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      Reduction of Viral Load in Patients with Acute Sore Throats: Results from an Observational Clinical Trial with Echinacea/ Salvia Lozenges Translated title: Reduktion der Viruslast bei Patienten mit akuten Halsschmerzen: Ergebnisse einer klinischen Beobachtungsstudie mit Echinacea/Salvia-Lutschtabletten

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          Abstract

          Background

          Acute tonsillopharyngitis or sore throat is an initial sign of viral respiratory tract infection (RTI) and an optimal indicator for early antiviral and anti-inflammatory intervention. Both of these actions have been attributed to Echinacea purpurea and Salvia officinalis.

          Methods

          74 patients (age 13–69 years) with acute sore throat symptoms (<48 h) were treated with five Echinacea/ Salvia lozenges per day (4,000 mg Echinacea purpurea extract [Echinaforce ®] and 1,893 mg Salvia officinalis extract [A. Vogel AG, Switzerland] daily) for 4 days. Symptom intensities were recorded in a diary and oropharyngeal swab samples collected for virus detection and quantification via RT-qPCR.

          Results

          The treatment was exceptionally well tolerated, no complicated RTI developed, and no antibiotic treatment was required. A single lozenge reduced throat pain by 48% ( p < 0.001) and tonsillopharyngitis symptoms by 34% ( p < 0.001). Eighteen patients tested virus positive at inclusion. Viral loads in these patients was reduced by 62% ( p < 0.03) after intake of a single lozenge and by 96% ( p < 0.02) after 4 days of treatment compared to pre-treatment.

          Conclusions

          Echinacea/ Salvia lozenges represent a valuable and safe option for the early treatment of acute sore throats capable to alleviate symptoms and contribute to reducing viral loads in the throat.

          Zusammenfassung

          Hintergrund

          Akute Tonsillopharyngitis oder Halsschmerzen/entzündungen sind ein erstes Anzeichen einer viralen Atemwegsinfektion (vAWI) und ein optimaler Indikator für eine frühzeitige antivirale und entzündungshemmende Intervention. Beide Wirkungen werden Echinacea purpurea und Salvia officinalis zugeschrieben.

          Methoden

          74 Patienten (Alter 13–69 Jahre) mit akuten Halsschmerzen/entzündungen (<48 h) wurden mit fünf Echinacea/Salvia-Lutschtabletten pro Tag (Tagesdosis: 4'000 mg Echinacea purpurea-Extrakt [Echinaforce®] und 1'893 mg Salvia officinalis Extrakt [A. Vogel AG, Schweiz]) behandelt für 4 Tage. Die Symptomintensität wurde in einem Tagebuch aufgezeichnet und Rachenabstrichproben wurden zum Virusnachweis und zur Quantifizierung mittels RT-qPCR entnommen.

          Resultate

          Die Behandlung wurde außergewöhnlich gut vertragen, es entwickelte sich keine komplizierten AWI und es waren keine Antibiotikabehandlungen erforderlich. Eine einzelne Lutschtablette reduzierte die akuten Halsschmerzen um 48% ( p < 0,001) und die allgemeinen Tonsillopharyngitis Symptome um 34% ( p < 0,001). Achtzehn Patienten wurden bei der Aufnahme viruspositiv getestet. Die Viruslast wurde bei diesen Patienten nach Einnahme einer einzigen Lutschtablette um 62% ( p < 0,03), und nach 4-tägiger Behandlung um 96% ( p < 0,02) reduziert im Vergleich zu vor der Behandlung.

          Schlussfolgerungen

          Echinacea/Salvia-Lutschtabletten stellen eine sichere Option für die frühzeitige Behandlung akuter Halsschmerzen/entzündungen dar, die Symptome lindern, und zur Verringerung der Viruslast im Hals beitragen können.

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          Most cited references30

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies
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            Viruses and bacteria in the etiology of the common cold.

            Two hundred young adults with common colds were studied during a 10-month period. Virus culture, antigen detection, PCR, and serology with paired samples were used to identify the infection. Viral etiology was established for 138 of the 200 patients (69%). Rhinoviruses were detected in 105 patients, coronavirus OC43 or 229E infection was detected in 17, influenza A or B virus was detected in 12, and single infections with parainfluenza virus, respiratory syncytial virus, adenovirus, and enterovirus were found in 14 patients. Evidence for bacterial infection was found in seven patients. Four patients had a rise in antibodies against Chlamydia pneumoniae, one had a rise in antibodies against Haemophilus influenzae, one had a rise in antibodies against Streptococcus pneumoniae, and one had immunoglobulin M antibodies against Mycoplasma pneumoniae. The results show that although approximately 50% of episodes of the common cold were caused by rhinoviruses, the etiology can vary depending on the epidemiological situation with regard to circulating viruses. Bacterial infections were rare, supporting the concept that the common cold is almost exclusively a viral disease.
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              Understanding the symptoms of the common cold and influenza

              Ron Eccles (2005)
              Summary The common cold and influenza (flu) are the most common syndromes of infection in human beings. These diseases are diagnosed on symptomatology, and treatments are mainly symptomatic, yet our understanding of the mechanisms that generate the familiar symptoms is poor compared with the amount of knowledge available on the molecular biology of the viruses involved. New knowledge of the effects of cytokines in human beings now helps to explain some of the symptoms of colds and flu that were previously in the realm of folklore rather than medicine—eg, fever, anorexia, malaise, chilliness, headache, and muscle aches and pains. The mechanisms of symptoms of sore throat, rhinorrhoea, sneezing, nasal congestion, cough, watery eyes, and sinus pain are discussed, since these mechanisms are not dealt with in any detail in standard medical textbooks.
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                Author and article information

                Journal
                Complement Med Res
                Complement Med Res
                CMR
                CMR
                Complementary Medicine Research
                S. Karger AG (Basel, Switzerland )
                2504-2092
                2504-2106
                8 March 2023
                September 2023
                : 30
                : 4
                : 299-306
                Affiliations
                [a ]Medical Department, A. Vogel AG, Roggwil, Switzerland
                [b ]Convex CRC, Diagnostics and Consultation Center Convex, Sofia, Bulgaria
                [c ]d.s.h. Statistical Services GmbH, Rohrbach, Germany
                Author notes
                Correspondence to: Ramon Weishaupt, r.weishaupt@ 123456avogel.ch
                Article
                530017
                10.1159/000530017
                10664317
                36889292
                1868bd14-b1ff-42ca-9eb6-81f54524fd55
                © 2023 S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission.

                History
                : 19 July 2022
                : 27 February 2023
                : 2023
                Page count
                Figures: 3, Tables: 1, References: 31, Pages: 8
                Funding
                This study was sponsored by A. Vogel AG, Roggwil, Switzerland. The sponsor covered the funding of the article and publication fees. The role of the funder was to supply the study medication, which was the Echinacea/ Salvia lozenge.
                Categories
                Research Article / Originalarbeit

                echinacea,salvia,sore throat,common cold,tonsillopharyngitis,acute therapy,antiviral effect,viral shedding,respiratory tract infections,halsschmerzen,halsentzündung,erkältung,akuttherapie,antiviral,virusausscheidung,atemwegsinfekte

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