Best Treatment For Rhinoviruses

Overview 

What most people refer to as the ‘common cold’, can be caused by a plethora of viral pathogens. Around 80% of these illnesses are a result of rhinoviruses,¹ which are RNA viruses that belong to the Picornaviridae family.²

In addition to the common cold - also referred to as acute upper respiratory tract illness, rhinoviruses have also been linked to acute lower respiratory tract illnesses, such as bronchiolitis and pneumonia, as well as to sinusitis and asthma.³

This article will explore rhinovirus infection symptoms, duration, treatment options, and prevention tactics. 

Management and treatment of rhinoviruses

Although most rhinovirus infections are mild, exacerbated symptoms in elderly patients can sometimes be fatal. Apart from the substantial morbidity, rhinovirus infections burden patients with economic costs.⁴ The frequency of the infection as well as the economic burden makes the development of effective treatment crucial. However, in most cases, common colds are treated at home and require rest and hydration.

Several home remedies can be helpful, such as: 

• Medication - antibiotics are not recommended for common colds, they are ineffective in viral infections and should not be taken unless there is a bacterial infection. The use of aspirin is also not recommended, especially in children. Ibuprofen and paracetamol can be used in moderation to alleviate symptoms such as fever and headache. Paracetamol should not be given to children under 3 months old before consulting a doctor. Ibuprofen should not be given to children under 6 months old. Consulting a doctor before taking any medication is encouraged⁵
• Decongestant nasal sprays - nasal sprays can help alleviate symptoms such as nasal congestion, rhinorrhea (runny nose), and sneezing. Such sprays should not be used for more than 5 consecutive days as they can irritate the nose causing dryness and a burning sensation.⁵ Consult a doctor before giving nasal sprays to children under 6 years old
• Saline nasal sprays/drops - in the case of nasal irritation, saline sprays can keep the nose and nasal passages moist. The use of saline sprays/ drops is generally safe in adults and children
• Hydration - warm liquids such as tea, soups, and warm water can help alleviate congestion and a sore throat. Adults and children over 1 year can add honey in a warm liquid to soothe pain in the throat and coughing. It is recommended that alcohol and caffeine are avoided, as they can be dehydrating⁵
• Vitamin C - vitamin C has been studied for many decades as a means to prevent and treat common colds. Vitamin C has antioxidant properties and might be able to reduce oxidative stress during infections. A meta-analysis and systematic review that investigated whether vitamin C is an effective preventative agent for rhinovirus infections as well as an effective treatment for the subsequent symptoms, showed that vitamin C did not exhibit any preventative properties. More specifically, individuals who took vitamin C and those who took placebo had no significant difference in the incidences of common colds. However, the same meta-analysis found that vitamin C can reduce the duration and severity of the symptoms. This effect was more pronounced in individuals who had undergone periods of heightened physical stress, such as marathon runners⁶
• Zinc - zinc has shown activity against rhinovirus infections, however the mechanisms that underlie this activity are not clear. It has been found to decrease histamine release.⁷ Histamine release is linked to some of the symptoms of a rhinovirus infection such as nasal congestion and sneezing. A study showed that taking zinc supplements within 24 hours of the initiation of symptoms can reduce the severity as well as duration. These results were mostly observed in adults⁸
• Antihistamines - two separate trials have suggested that antihistamines can reduce symptoms such as a runny nose and sneezing by approximately 62% and 50% respectively, when administered 4 times daily. However, the severity of symptoms such as coughing and sore throat are not benefited by antihistamines. Side effects including dry mouth, nose, and eyes often occur⁷

Causes of rhinoviruses

Rhinovirus is spread by direct contact with an infected individual or indirect contact through objects, as well as small and large particle aerosols.⁹ Person-to-person transmission is often attributed to the viral contamination of the hands.⁴ More specifically, the virus could be recovered from the hands of around 40% of adults with a rhinovirus infection. The virus can be transferred to the hands through eye rubbing or nose scratching.³ Regardless of how the virus is transmitted, the infection starts when the virus comes in contact with the nasal mucosa. 

Signs and symptoms of rhinoviruses

Symptoms usually emerge 1-2 days after the infection, and peak approximately 2 to 4 days later.¹⁰  Most commonly, early symptoms include a runny nose, sneezing, nasal obstruction as well as a sore and scratchy throat.¹¹

Nasal symptoms are generally more persistent and take longer to subside compared to the sore throat. However, when the nasal symptoms do subside, in approximately 30% of cases, a cough can appear and often become very bothersome.

The duration of the illness averages 1 week, while in about a quarter of cases - especially in elderly patients, the illness can last for up to 2 weeks.¹² 

Less frequent symptoms can include headaches, myalgia (muscle pain), and low-grade fever. After the symptoms are resolved, there is a chance for viral shedding, meaning that the virus can still be recovered for up to 2-3 weeks after the infection in some patients.³

FAQs

How are rhinoviruses diagnosed?

As the symptoms associated with a rhinovirus infection are similar to symptoms caused by bacterial upper respiratory tract infections, it can be challenging to accurately diagnose whether  the symptoms can be attributed to a bacterial or a viral infection.³ Distinguishing between the two infections is required to provide patients with the appropriate treatment options. 

The diagnosis consists of a thorough examination of the nasal cavity, sinuses, pharynx (part of the throat), and ears. However, the lack of onsite laboratory testing for viruses leads to patients with such illnesses being diagnosed empirically, based on the nature of the symptoms. 

How can I prevent rhinoviruses?

While it is difficult to completely prevent rhinoviruses, there are some steps you can take to reduce your risk:

• Hand hygiene - person to person direct transmission via hands is very common, placing the focus on developing treatments that can inactivate the virus on the patient’s hands. A study by Turner and colleagues showed that ethanol hand sanitizer is almost 50% more effective in removing the detectable virus from the hands than hand washing with water and soap⁷
• Self-isolation & respiratory masks - the recent COVID-19 pandemic showed how effective social distancing and the use of respiratory masks can be for the prevention of illness transmission. Staying home and not coming into contact with people when symptomatic, when possible,  can help stop the transmission to other susceptible individuals. If a symptomatic patient for whatever reason needs to come into contact with people, the use of respiratory masks is recommended, as it has been found that masks are an effective way to prevent respiratory virus transmission⁷
• Zinc - zinc supplement intake has been linked with a decreased incidence of common colds. However, the optimal dosage for the best results has yet to be confirmed. Notably, some forms of zinc supplementation (zinc lozenges) can cause unpleasant side effects such as nausea and bad taste⁸

The development of a relevant and effective vaccine for the prevention of rhinovirus infections remains challenging due to the variety of distinct rhinovirus serotypes.⁵

Who are at risk of rhinoviruses?

Rhinovirus infections are increasingly common in young children, especially those who attend daycare. These infections are often transmitted from the child to the parents via hand-to-hand transmission. Immunocompromised groups such as infants and the elderly are at higher risk of developing more severe symptoms that can lead to more serious illnesses. 

How common are rhinoviruses?

Data suggests that both children and adults are infected with rhinovirus every 1-2 years.¹³ Although rhinovirus infections can occur any time during the year, they are most common in the autumn and spring.¹ Rhinoviruses are the most common causative factor for common colds, accounting for approximately 80% of cases. 

When should I see a doctor?

You should seek medical advice if your child has:

• High and persistent fever, more specifically a fever of 39.4℃ that lasts for more than 3 days Persistent fever can be indicative of a separate infection in the body, for which alternative treatment may be required
• Difficulty breathing, wheezing, fast breathing, and cough that produces coloured phlegm. These symptoms can indicate a more severe and serious issue such as pneumonia or bronchitis. Immunocompromised individuals such as infants are more likely to develop these illnesses
• Symptoms that do not go away for more than 10 days, or worsen as the days pass
• Persistent earache
• Seizures

For adults, medical advice is needed if you have: 

• High and persistent fever (over 38.9℃)
• Difficulty breathing, chest pain, chest pressure
• Vomiting, fainting, as well as feelings of disorientation or confusion

Summary

Rhinovirus infections are the leading causal factor for the common cold. Symptoms usually include rhinorrhea (runny nose), nasal congestion, sneezing, a sore and scratchy throat, coughing, low-grade fever, and a headache. The symptoms start 1-2 days after the infection and worsen 2-4 days in. In most cases, the illness lasts around a week, but sometimes symptoms can persist for up to 2 weeks.

In case of a prolonged high fever, persistent vomiting and disorientation, trouble breathing, and chest pain, it is recommended to visit a doctor. Common colds can develop into more serious illnesses, such as pneumonia and bronchitis, that require different interventions.

Diagnosis of rhinovirus infections is usually empirical due to the lack of onsite laboratory testing.

Treatments include vitamin C and zinc supplements, antihistamines, and more. Prevention is always important and can be achieved with hand hygiene, self-isolating, and the use of respiratory masks.