New horizons: Current and potential future self-treatments for acute upper respiratory tract conditions

Acute upper respiratory tract conditions (URTCs), including the common cold, allergic rhinitis (AR), and acute sinusitis, are among the most common afflictions worldwide, affecting millions of individuals annually in the United States alone. A common theme among these conditions is that they share similar symptomatology and are often inadequately treated. These conditions typically cause mild, albeit bothersome, symptoms for a typical duration of 7 to 10 days in the case of the common cold, ≥ 2 weeks for AR exacerbations, and ≤ 4 weeks for acute sinusitis. The common cold and AR elicit localized (upper airway) and systemic inflammatory cascades responsible for symptoms such as cough, nasal congestion, rhinorrhea, watery eyes, sneezing, headache, and general malaise. Acute sinusitis typically occurs because of a secondary bacterial or fungal infection of mucus-clogged nasal and sinus cavities and has symptoms similar to those previously listed, with the addition of increased facial and ear pressure/pain. Acute URTC symptoms are frequently managed with over-the-counter (OTC) products. Currently available OTC options can have limited efficacy in treating the broad array of symptoms associated with acute URTCs, and some have unwanted side effects. There is an unmet need for OTC therapies that have broad clinical activity, can reduce the severity and duration of illness when taken at the first sign of symptoms, and/or provide prophylaxis. This review article examines the available evidence supporting emerging and potentially new OTC pharmacologic, nutraceutical, and nonpharmacologic therapies on the horizon for the treatment of acute URTCs. This review is not intended to be a comprehensive evaluation of all potential URTC therapies, and the approvability of many of the agents discussed for OTC use in the United States may be subject to debate.