The role of Airway Hypersensitivity: relevance in Allergy
The theory of airway hypersensitisation posits a heightened sensitivity
in laryngeal and pharyngeal tissues as a potential aetiological factor
for UCTS[4 , 6 , 11 , 49-54 ]. Underlying
this theory is the concept that peripheral and/or central sensitization
of neuronal pathways results in exaggerated afferent nerve activity,
transforming normally non-noxious stimuli into distressing
symptoms[11 , 28 , 55 , 56 ]. This state may
arise from an initial insult including viral infection, allergy, or acid
reflux, but persists even after the resolution of the original trigger,
and is likely modulated by complex biopsychosocial factors.
Consequently, the sensitized airway tissues may be reactive to various
dietary, endogenous and environmental irritants and in some cases by
innocuous stimuli (such as phonation or emotion), leading to persistent,
often refractory symptoms that defy conventional diagnostic
categorization and therapeutic approaches. The role of allergy in
precipitating or contributing to somatosensory aberrations, or indeed
the role of sensitisation in the occurrence or expression of throat
symptoms in this group is poorly understood at present.