Discussion
Chronic throat symptoms, when unexplained and devoid of structural or
malignant origins, are often dismissed as minor irritations. However,
their prevalence and substantial morbidity for affected patients are now
increasingly recognized. The absence of a standardized terminology for
these localized and often vague aerodigestive complaints may contribute
to underestimation of their public health significance. The prevailing
focus on empirical diagnoses of laryngopharyngeal reflux or functional
throat disorders has led to divergent specialty treatments may
contribute to patient dissatisfaction with inconsistent symptom relief
and varying degrees of medical skepticism.
Among the proposed aetiologies for UCTS, the role of allergies continues
to remain relatively under-explored.
Key observations from our review include. UCTS, inclusive of dysphonia,
cough, globus sensation, dysphagia, throat clearing and others appear to
be prevalent in patients with respiratory allergies compared to general
populations.
The current discourse on the allergy-UCTS association bifurcates by
primary and secondary symptom mechanisms. Primary symptoms point to
IgE-mediated mucosal reactions upon exposure to aerosolised allergens in
sensitized individuals, provisionally termed ”Allergic Laryngitis.”
Preliminary data from both animal and human studies support this
emerging theory, but additional dedicated research is needed to
elucidate this concept and determine its clinical significance,
especially regarding treatment implications.
Several theories likewise identify potential interactions between type 2
inflammation in the nasal or bronchopulmonary lining and the
laryngopharynx as a cause of non-specific throat symptoms. Their
clinical relevance to the patient with UCTS remains inadequately
defined, but nonetheless contributes to the contention that allergy may
be under-recognised as an aetiologic factor in such scenarios.
Current clinical guidelines for treatment of AR/ARS and lower airway
allergy phenotypes largely overlook UCTS, indicating a potential
interdisciplinary treatment gap. Existing treatment approaches targeting
nasal and lower airway Type 2 inflammation might not adequately address
laryngopharyngeal issues or a primary mucosal IgE-mediated process. This
literature review reveals limited evidence concerning efficacy of
current treatment options for throat symptoms in allergic patients,
precluding provision of evidence-based recommendations. Moreover, some
allergy treatments, like inhaled corticosteroids and systemic
antihistamines, might exacerbate laryngopharyngeal symptoms in UCTS
patients. At present the efficacy of therapies targeting airway
hypersensitivity in UCTS and allergy remains uncertain.
We suggest based on the findings in this review that the role of allergy
in contributing to chronic aerodigestive complaints, and the appropriate
therapeutic response in these scenarios remains a significant area of
unmet research need.