Nasal Congestion, More Than Physical Obstruction

Main Category: Ear, Nose and Throat
Also Included In: Allergy;  Respiratory / Asthma
Article Date: 14 Oct 2011 - 1:00 PDT

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Nose feel congested and stuffed up? Scientists from the Monell Center report that the annoying feeling of nasal obstruction is related to the temperature and humidity of inhaled air. The findings suggest that sensory feedback from nasal airflow contributes to the sensation of congestion. This knowledge may help researchers design and test more effective treatments for this familiar symptom of nasal sinus disease.

Nasal sinus disease, usually caused by infection or allergy, is one of the most common medical conditions in the United States, afflicting approximately 33 million people and accounting for over $5.8 billion in healthcare costs annually. Nasal congestion and the associated feeling of obstruction is the symptom that typically causes individuals to seek medical assistance.

However, symptoms of nasal congestion have been difficult to treat effectively because, as many physicians have found, patient reports of congestion often have little relationship to the actual physical obstruction of nasal airflow.

"By establishing that feelings of nasal congestion can be sensory-related, we open doors for more targeted treatment," said study lead author Kai Zhao, Ph.D., a bioengineer at Monell. "For example, effective treatments may need to include a focus on restoring optimal humidity and temperature in the patient's nasal airflow."

In the study, published online in the free-access journal PLoS One, 44 healthy volunteers rated symptoms of nasal congestion after breathing air from three boxes: one containing room air at normal humidity, another containing dry air at room temperature, and the third containing cold air.

The volunteers reported reduced nasal congestion after breathing from both the cold air box and the dry air box as compared with the room air box, with the cold air box decreasing reports of congestion most effectively.

Calculations revealed that humidity also was an important factor, with lower humidity associated with decreased feelings of congestion.

The authors speculate that temperature and humidity interact as air moves through the nasal cavity to influence nasal cooling. It is this cooling that is then detected by 'cool sensors' inside the nose to influence the feeling of air flow as being either easy or obstructed.

"Someone in the desert, all other things being equal, should feel less congested than someone in the jungle. In the low humidity of the desert, there is more evaporative cooling inside of the nose, such that the temperature of the nasal passages is lower. This leads to a feeling of greater air flow and less sensation of obstruction." said co-author Bruce Bryant, Ph.D., a sensory scientist at Monell.

Future studies will examine patients reporting nasal obstruction to see if the sensory findings reported here can explain their symptoms, and also explore how sensory factors interact with other predictors of nasal obstruction.

Also contributing to the study were Kara Blacker, Yuehao Luo, and Jianbo Jiang, all of Monell. The research was funded by the National Institute on Deafness and Other Communication Disorders.

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New Approach To Peanut Allergy Prevents Life-Threatening Reaction

Main Category: Allergy
Also Included In: Immune System / Vaccines
Article Date: 12 Oct 2011 - 1:00 PDT

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Researchers have turned off a life-threatening allergic response to peanuts by tricking the immune system into thinking the nut proteins aren't a threat to the body, according to a new preclinical study from Northwestern Medicine. The peanut tolerance was achieved by attaching peanut proteins onto blood cells and reintroducing them to the body - an approach that ultimately may be able to target more than one food allergy at a time.

"We think we've found a way to safely and rapidly turn off the allergic response to food allergies," said Paul Bryce, an assistant professor of medicine in the division of allergy-immunology at Northwestern University Feinberg School of Medicine. Bryce and Stephen Miller, professor of microbiology-immunology at Feinberg, are co-senior authors of a paper published in the Journal of Immunology.

It's the first time this method for creating tolerance in the immune system has been used in allergic diseases. It has previously been used in autoimmune diseases.

The approach also has a second benefit. It creates a more normal, balanced immune system by increasing the number of regulatory T cells, immune cells important for recognizing the peanut proteins as normal.

"T cells come in different 'flavors'," Bryce said. "This method turns off the dangerous Th2 T cell that causes the allergy and expands the good, calming regulatory T cells. We are supposed to be able to eat peanuts. We've restored this tolerance to the immune system."

Peanut allergies often cause life-threatening allergic reactions, called anaphylaxis. Each year there are between 15,000 and 30,000 episodes of food-induced anaphylaxis and 100 to 200 related deaths in the United States, according to the National Institutes of Health. There is no safe treatment to protect people from a severe allergic reaction to food.

When an allergic person eats a peanut, the proteins are absorbed through the intestine and can activate a life-threatening, full-body immune response. This includes constriction of the airways, low blood pressure and/or shock and can lead to loss of consciousness and death.

Using a mouse model that mimics a life-threatening peanut allergy (which the Northwestern team developed several years ago), researchers attached peanut proteins onto white blood cells called leukocytes and infused those back into the mice. After two treatments, the mice were fed a peanut extract. They did not have the life-threatening allergic reaction because their immune system now recognized the protein as safe.

"Their immune system saw the peanut protein as perfectly normal because it was already presented on the white blood cells," Bryce said. "Without the treatment, these animals would have gone into anaphylactic shock." Bryce thinks more than one protein can be attached to the surface of the cell and, thus, target multiple food allergies at one time.

In the second part of the study, Northwestern researchers used the same approach with an egg protein, which was to provoke an immune response - similar to an asthma attack - in the lungs. They attached the proteins to white blood cells and infused the cells back into the mice. When the mice inhaled the asthma-provoking egg protein, their lungs didn't become inflamed.

"This is an exciting new way in which we can regulate specific allergic diseases and may eventually be used in a clinical setting for patients," said Miller, the Judy Gugenheim Research Professor at the Feinberg School.

Miller also has used the same approach in autoimmune diseases. His previous published research has shown the same technique to stop the progression of multiple sclerosis and type 1 diabetes, both autoimmune diseases, in animal models. This approach is currently being tested in multiple sclerosis patients in a phase I/IIa clinical trial.

For autoimmune diseases and allergic airway diseases, Miller also is working with microparticles rather than white cells to induce tolerance, because the microparticles are more easily standardizd for manufacturing.

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