The term the common cold does not denote any precisely defined disease, but this illness

is familiar to most people. Typically symptoms of the common cold consist of some combination of nasal discharge and obstruction, sore throat, cough, lethargy and malaise, with or without fever. The common cold is the leading cause of acute morbidity and of visits to a physician in high-income countries, and a major cause of absenteeism from work and school (1).

The common cold is usually caused by respiratory viruses (rhino, corona, adeno, parainfluenza, influenza, respiratory syncytial), which overall have some 200 serotypes. Thus, the term the common cold does not refer to a single entity but to a group of diseases caused by numerous unrelated aetiological agents. The most frequent agent causing the common cold is rhinovirus, which is found in 30% to 50% of sufferers. In a third of participants with cold symptoms, the aetiology remains undefined even when extensive virological tests are used. It is not clear to what extent this latter group is explained by the low sensitivity of the tests, unidentified viruses, or similar symptoms arising fromnon-viral aetiology, such as allergic or mechanical irritation of the airways. Different respiratory viruses have different symptom profiles, but the patterns are not consistent enough to validate aetiological conclusions from the patients symptoms (1). Although the great majority of common cold episodes are caused by the respiratory virus group, the symptom-based definition of the common cold also covers some diseases caused by other viruses (varicella, measles, rubella, cytomegalo, Epstein-Barr) and some bacterial infections. For example, since

streptococcal pharyngitis cannot be differentiated fromviral pharyngitis on clinical grounds, it can also be included within the broad definition of the common cold. Symptoms of illnesses caused by Mycoplasma pneumonia (M. pneumoniae) and Chlamydia pneumoniae (C. pneumoniae) may also be similar to the symptoms caused by the respiratory viruses. The manifestations of the common cold are so typical that usually the clinical diagnosis of the common cold can be made reliably by adult patients themselves. Allergic and vasomotor rhinitis can sometimes mimic the common cold, but these conditions can usually be easily differentiated (1). In common cold trials an operational definition of the common cold is used for logistic reasons; for example, based on the duration and the set of symptoms to yield an explicitly defined outcome. However, such limits are biologically arbitrary. There is no exact minimum duration or combination of symptoms which is meaningful when drawing a conclusion as to whether the symptoms should be explained by a viral infection, or by allergic or mechanical irritation of nasal airways or throat (1). The occurrence of the common cold is predictable in terms of who is most affected and when colds usually occur. Cold season begins in September after children are back in school, at which time their frequency sharply elevates and remains at a constant level until spring returns. This epidemic results not from a single cold virus but from a number of viruses moving through the community during the fall and winter seasons. In the early fall, rhinovirus begins to increase; parainfluenza viruses follow in late fall, with RSV and coronavirus infections

increasing during the winter months. Cold season concludes with a final surge of rhinovirus infections in the spring. Only a few rhinovirus and enterovirus infections are still present in the community in the summer (2). Colds are most common in children younger than the age of 6 years, who routinely experience six to eight colds annually. This frequency may result from susceptibility due to lack of previous exposure as well as from the natural attributes of childhood, namely, curious exploration of the world with concomitant poor hygiene. Child care attendance increases the number of colds experienced by young children as a result of repeated exposure to other children. By the teenage years, the frequency decreases to four to five colds every year, with parents of young children experiencing only three to four colds annually. Adults who live with young children experience more colds than other adults living without young children in the home (2). Given the number of potential viral etiologies associated with the common cold, treatment options are limited to control of symptoms. In the pediatric population, treatment becomes more challenging because of current recommendations for this age-group (3).