Affiliations: Gainesville, FL
Dr. Bender is Professor of Medicine, University of Florida College of Medicine and Veterans Affairs Medical Center.
Correspondence to: Bradley S. Bender, MD, University of Florida College of Medicine, VA Medical Center 182, Gainesville, FL 32608-1197
Viral respiratory tract infections are
extremely common. For example, there are an estimated 20 to 50 million
influenza virus infections annually in the United States resulting in
24 million patient visits, 300,000 hospitalizations, and 20,000 to
50,000 deaths.1 Various folk remedies have long played a
complementary role in the management of these infections. Simply
stated, these are to rest, stay warm, and drink plenty of fluids.
Most patients with influenza who die do so from complications of
pneumonia. Rest is thought to decrease the risk of aspirating virus
from the upper airways into the lungs. The soldiers most affected in
the swine flu outbreak of 1976 in Ft. Dix, NJ, were just beginning
basic combat training, a time of exceptional exertion.2
Fever clearly has a beneficial effect on the course of most
infections.3In ferrets that were experimentally infected
with influenza virus, significant inverse correlations were found
between body temperature and nasal viral titers.4–
Furthermore, the suppression of fever either by shaving or by treatment
with sodium salicylate prolonged viral shedding.5The
treatment of rhinovirus-infected volunteers with antipyretics also
prolongs viral shedding.6–7 The mechanisms by which
elevated temperatures inhibit viral replication are not clear but
include enhanced immune function and direct inhibition of viral growth.
Influenza virus grows best at 34 to 35°C and poorly, if at all, at
temperatures > 37°C. Hence, staying warm may have a beneficial
antiviral effect. More properly stated, the patient should probably
stay in a warm environment; this will keep the airways at a higher
Proper hydration also appears to be important for loosening secretions.
Influenza infection produces a severe tracheitis.8 Early
in the disease process, there are copious amounts of pulmonary
secretions, which are associated with gaps in the tight junctions. This
is followed by thicker secretions later on. The loss of ciliated
epithelium emphasizes the need for hydration to improve the pulmonary
As best as I can determine, Moses Maimonides first wrote of the
medicinal effects of chicken soup.9Based on the above
adages, chicken soup would appear to be an ideal remedy. First, chicken
soup is best consumed while sitting down. I have an image of my mother
and both grandmothers telling me to “Slow down! Don’t eat so fast!
You’ll ruin your digestion!” If the infected subject also had to
prepare the soup using Mrs. Fleischer’s recipe, cited in the article
by Rennard et al in this issue of CHEST (see page
1150), additional “down time” would be assured. (By the way,
this recipe is much too complicated for me.) Second, inhaling the warm
steam of such a well-prepared delicacy would undoubtedly raise the
temperature of the airways and help loosen secretions.10
Finally, the consumption of large amounts of liquid would maintain
hydration. Though not true for all medications, in this case if a
little is good, then a lot would be better.
Rennard et al address another potential biological benefit of
chicken soup on respiratory viral infections. Oy, what a manuscript! (I
hope the reader takes Dr. Soffer’s comments on previous chicken soup
articles to heart while reading this one.11–) They showed
that extracts of chicken soup significantly inhibited neutrophil
chemotaxis (migration) in a standard in vitro assay. The
inhibitory substance was present in the chicken and in the vegetables.
On a theoretical basis, it makes some sense that the inhibition of
chemotaxis would be beneficial in reducing symptoms. Following viral
infections, there is an influx of neutrophils to the infected site,
which may be responsible for producing some of the local symptoms. This
potential mechanism for the beneficial effect of chicken soup needs to
be counterbalanced by the concern that the inhibition of chemotaxis may
contribute to the increased bacterial superinfection seen in viral
infections.12 More importantly, as the authors point out,
this is an in vitro study, and whether there are
physiologically significant changes in neutrophil chemotaxis following
the ingestion of chicken soup has not been demonstrated. One
possible method to determine this would be to measure neutrophil
chemotaxis in a group of subjects, feed them chicken soup, and then
repeat the chemotaxis measurements. (Even better would be to measure
experimentally infected subjects’ chemotaxis before and after chicken
soup ingestion.) Volunteers for this study should form a line behind
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