An explanation for the seasonality of acute upper respiratory tract viral infections

Despite a great increase in our understanding of the molecular biology of the viruses associated with acute upper respiratory tract viral infections (URTIs) there is a remarkable lack of knowledge and ideas about why URTI should exhibit a seasonal incidence. Most publications in this area either acknowledge a complete lack of any explanation for the seasonality of URTI or put forward an explanation relating to an increased crowding of susceptible persons in winter. This review will discuss some of the ideas concerning the seasonality of URTI and put forward a new hypothesis for discussion, namely that seasonal exposure to cold air causes an increase in the incidence of URTI due to cooling of the nasal airway. The hypothesis is supported by literature reports demonstrating that inhalation of cold air causes cooling of the nasal epithelium, and that this reduction in nasal temperature is sufficient to inhibit respiratory defences against infection such as mucociliary clearance and the phagocytic activity of leukocytes. A case is also made to suggest that warming of the nasal airway during fever and nasal congestion may help to resolve a current URTI.