bacterial infection, if present
• Pain relievers to reduce any pain

You should, however, use over-the-counter or prescription decongestant nose drops and sprays for only few days. If you use these medicines for longer periods, they can lead to even more congestion and swelling of your nasal passages.

If bacteria cause your sinusitis, antibiotics used along with a nasal or oral decongestant will usually help. Your doctor can prescribe an antibiotic that fights the type of bacteria most commonly associated with sinusitis.

Many cases of acute sinusitis will end without antibiotics. If you have allergic disease along with infectious sinusitis, however, you may need medicine to relieve your allergy symptoms. If you already have asthma then get sinusitis, you may experience worsening of your asthma and should be in close touch with your doctor.

In addition, your doctor may prescribe a steroid nasal spray, along with other treatments, to reduce your sinus congestion, swelling, and inflammation.

Chronic sinusitis

Doctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after taking antibiotics for a long period. In general, however, treating chronic sinusitis, such as with antibiotics and decongestants, is similar to treating acute sinusitis.

Some people with severe asthma have dramatic improvement of their symptoms when their chronic sinusitis is treated with antibiotics.

Doctors commonly prescribe steroid nasal sprays to reduce inflammation in chronic sinusitis. Although doctors occasionally prescribe them to treat people with chronic sinusitis over a long period, they don't fully understand the long-term safety of these medications, especially in children. Therefore, doctors will consider whether the benefits outweigh any risks of using steroid nasal sprays.

If you have severe chronic sinusitis, your doctor may prescribe oral steroids, such as prednisone. Because oral steroids are powerful medicines and can have significant side effects, you should take them only when other medicines have not worked.

Although home remedies cannot cure sinus infection, they might give you some comfort.

• Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities.
• Saline nasal spray, which you can buy in a drug store, can give relief.
• Gentle heat applied over the inflamed area is comforting.

When medical treatment fails, surgery may be the only alternative for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and better quality of life.

In children, problems often are eliminated by removal of adenoids obstructing nasal-sinus passages.

Adults who have had allergic and infectious conditions over the years sometimes develop nasal polyps that interfere with proper drainage. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms.

The most common surgery done today is functional endoscopic sinus surgery, in which the natural openings from the sinuses are enlarged to allow drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.

How can I prevent sinusitis?

Although you cannot prevent all sinus disorders-any more than you can avoid all colds or bacterial infections-you can do certain things to reduce the number and severity of the attacks and possibly prevent acute sinusitis from becoming chronic.

• You may get some relief from your symptoms with a humidifier, particularly if room air in your home is heated by a dry forced-air system.
• Air conditioners help to provide an even temperature.
• Electrostatic filters attached to heating and air conditioning equipment are helpful in removing allergens from the air.

If you are prone to getting sinus disorders, especially if you have allergies, you should avoid cigarette smoke and other air pollutants. If your allergies inflame your nasal passages, you are more likely to have a strong reaction to all irritants.

If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger an upper respiratory reaction-you should consult your doctor. Your doctor can use various tests to determine whether you have an allergy and its cause. This will help you and your doctor take appropriate steps to reduce or limit your allergy symptoms.

Drinking alcohol also causes nasal and sinus membranes to swell.

If you are prone to sinusitis, it may be uncomfortable for you to swim in pools treated with chlorine, since it irritates the lining of the nose and sinuses.

Divers often get sinus congestion and infection when water is forced into the sinuses from the nasal passages.

You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head blocking your sinuses or eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane's ascent or descent. Some doctors recommend using decongestant nose drops or inhalers before your flight to avoid this problem.

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Sinus Infection Research

Scientific studies have shown a close relationship between having allergic rhinitis and chronic sinusitis. In fact, some studies state that up to 80 percent of adults with chronic sinusitis also had allergic rhinitis. There is also an association between asthma and sinusitis. Some researchers think that as many as 75 percent of people with asthma also get sinusitis. The National Institute of Allergy and Infectious Diseases (NIAID) conducts and supports research on allergic diseases as well as bacteria and fungus that can cause sinusitis. This research is focused on developing better treatments and ways to prevent these diseases.

Scientists supported by NIAID and other institutions are investigating whether chronic sinusitis has genetic causes. They have found that the alterations in genes which cause cystic fibrosis may also contribute to chronic sinusitis. This research focus will give scientists new insights into the cause of the disease in some people and points to new strategies for diagnosis and treatment.

Another NIAID-supported research study is trying to determine whether fungi may play a role in causing many cases of chronic sinusitis. This research also will help scientists develop better medicines to treat chronic sinusitis.

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Where can I get more information about cold, flu, and sinus infections?

Time is The Only Sure Cure
http://www.fda.gov/

American Academy of Allergy, Asthma and Immunology
611 East Wells Street
Milwaukee, WI 53202
1-800-822-ASMA (2762)
http://www.aaaai.org

Joint Council of Allergy, Asthma, and Immunology
50 N. Brockway, Suite 3.3
Palatine, IL 60067
(847) 934-1918
http://www.jcaai.org

American Academy of Otolaryngology-Head and Neck Surgery, Inc.
One Prince Street
Alexandria, VA 22314-3357
(703) 836-4444
http://www.entnet.org

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services

The best research has been able to offer is the development of over-the-counter (OTC) medicines to treat cold and flu symptoms. However, there is some consensus that treating the symptoms of colds and flu infections may actually prolong the duration of the disease and prolong the misery.1,2 In addition, some potentially serious side effects have been associated with the use of OTC cold and flu medications.8,9

A variety of OTC products are available. Decongestants temporarily dry up runny noses, stop sneezing, and relieve watery eyes.

Acetaminophen, aspirin, and ibuprofen reduce body aches. Aspirin and ibuprofen bring down fevers.1,2

All these medications can cause side effects. Aspirin and ibuprofen can cause gastrointestinal upset.10,11 Additionally, aspirin should never be given to children and adolescents with colds or the flu. Several studies have linked the use of aspirin to the development of Reye’s syndrome, a rare and potentially fatal illness.1,2

Taking acetaminophen over an extended length of time can cause liver and kidney damage so the daily dose should be limited to no more than four grams.12,13 Decongestants can cause high blood pressure, heart palpitations, urinary retention, nausea, vomiting, drowsiness, anxiety, tremors, and insomnia.14 Decongestant use can alter the normal tissue of the nose and actually increase the duration of nasal congestion.15,16

However, suffering with an untreated cold or the flu can be very distressing and quite uncomfortable. Thankfully, there are natural supplements available that can shorten the duration and severity of both the common cold and the flu. Echinacea, white cedar leaf, and wild indigo root are some of the most popular cold and flu herbs.

Echinacea is one of the most effective herbal remedies available. Not only do the extracts from this pretty purple coneflower treat common cold symptoms but prevent these infections after exposure as well.3

Most importantly, echinacea extracts, combined with wild indigo and white cedar, can provide even greater cold and flu protection.4,5

Echinacea, a member of the sunflower family, was first used by Native Americans to treat a variety of illnesses and injuries. Knowledge of the herb’s potent properties was passed on to white settlers who rapidly discovered its ability to relieve cold symptoms. Echinacea was quickly recognized as remarkably effective and, by 1920, American doctors prescribed echinacea more than any other medicinal plant preparation.17

However, echinacea fell out of favor in the 1930s in the U.S. with the advent of sulfa drugs. Physicians saw little value in using a mere flower to cure infectious disease when stronger remedies were being discovered every day.17

While echinacea slowly gave way to antibiotics in the U.S., use of the herb to treat colds and flu remained steady in Europe, especially in Germany. German scientists, physicians, pharmacists, and chemists started to study echinacea’s properties and continue to do so today. Presently, there are more than 280 commercial preparations containing echinacea in Germany.17

Additionally, the important discovery that combining white cedar leaf, wild indigo root, and echinacea for improved immune system health was made in Germany. These herbs have been in continuous use together since 1928 and have been studied in more than 15 clinical trials. Formulations of echinacea, white cedar leaf, and wild indigo root are available in Germany as a prescription drug as well as an OTC medication, and in the U.S. as a nutritional supplement.4,5

Interest in herbal extracts re-emerged in the U.S. in the 1960s and echinacea soon gained a loyal following here. The research behind echinacea has been and continues to be impressive. Most importantly, when echinacea, white cedar leaf, and wild indigo root are combined for use against colds and flu, they work quite well.

Three varieties of echinacea are currently used in nutritional supplements. These are Echinacea angustifolia, Echinacea purpurea, and Echinacea pallid. The most studied varieties (and therefore, the varieties with documented beneficial effects) are E. purpurea and E. pallida.18-23

Because echinacea is so popular and effective, quite a bit of research has been performed to understand how this herb actually works. Simply stated, while antibiotics kill the disease-causing microbes, echinacea enhances the body’s own ability to fight off infections.3

Research has discovered echinacea stimulates the production of important immune cells.24,25 These cells—known as macrophages—engulf bacteria, viruses, and cellular debris, essentially acting as garbage collectors for the body. They are responsible for the body’s initial attack against invading viruses. Echinacea also helps macrophages work more effectively.26 In addition, echinacea enhances the function of monocytes, special blood cells that mature into macrophages.27

Echinacea increases both the numbers of natural killer (NK) cells as well as NK cell activity.28,29 These specialized immune cells are programmed to automatically kill cells infected with viruses.30

Echinacea also increases the release of some important immune proteins, “tumor necrosis factor”(TNF), and the interferons.3 TNF regulates immune responses, mediates inflammation, and kills certain cancer cells.

Interferons are produced in response to an attack by a virus.30 White cedar increases TNF production 31,32 and both wild indigo and white cedar increase macrophages and interferons.33-37

The German Commission E notes that because of possible overactivation of the immune system, echinacea should not be taken by persons who have multiple sclerosis, lupus or other autoimmune diseases, tuberculosis, HIV, or AIDS. It should not be taken during pregnancy or by individuals who are allergic to plants of the sunflower (Asteraceae) family. The Commission E further recommends that echinacea should not be taken longer than eight weeks.38,39 To date, there are no concerns for white cedar or wild indigo.

The 1999 American Herbal Products International Echinacea Symposium addressed issues regarding the safe use of echinacea preparations. An expert panel discussed the lack of evidence substantiating such caution. Much of the early echinacea research was performed on the European variety, E. angustifoliResults from this variety may not have application in other varieties. The consensus of the expert panel was that these warnings are based more on theoretical concerns than on specific scientific data and urged the continuation of controlled studies to confirm clinical efficacy.40

For adults and children over 12 years of age, studies have shown the most effective dose of echinacea is 7.5 mg of a one-to-one (1:1) mixture of E. purpurea and E. pallida taken three times per day.38,39 The most effective dose of white cedar leaf is 2 mg taken three times per day and wild indigo root is 10 mg taken three times per day.3

If family members or co-workers have an active cold or the flu and individuals hope to prevent infection, this same regimen can be followed. This dosing can continue for several days even if no signs of illness develop.3,38,39

Experts’ opinions vary; most recommend taking them for three to five days. If symptoms persist or recur then take them for another three to five days.3,4,38,39 The best advice is to take the herbs for different amounts of time when the immune system needs extra support.

Yes, children ages 1 and older can safely benefit from these herbs. Doses for children should be adjusted to age and weight.3,38,39

Supplementing with elderberry during the flu may reduce its symptoms.41 Elderberry is an herb that causes an increase in viral antibodies. While elderberry is available as an individual supplement, it is also frequently combined with other vitamins, minerals, glandular extracts, or herbs for maximum cold and flu symptom relief.

If you also have an irritated throat, English ivy extract has been shown to provide natural and effective relief. English ivy soothes and quiets coughs due to colds and flu without the side effects often found in some products containing synthetic ingredients.42-44

Getting lots of rest and drinking lots of fluids (a minimum of 64 ounces of water and juice a day) are also very important. Drinking hot beverages such as tea and eating chicken soup are not only comforting, but they can open up stuffy noses. Gargling with salt water may help reduce painful sore throats.1,2

Individuals should seek care from a licensed health care practitioner if they have a fever that lasts longer than three days, are coughing up yellow-green mucus, or have chest pain that occurs with breathing. These symptoms may signal more serious conditions.1,2

With colds and flu, an ounce of prevention is truly worth a pound of cure. Frequent hand washing and sneezing into facial tissues (that are promptly thrown away) are the easiest and most effective ways to prevent the spread of colds and flu.1,2

Echinacea is the most widely used herbal supplement in the United States for good reason: it works. Combining echinacea with white cedar and wild indigo greatly improves the herb’s effectiveness. While a cure for colds and the flu may be years away, herbs such as echinacea, white cedar, wild indigo, elderberry, and English ivy extract can make this wait much more bearable. Together, these herbs can prevent, treat, and reduce the duration of these common viral illnesses.

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1. The Common Cold. National Institutes of Health Web site. Available at: http://www.niaid.nih.gov/
factsheets/cold.htm.
Accessed on April 30, 2001.

2. Flu. Centers for Disease Control and Prevention Web site. Available at: http://www.cdc.gov/ncidod/
diseases/flu/fluinfo.htm. Accessed April 30, 2001.

3. Robbers JE, Tyler VE. EchinaceTyler’s Herbs of Choice. Binghamton, NY: The Haworth Herbal Press; 1999: 253-257.

4. Wustenberg R, Henneicke-von Zepelin HH, Kohler G, Stammwitz U. Efficacy and mode of action of an immunomodulator herbal preparation containing echinacea, wild indigo, and white cedar. Adv Ther. 1999;16:51-70.

5. Henneicke-von Zepelin HH, Hentschel C, Schnitker J, Kohnen R, Kohler G, Wustenberg P. Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Op. 1999;15:214-227.

6. Porth CM. The common cold. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 502.

7. Norris J, Ed. InfluenzProfessional Guide to Diseases. 5th ed. Springhouse, Pa: Springhouse Corporation; 1995:212-213.

8. Karch AM, Karch FE. Let the user beware. OTC drugs aren’t necessarily ‘safe when taken as directed.’ Am J Nurs. 2001;101:25.

9. Ornato JP. Over-the-counter stroke? Health News. 2000;6:3.

10. Hirschowitz BI, Hawkey CJ. Questions regarding future research on aspirin and the gastrointestinal tract. Am J Med. 2001;110(Suppl):S74-S78.

11. Hunt RH, Bowen B, Mortensen ER, et al. A randomized trial measuring fecal blood loss after treatment with rofecoxib, ibuprofen, or placebo in healthy subjects. Am J. Med. 2000;109:201-206.

12. Noriega GO, Ossola JO, Tomaro ML, Batlle AM. Effect of acetaminophen on heme metabolism in rat liver. Int J Biochem Cell Biol. 2000;32:983-991.

13. Broughan TA, Soloway RD. Acetaminophen hepatoxicity. Dig Dis Sci. 2000;45:1553-1558.

14. Johnson DA, Hrieik JG. The pharmacology of alpha-adrenergic decongestants. Pharmacotherapy. 1993;13:110-115.

15. Graf P. Adverse effects of benzalkonium chloride on the nasal mucosa: allergic rhinitis and rhinitis medicamentosClin Ther. 1999;21:1749-1755.

16. Graf P. Rhinitis medicamentosa: aspects of pathophysiology and treatment. Allergy. 1997;52:28-34.

17. Foster S, Tyler VE. EchinaceIn: The Honest Herbal. Binghamton, NY: The Haworth Press; 1999:143-145.

18. Bauer R, Hoheisel O, Stuhlfauth I, Wolf H. Extract of the Echinacea purpura herb: an allopathic phytoimmunostimulant. Wein Med Wochenschr. 1999;149:185-189.

19. Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6:327-334.

20. Currier NL, Miller SC. Natural killer cells from aging mice treated with extracts from Echinacea purpurea are quantitatively and functionally rejuvenated. Exp Gerontol. 2000;35:627-639.

21. Melchart D, Linde K, Worku F, et al. Results of five randomized studies on the immunomodulatory activity of preparations of EchinaceJ Altern Complement Med. 1995;1:145-160.

22. Bauer R. Echinacea drugs—effects and active ingredients. Z Arztl Fortbild (Jena). 1996;90:111-115.

23. Dorsch W. Clinical applications of extracts of Echinacea purpurea or Echinacea pallidCritical evaluation of controlled clinical studies. Z Arztl Fortbild (Jena). 1996;90:117-122.

24. Stimpel M, Proksch A, Wagner H, Lohmann-Matthes ML. Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpureInfect Immun. 1984;46:845-849.

25. Luettig B, Steinmuller C, Gifford GE, Wagner H, Lohmann-Matthes ML. Macrophage activation by the polysaccharide arabinogalactan isolated from plant cell cultures of Echinacea purpureJ Natl Cancer Inst. 1989;81:669-675.

26. Burger RA, Torres AR, Warren RP, Caldwell VD, Hughes BG. Echinacea-induced cytokine production by human macrophages. Int J Immunopharmacol. 1997;19:371-379.

27. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody- dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology. 1997;35:229-235.

28. Sun LZ, Currier NL, Miller SC. The American coneflower: a prophylactic role involving nonspecific immunity. J Altern Complement Med. 1999;5:437-446.

29. Kindzel’skii LP, Zlochevskaia LL, Tsyganok TV, Shebava MM. The effect of natural immunomodulators on the lymphocytic natural killer activity in patients with malignant lymphoproliferative diseases. Lika Sprav1995;1:146-148.

30. Summers C. Immunity and inflammation. In: Porth CM. Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:189-212. 31. Hansel R, Keller K, Rimpler H, Schneider. Hagers Hanbuch der pharmazeutischen Praxis: Drogen P-Z (Thuja). New York, NY:Springer-Verlag; 1994.

32. Offergeld R, Reinecker C, Gumz E, et al. Mitogenic activity of high molecular polysaccharide fractions isolated from the cupprassaseae Thuja occidentalis L. enhanced cytokine-production by thyapolysaccharide, g-fraction (TPSg). Leukemi1992; 3(Suppl):189S-191S.

33. Neth R, Drize N, Gohla S, Offergeld R, Reski R, Schrum S. Phytotherapeutische forschung: Thuja occidentialis LZ. Allg Med. 1995;71:522-530.

34. Vomel T. Der einflub eins pflanzlichen immunostimulans auf die phagozytose von erythrozyten durch das retikulohistiozytare system der isoliert perfundunierten rattenleber. Arzneimittelforschung/Drug Res. 1985;35:1437-1439.

35. Beuscher N, Kopanski L, Ernwein C. Modulation der immunanatwort durch polymere substanzen aus baptista tinctoria und echinacea angustifoliIn: Masihi KN et al, eds. Immunotherapeutic Prospects of Infectious Diseases. Berlin, Heidelberg:
Springer-Verlag;1987.

36. Beuscher N, Scheit KH, Bodinet C, Egert D. Modulation der korpereigenen immunabwehr substanzen aus baptista tinctoria und echinacea purpureIn: Masihi KN et al, eds. Immunotherapeutic Prospects of Infectious Diseases. Berlin, Heidelberg:Springer-Verlag; 1991.

37. Hansel R, Keller K, Rimpler H, Schneider G. Hagers Handbuch der pharmazeutischen Praxis: Drogen A-D (baptista). New York, NY:Springer-Verlag; 1992.

38. Echinacea pallida root. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998:121-122.

39. Echinacea purpurea herb. In: Blumenthal M., ed. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 1998:122-123. 40. Liske E. Panel discussion. Possible contraindications and side effects of echinace1999. Presented at the 1999 American Herbal Products Association International Echinacea Symposium. Kansas City, Mo.

41. Zakay-Jones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L) during an outbreak of influenza B PanamJ Altern Complement Med. 1995;1:361-369.

42. Ivy Leaf. In: Blumenthal M, Goldberg A, Brinckmann J., ed. Herbal Medicine. Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000:215-217.

43. Meyer-Wegener J, Liebscher K, Hettich M. Ivy versus ambroxol in chronic bronchitis. Zeitschrift Fur Allgemeinmedizin (Journal of General Medicine). 1993;69:61-66.

44. Gulyas A, Repges R, Dethlefsen U. Systematic therapy of chronic obstructive respiratory disease in children. Atemw und Lungenkrankheiten (Respiratory and Lung Disease). 1997;23:291-294