When should you treat a fever? Before people used aspirin or acetaminophen to lower a fever, healers around the world believed that raising body temperature would speed recovery from infection. A few generations back, grandmothers would often pile on the quilts when someone was sick with a cough or a cold. Once drug companies introduced “antipyretics” to lower fevers, though, behavior changed.
Parents were encouraged to give children aspirin or Tylenol (acetaminophen) even if their temperature was only slightly elevated. It took decades to discover that aspirin posed a serious risk for children with flu or chicken pox. Now, doctors warn that children or teenagers should avoid aspirin to reduce the risk of a rare but deadly complication called Reye’s syndrome.
People continue to argue about the need to treat a fever, as this family demonstrates:
Should You Always Lower a Fever?
Family Feuds Over Fever:
Q. Please resolve a family dispute. Every time our daughter has a slight fever, my wife rushes for the Tylenol. I was brought up to believe that a little fever is part of the healing process. Who is right?
A. Surprisingly, experts don’t agree about the answer to this fundamental question. While research shows that fever helps lizards fight off infections, there has been surprisingly little information when it comes to humans.
A summary of fever research in the journal Nature Reviews Immunology (May 15, 2015) notes that:
“Fever is a cardinal response to infection that has been conserved in warm and cold-blooded vertebrates for over 600 million years of evolution. The fever response is executed by integrated physiological and neuronal circuitry and confers a survival benefit during infection.
“The evolutionary conservation of the fever response over millions of years is in line with its protective role — the survival benefit conferred on the host outweighs the metabolic cost of elevating core body temperatures during infection.”
The authors describe a complex immunological response in which immune cells are activated by elevated temperature. These include NK (natural killer) cells, macrophages, neutrophils, dendritic cells and lymphocytes.
A Short History of Hydrotherapy:
The ancient Greeks and Romans valued “balneotherapy” (bathing in hot mineral waters). Hot springs and spas have been popular for centuries because people believed they had healing properties.
Hydrotherapy was used during the 1918 influenza pandemic. Seventh-day Adventist schools and hospitals used hot water therapy to fight complications of the flu. The death rate in 10 Adventist sanitariums was dramatically lower than in Army hospitals that used aspirin.
Did Aspirin Lower a Fever but Increase Deaths during the 1918 Flu Pandemic?
An article published in the journal Clinical Infectious Diseases, Nov. 15, 2009 proposed a controversial reason why aspirin may have been counterproductive during the Spanish flu outbreak:
“The high case-fatality rate—especially among young adults—during the 1918–1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely ‘wet,’ sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike.”
Drug Companies Love to Lower a Fever!
Even though there are no well-controlled clinical trials proving that lowering a fever when you have the flu will do any good whatsoever, drug companies have loaded up their OTC remedies with acetaminophen or ibuprofen (another fever reducer).
It’s even possible such drugs could be counterproductive by allowing viruses to replicate more efficiently. One study revealed that subjects who came down with the flu were sick longer (up to four days longer) if they took aspirin or acetaminophen (Pharmacotherapy, Dec., 2000).
The Food and Drug Administration recently admitted that some of the most popular OTC cold and flu remedies contain the decongestant phenylephrine (PE), an ingredient that is worthless. You read about this screwup at this link.
What Does the Temperature Mean?
An elevated temperature is merely a symptom of an underlying infection. The infection may call for treatment, but a mild fever usually does not. Grandmothers realized this generations ago. As mentioned above, they tended to pile on the quilts to help the body attempt to fight off the invading organisms.
Investigators have found that when people develop a mild to moderate fever, they are more likely to survive a serious infection (Australian Critical Care, Aug. 2013). Cancer researchers are reexamining the role of fever in boosting the immune system’s fight against abnormal cells.
Symptoms Are Different from Disease:
Americans often confuse symptoms with the underlying disease. That’s easy to understand. Symptoms are obvious. What causes them can be hard to discern.
Take heartburn for example. It could be a result of dietary indiscretion: too many slices of pepperoni pizza plus too many beers. Or the indigestion could be triggered by a big dose of ibuprofen. Then again, sharp burning pain under the breastbone could be the first sign of a heart attack. Digestive discomfort does not tell you the cause of the condition.
Why Do We Lower a Fever?
What do you do when you have a fever? If you are like most people, you reach for acetaminophen (Tylenol), ibuprofen (Advil or Motrin IB), naproxen (Aleve) or old-fashioned aspirin. But is that a good idea?
It is easy to understand why people could perceive a fever as the problem rather than part of the body’s reaction to infection. Fever is obvious and people with fevers usually feel bad. However, that isn’t the only way to interpret elevated body temperature.
Is an Elevated Temperature Functional?
Hippocrates, the father of “modern” medicine thought that fever could be beneficial. Many different cultures have adopted ritual use of inducing a fever-like state. Steam baths, hot springs and sweat lodges can raise body temperature.
In Russia, the banya or bathhouse has a long healing tradition. People go from a cold pool to a hot steam room. Historically, village healers used the steam heat of the bathhouse to treat a variety of ailments.
The Sweat Lodge:
Native American and First Nations people used the sweat lodge for both spiritual and physical healing. There are suggestions that such ceremonies can impact the immune system and enhance recovery from wounds or infections (IHS Primary Care Provider, June, 1998).
Waon Therapy from Japan:
Healers in Japan have developed a form of therapy that uses heat to treat cardiovascular disease. It is a kind of dry sauna. The practitioners describe it this way (Circulation Journal, Feb. 13, 2010):
“‘Wa’ means soothing, and ‘On’ means warmth, hence Waon or ‘soothing warmth’ infers a warmth that comfortably refreshes the mind and body. Waon therapy is defined as warming the entire body in a uniformly heated chamber for 15min at a temperature that relaxes the mind and body.”
This relatively new heat approach may have evolved from the Japanese onsen or natural hot springs. Soaking in these natural thermal formations has been practiced for thousands of years to help heal both the mind and the body.
The Finnish Sauna Tradition:
Finland is the country of saunas. Although people in Norway and Sweden also engage in sauna bathing, this is really a sacred Finnish practice. There are more than 5.5 million Finns and over 3.3 million saunas.
It has been estimated that sauna bathing dates back thousands of years. Almost every home in Finland has a sauna. These rooms are heated to between 170 and 230 degrees F. That’s hot! People often go from the sauna to cold water or snow and then hop back into the sauna.
There are numerous studies that have examined the impact of sauna bathing on the immune system. One, published in the Journal of Human Kinetics (Dec. 18, 2013) noted that runners often experience immunosuppression because of intense physical exercise. The authors concluded :
“Sauna bathing could be recommended for athletes as a means of enhancing immunological defence.”
A review of the evidence of the health benefits of sauna bathing in the Mayo Clinic Proceedings (Aug. 2018) states:
“Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits, which include reduction in the risk of vascular diseases such as high blood pressure, cardiovascular disease, and neurocognitive diseases; nonvascular conditions such as pulmonary diseases; mortality; as well as amelioration of conditions such as arthritis, headache, and flu. The beneficial effects of sauna bathing on these outcomes have been linked to its effect on circulatory, cardiovascular, and immune functions.”
Researchers writing in Experimental Gerontology, (Aug. 5, 2021) reinforce the value of sauna bathing. They state that it can improve circulation, lower blood pressure and cholesterol and reduce the risk for sudden death.
Other investigators add (European Journal of Clinical Investigation, March, 2021):
“Sauna bathing, a passive heat therapy commonly undertaken in Finland for the purposes of pleasure and relaxation, has been linked to several health benefits including a reduced risk of respiratory tract diseases such as pneumonia”
Malaria Therapy vs. Venereal Disease:
Another method for raising body temperature used during the early 20th century was “malaria therapy.” In this extreme treatment, doctors actually injected malaria parasites to give the patient a high fever.
An Austrian physician, Dr. Julius Wagner-Jauregg, developed this approach for patients suffering from syphilis infections affecting their brains. The pathogen causing syphilis could not survive high body temperatures. Dr. Wagner-Juaregg received the Nobel prize for this innovation in 1927.
If Heat is Healing, Why Should We Lower a Fever?
Aspirin was the first popular drug to lower a fever. The Bayer company developed it in 1897 and began distributing it without prescription in 1915. However, the company lost its patent during the First World War, and drug manufacturers in other countries began making it.
An advertising campaign in August of 1918 promoting aspirin was very successful. The drug was widely used that fall during the influenza pandemic. A spike in deaths that occurred in October has been attributed to the overuse of aspirin.
When body temperature is high, both the innate and adaptive branches of the immune system are more effective against infection. That means the white blood cells that serve as the surveillance system are activated. In addition to attacking the invaders, they also alert B cells to produce antibodies that will tag the pathogen for destruction.
Does Ibuprofen Pose a Risk if You Lower a Fever?
If a fever serves a protective function, does lowering it put people at risk? There are some data to support that concept. The French Minister of Health stirred up a hornet’s nest when he said that people with COVID-19 should not take ibuprofen.
Many health professionals discounted his advice on the grounds that there is no clinical evidence to support such a prohibition. More to the point, however, is the question: is it counterproductive to lower a fever when people have a viral infection?
Some scientists have found that reducing fevers can increase the transmission of infectious diseases (Proceedings of the Royal Society B: Biological Sciences, March 7, 2014).
When Should You Lower A Fever?
Readers want to know when a parent should lower a fever in a child. To answer that question we turn to the American Academy of Pediatrics (Pediatrics, March 1, 2011):
“…the real goal of antipyretic therapy is not simply to normalize body temperature but to improve the overall comfort and well-being of the child…When counseling a family on the management of fever in a child, pediatricians and other health care providers should minimize fever phobia and emphasize that antipyretic use does not prevent febrile seizures. Pediatricians should focus instead on monitoring for signs/symptoms of serious illness, improving the child’s comfort by maintaining hydration, and educating parents on the appropriate use, dosing, and safe storage of antipyretics.”
The Mayo Clinic emphasizes that there is no hard and fast rule about when to lower a fever. If a child is really sick, a physician should always be consulted. The Mayo experts suggest that a fever up to 102 degrees F may not require treatment for older children or adults. Of course any fever that lasts more than a few days requires medical oversight.
A high fever (over 102) can be problematic. There are people with underlying health conditions that make even a modest fever dangerous. In addition, people with septic shock are at greater risk of dying if their fever rages out of control.
Perhaps researchers might reconsider the benefits of a fever. Rather than fighting the body’s own immune reaction to infection, we should learn how to use it safely. Some people should avoid heat therapy because of a heart condition, pregnancy, epilepsy, severe blood pressure problems or difficulty with balance. When in doubt, consult a physician.
As in all things, moderation and common sense should be followed. A mild to moderate fever may be helpful for many people without severe illness. Lowering it with over-the-counter medicines could be counterproductive.
This raises the question, how many OTC cold, cough and flu medicines are helpful and how many are potentially harmful? We discussed the amount of money that is wasted on OTC products that contain the ineffective oral decongestant phenylephrine during this radio interview:
Questions have also been raised about OTC cough suppressants and expectorants. If you would like to learn more about natural alternatives for treating upper respiratory tract infections, here is a link to our eGuide to Colds, Coughs & the Flu. It can be found under the Health eGuides tab.
What do you think about drug companies that promote the idea that you should lower a fever if you have a cold? Do you value grandma’s wisdom about sweating out a fever? Do you have a favorite home remedy for colds or coughs? Please share it and your thoughts about fever in the comment section below.