A Systematic Review on Medicinal Plant Species to treat Pharyngitis

 

Payal N. Vaja1*, Chetan H. Borkhataria2, Hiral S. Popaniya3, Chintankumar J. Tank4,

Dhrushit R. Pithiya5, Akhil N. Vachhani6

1Assistant Professor, School of Pharmacy, Dr. Subhash University, Junagadh - 362001, Gujarat, India.

2Assistant Professor, Department of Pharmaceutics,

B. K. Mody Government Pharmacy College, Rajkot - 360003, Gujarat, India.

3Assistant Professor, School of Pharmacy, Dr. Subhash University, Junagadh - 362001, Gujarat, India.

4Professor, School of Pharmacy, Dr. Subhash University, Junagadh - 362001, Gujarat, India.

5Research Scholar, School of Pharmacy, Dr. Subhash University, Junagadh - 362001, Gujarat, India.  

6Research Scholar, School of Pharmacy, Dr. Subhash University, Junagadh - 362001, Gujarat, India.

*Corresponding Author E-mail: payalvaja55@gmail.com, chetanborkhataria@gmail.com, hpopaniya@gmail.com, chintankumartank@gmail.com, dhrushitpithiya@gmail.com, vachhaniakhil@gmail.com

 

ABSTRACT:

Pharyngitis, commonly known as a sore throat, is a prevalent condition characterized by inflammation and discomfort in the throat. This ailment can be caused by various factors, including viral or bacterial infections, allergies, or environmental irritants. While conventional treatments like antibiotics and over-the-counter medications are widely used, interest in herbal remedies for pharyngitis has been steadily increasing. Herbal remedies have been used for centuries to treat sore throats, and there is some scientific evidence support their use. Some of the most commonly used herbs for sore throat include Glycyrrhiza glabra, Althaea officinalis, Ulmus glabra, and Salvia officinalis. These herbs can be used to make tea, lozenges, or gargles. It is important to note that herbs can interact with other medications, so it is always best to consult your doctor before using them. This abstract provides an overview of the herbal remedies that have been traditionally used and explored in recent review for alleviating pharyngitis. The paper summarizes the potential benefits of these herbs in managing sore throat infections, highlighting their anti-inflammatory, antimicrobial, and soothing properties as promising candidates for pharyngitis relief.

 

KEYWORDS: Gastroesophageal reflux disease, Pharynx, Demulcent.

 

 


INTRODUCTION:

Pharyngitis is a common ailment that affects individuals of all ages. It is a medical term that refers to the inflammation of the pharynx, the muscular tube situated at the back of the throat. This condition is often recognized by its hallmark symptom of a sore throat.

 

Pharyngitis can be attributed to a variety of underlying causes, making it a frequent reason for doctor visits and discomfort among people worldwide. Pharyngitis can be categorized into two primary forms: viral and bacterial1. Viral pharyngitis is typically caused by common respiratory viruses like the rhinovirus or the influenza virus. It is the most prevalent form and tends to be self-limiting, requiring no specific medical intervention. Conversely, bacterial pharyngitis, most notably caused by Streptococcus pyogenes (Group A Streptococcus), demands prompt attention due to the potential for complications and the need for antibiotic treatment. Beyond these infectious origins, pharyngitis can also result from irritants like tobacco smoke, allergens, or environmental pollutants. Its clinical presentation encompasses a spectrum of symptoms, ranging from a scratchy or itchy throat to severe pain and difficulty swallowing. Given the diverse etiologies and clinical manifestations of pharyngitis, accurate diagnosis and appropriate management are crucial to ensure optimal patient outcomes.

 

Pharyngitis can also be caused by allergies, trauma, cancer, gastroesophageal reflux disease (GERD)2, and certain toxins. Pharyngitis is the inflammation of the mucous membranes of the oropharynx. In most cases, it is caused by an infection, either bacterial or viral. Other less common causes of pharyngitis include allergies, trauma, cancer, reflux, and certain toxins3,4.

 

 

Figure 1: Pharyngitis5

 

Causes of pharyngitis:

The most common cause of pharyngitis is a viral infection, such as the common cold or flu. Other viruses that can cause pharyngitis include adenovirus, coronavirus, and parainfluenza virus. Bacterial infection is another common cause of pharyngitis, with Group A Streptococcus (GAS) bacteria being the most common culprit. GAS infection, also known as strep throat, can cause serious complications such as rheumatic fever and post-streptococcal glomerulonephritis. Less common causes of pharyngitis include allergies, trauma (such as from a foreign object in the throat), cancer of the throat or larynx, gastroesophageal reflux disease (GERD), and certain toxins, such as cigarette smoke and chlorine6.

 

Symptoms of pharyngitis:

The most common symptom of pharyngitis is a sore throat. Other symptoms include pain or difficulty swallowing, a red, swollen, or inflamed throat, white or yellow patches on the tonsils or back of the throat, swollen lymph nodes in the neck, fever, and cough. Additional symptoms can include a runny or stuffy nose, headache, fatigue, and loss of appetite7,8.

 

Types of pharyngitis:

There are two types of pharyngitis:

Acute pharyngitis:

Acute pharyngitis is the sudden onset of inflammation in the pharynx (the back of the throat) and can be caused by various factors. Viral infections are the most common cause of acute pharyngitis, including rhinoviruses (common cold), influenza viruses, adenoviruses, and others9.

 

Bacterial Infections: Group A Streptococcus (Streptococcus pyogenes) is a common bacterial cause of acute pharyngitis, often referred to as strep throat. Environmental Irritants: Exposure to irritants like smoke, pollution, dry air, or chemical fumes can irritate the throat, leading to acute pharyngitis, especially in individuals with sensitivity or preexisting conditions. Allergies: Allergic reactions to pollen, pet dander, dust mites, or other allergens can cause allergic pharyngitis, characterized by throat irritation, itching, and discomfort. Gastroesophageal Reflux Disease (GERD): Acid reflux can lead to irritation and inflammation of the throat, causing symptoms similar to acute pharyngitis. Foreign Body or Injury: Swallowing or inhaling a foreign object or experiencing trauma to the throat can result in acute pharyngitis. Chemical Irritants: Exposure to harsh chemicals, such as cleaning agents, can irritate the throat and cause acute pharyngitis9.

 

Figure 2: Types of Pharyngitis10

 

Chronic pharyngitis:

Chronic pharyngitis is characterized by persistent inflammation and irritation of the pharynx (the back of the throat) that lasts for an extended period, typically several weeks or longer11.

Several factors can contribute to the development of chronic pharyngitis, and sometimes it can be a combination of these factors. Some common causes include:

1.     Recurrent Infections: Repeated viral or bacterial infections of the throat can lead to chronic pharyngitis, as the throat may not have sufficient time to fully heal between episodes.

2.     Smoking: Smoking tobacco is a significant risk factor for chronic pharyngitis. The chemicals in tobacco smoke can irritate and inflame the throat lining over time.

3.     Excessive Alcohol Consumption: Heavy alcohol consumption can irritate the throat and contribute to chronic pharyngitis.

4.     Environmental Factors: Prolonged exposure to environmental irritants such as dry air, dust, pollution, or workplace chemicals can lead to chronic throat irritation.

5.     Gastroesophageal Reflux Disease (GERD): Chronic acid reflux, where stomach acid frequently backs up into the throat, can cause chronic pharyngitis due to the irritation caused by the acid.

6.     Allergies: Chronic allergies, such as allergic rhinitis, can result in postnasal drip, which can irritate the throat and contribute to chronic pharyngitis.

7.     Chronic Sinusitis: Persistent inflammation and drainage from the sinuses can lead to throat irritation and chronic pharyngitis.

8.     Voice Strain: People who use their voice excessively, such as singers, teachers, or call center workers, may develop chronic pharyngitis due to vocal cord strain and throat irritation.

9.     Underlying Medical Conditions: Certain medical conditions, such as autoimmune disorders or immune system deficiencies, can make individuals more susceptible to chronic pharyngitis.

10. Medications: Some medications, such as inhaled corticosteroids for asthma, can lead to throat irritation and potentially contribute to chronic pharyngitis11.

 

Pathophysiology of pharyngitis:

Pharyngitis occurs due to a viral or bacterial infection. This infection triggers an antigen-antibody reaction, leading to the release of histamine and prostaglandins. Histamine can cause acid reflux, while prostaglandins induce inflammation. The resulting inflammation manifests as pharyngitis12.

 

Pathology of viral pharyngitis:

The pathology of pharyngitis refers to the structural and functional changes that occur in the throat (pharynx) when it becomes inflamed. Viral infections, such as those caused by rhinoviruses or adenoviruses, can lead to viral pharyngitis. The virus enters the cells of the pharyngeal lining, causing cell damage and death. This cell damage triggers an inflammatory response, with increased blood flow to the area, resulting in redness and swelling of the pharyngeal tissues. The immune system releases cytokines and other chemicals to combat the virus, which contributes to the inflammatory process. The throat may appear red and irritated, and symptoms may include a sore throat, often accompanied by cold or flu-like symptoms12.

 

Pathology of bacterial pharyngitis:

Group A Streptococcus (Streptococcus pyogenes) is a common bacterium responsible for strep throat. Streptococci produce toxins and antigens that damage pharyngeal tissue and trigger an intense immune response. This immune response can lead to the formation of pus (a viscous liquid composed of dead or dying bacteria and neutrophils) in the throat, visible as white patches or streaks. The tonsils, which are part of the pharyngeal tissue, can become swollen and inflamed. The inflammation can extend to nearby lymph nodes13.

 

Mechanism of action of herbs:

Anti-inflammatory:

Many herbs, like liquorice and marshmallow root, contain compounds that can reduce inflammation in the throat, alleviating pain and discomfort. Herbal plants can help to reduce inflammation in the throat, providing relief from pain and discomfort. For example, liquorice root, chamomile, and marshmallow root all contain compounds with anti-inflammatory properties14.

 

Antimicrobial:

Many herbal plants contain compounds that have antimicrobial activity against the bacteria and viruses that can cause pharyngitis. For example, garlic, oregano, and thyme all contain compounds that have been shown to inhibit the growth of Streptococcus pyogenes, the most common cause of bacterial pharyngitis. Additionally, herbs such as sage, thyme, and echinacea possess antimicrobial properties that can help combat the infection causing pharyngitis14.

 

Demulcent activity:

Demulcent herbs form a protective coating over the throat, which can soothe irritation and reduce coughing. For example, slippery elm bark and marshmallow root are both demulcent herbs that are often used to treat pharyngitis15.


 

Scientific classification of herbal plants used for pharyngitis:

Table 1: Scientific classification of plants

Plants

Kingdom

Division

Class

Order

Family

Genus

Species

Tulsi16

Plantae

Tracheophytes

Angiosperms

Lamiales

Lamiaceae

Ocimum

O. tenuiflorum

Garlic17

Plantae

Tracheophyta

Monocots

Asparagales

Amaryllidaceae

Allium

A. Sativum

Clove18

Plantae

Tricheophytes

Angiosperms

Myrtales

Myrtaceae

Syzygium

S. aromaticum

Turmeric19

Plantae

Tricheophytes

Angiosperms

Zingiberales

Zingiberaceae

Curcuma

C.longa

Liquorice root20

Plantae

Tricheophytes

Angiosperms

Fabales

Fabaceae

Glycyrrhiza

G. glabra

Ginger21

Plantae

Tricheophytes

Angiosperms

Zingiberales

Zingiberaceae

Zingiber

Z. officinale

Echinacea22

Plantae

Tricheophytes

Angiosperms

Asterids

Asteraceae

Echinacea

E. purpurea

Chamomile23

Plantae

Tricheophytes

Angiosperms

Asterales

Asteraceae

Matricaria

M. chamomilla

Marshmallow24

Plantae

Tricheophytes

Angiosperms

Malvales

Malvaceae

Althaea

A. officinalis

Malabar25

Plantae

Tricheophytes

Angiosperms

Poales

Poaceae

Cymbopogon

C. Citratus

Neelgiri26

Plantae

Tricheophytes

Angiosperms

Myrtales

Myrtaceae

Eucalyptus

E. globulus


Various Plants: Applications in pharmaceutical formulations for Medicinal and Beyond

1. Tulsi:

It consists of the fresh leaves of Ocimum tenuiflorum linn., belonging to the Lamiaceae family. The active constituents of tulsi include linalool (30-40%), eugenol (8-30%), and methyl chavicol (20-25%). It also contains glycosides, saponins, and tannins (0.1-0.9%)27,49.

 

Figure 3: Structure of Eugenol27

 

Uses: Tulsi provides antibiotic, antiviral, and antibacterial activities. Medicinally, it is also used for relieving pharyngitis, cough, and fever, and helping to cure a sore throat28.

 

2.     Garlic:

Alliin is obtained from the bulbs of a plant known as Allium sativum linn., belonging to the Liliaceae family. Garlic bulbs contain volatile oil (0.06-0.1%), mucilage (2-5%), phosphorus (5-10%), and protein (5-6%). The chief active constituent of garlic is alliin29.

 

Figure 4: Structure of Alliin29

 

Uses: This is used to treat pharyngitis, cough, and cold. It also acts as an antioxidant and antidiabetic. Additionally, it provides antimicrobial and antiviral activity and has carminative and expectorant effects30.

 

3.     Clove:

Clove consists of the dried flower buds of Eugenia caryophyllus, belonging to the Myrtaceae family. Clove contains about 15-20% volatile oil, 10-13% tannin, and 70-90% eugenol. It also contains resin, chromone, and caryophyllenes. The chief chemical constituent is eugenol acetate31.

 

Figure 5: Structure of Euginol acetate31

 

Uses: Clove exhibits anti-inflammatory, anticancer, and antioxidant activities. Therefore, it is used to treat pharyngitis and helps to cure colds and coughs. It is also used in the treatment of asthma, dental cavities, nausea, and bronchitis32.

4.     Turmeric:

Turmeric is obtained from the dried rhizomes of Curcuma longa Linn., belonging to the Zingiberaceae family. Turmeric contains about 50-60% curcumin, which is the chief active constituent of curcuminoids. It also contains volatile oil, cineol, zingiberene, and curcuminoids33.

 

Figure 6: Structure of Curcumin33

 

Uses: Curcumin is used to treat pharyngitis and helps to cure colds and coughs. It aids in wound healing and provides antioxidant, anti-inflammatory, and antiseptic actions. It is also used as a hypolipidemic and flavoring agent34.

 

5.     Liquorice root:

It consists of the dried unpeeled roots and stolons of Glycyrrhiza glabra linn., belonging to the Fabaceae family31. The roots of Glycyrrhiza glabra Linn. contain glycyrrhizin, which is the chief active constituent. They also contain glycyrrhizic acid, glycyrrhitic acid, and glucuronic acid35.

 

Figure 7: Structure of Glycyrrhizin35

 

Uses: It is used for cough and sore throat. Glycyrrhizin provides anti-inflammatory, antiviral, antimalarial, antifungal, antibacterial, and anti-allergic activities36.

 

6.     Ginger:

Ginger consists of whole or cut, dried, scraped or unscraped rhizomes of Zingiber officinale. It belongs to the Zingiberaceae family. Ginger rhizome contains volatile oil (1-4%), starch (40-60%), and organic material (5%). Ginger oil is constituted with zingiberene, zingiberol, and phenylpropanoids37.

 

Figure 8: Structure of Zingiberene37

 

Uses: Ginger is used to treat throat infections, colds, and coughs. It is also used as an aromatic carminative, stimulant, and to alleviate cold extremities, morning sickness, and nausea38.

7.     Echinacea:

It consists of flower juice extracted from Echinacea purpurea linn. It belongs to the Asteraceae family. Echinacea contains caftaric acid, chlorogenic acid, caffeine, cichoric acid, and echinacoside as the chief active constituents39.

 

Figure 9: Structure of Echinacoside39

 

Uses: Echinacea is used to treat pharyngitis. It also acts as an antioxidant, anti-inflammatory agent, and immunity booster. It is used to cure infected wounds, ear infections, acne, and boils. Additionally, it is used for upper respiratory infections, lowering blood sugar levels, and mouth infections40.

 

8.     Chamomile:

Chamomile consists of the dried flower heads of Matricaria chamomilla Linn. belonging to the Asteraceae family. Chamomile contains about 15-20% chamazulene, 10-13% spiroether, and 80-90% carene, as well as visabolol, β- and α-farnesene. It also contains terpineol, thymol, and caryophyllene41.

 

Figure 10: Structure of Farnesene41

 

Uses: It is used to treat sore throat, hay fever, inflammation, muscle spasm, Gastrointestinal disorder and rheumatic pain, Menstrual disorder, Insomnia, Hemorrhoids42.

 

9.     Marshmallow:

Marshmallow consists of the dried roots of Althaea officinalis. It belongs to the Malvaceae family. Marshmallow root contains pectin, starch, polysaccharides, mucilage, and flavonoids, including hypolaetin-8-glucoside, isoquercitrin, and kaempferol, which are its chemical constituents43.

 

Figure 11: Structure of Kaempferol43

 

Uses: Marshmallow root contains kaempferol, which provides anti-inflammatory and antioxidant effects. These constituents help reduce inflammation, alleviate irritation, and provide relief from sore throat symptoms44.

 

10. Malabar:

It consists of the stems of Cymbopogon citratus. It belongs to the Poaceae family. The active constituents of lemongrass are citral (neral and geranial), myrcene, limonene, citronella, geranyl acetate, and nerol45.

 

Figure 12: Structure of Neral and Geranial45

 

Uses: Malabar is used as a natural remedy for sore throat and menstrual pain. Lemongrass is rich in antipyretic properties and works effectively as a painkiller for general causes46.

 

11. Eucalyptus:

It is obtained from the fresh leaves of Eucalyptus globulus and belongs to the Myrtaceae family. The chemical constituents of eucalyptus include 1,8-cineole, 8-cimene, α-pinene, and α-limonene47.

 

Figure 13: Structure of Cineole47

 

Uses: Eucalyptus is used to treat coughs and the common cold. Its fresh leaves are used for gargles to soothe sore throats and to treat bronchitis and sinusitis48.

 

CONCLUSION:

Pharyngitis is a common ailment that affects individuals of all ages. It is the inflammation of the pharynx, the muscular tube situated at the back of the throat. This condition can be self-perpetuating unless interrupted with active treatment. Herbal medicines are increasingly in demand in the developing world for primary healthcare, not only because they are relatively inexpensive but also due to their better cultural acceptability, compatibility with the human body, and minimal side effects. This review focuses on various herbal plants with anti-inflammatory and soothing properties. The review concludes by providing a comprehensive view of various herbal medicines used for the treatment of Pharyngitis. These herbal options are considered good alternatives to modern cough drugs, which often have significant side effects.

 

CONFLICT OF INTEREST:

The authors have no conflict of interest regarding to this investigation.

 

ACKNOWLEDGEMENT:

The authors express their sincere thanks to Principal, Teaching and non-teaching faculties, Dr. Subhash University, Junagadh, Gujarat, India for providing guidance and support to this review work.

 

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Received on 05.02.2024         Modified on 08.05.2024

Accepted on 15.07.2024   ©Asian Pharma Press All Right Reserved

Asian J. Pharm. Tech. 2024; 14(3):213-219.

DOI: 10.52711/2231-5713.2024.00035