Introduction
Chronic symptoms affecting the aerodigestive tract, such as persistent
cough, dysphonia, globus sensation, dysphagia, and throat clearing, are
frequently encountered in non-acute clinical settings. Their
non-specific nature poses diagnostic challenges, often requiring
multidisciplinary evaluations that may yield inconclusive
results[1-3 ]. Aetiological uncertainty in these scenarios of
Unexplained Chronic Throat Symptoms (UCTS) emerge as a challenging
clinical entity, given increasing recognition of their prevalence and
substantial morbidity[2 , 4-8 ]. Some authors estimate
patients with UCTS account for as many as 5-10% of total primary care
presentations[2 ], indicating this localised symptom
constellation is of significant public health importance. Diagnostic
uncertainties often lead to provisional diagnoses predicated on
empirical associations with gastroesophageal reflux (GORD) or various
functional aerodigestive disorders, often without unified
interdisciplinary guidance[2 , 9-13 ].
Amongst various competing aetiological hypotheses for UCTS, the role of
respiratory allergies remains under-represented in current scientific
discourse[14-20 ]. Preliminary evidence indicates a higher
prevalence of sensitisation to airborne allergens among UCTS patients
compared to non-allergic cohorts [14 , 16 , 18 ,20-23 ]. In the absence of a distinct laryngopharyngeal allergy
phenotype, it is often postulated that these irritative symptoms may
relate to secondary impacts of
type 2 inflammation in the nasal and/or lower airways[24-26 ].
However, existing clinical guidelines seldom address this association
directly, with the exception of the somewhat controversial ”Upper Airway
Cough Syndrome (UACS),” which correlates persistent cough with
inflammatory nasal conditions, such as allergic rhinitis (AR) or
rhinosinusitis (ARS)[14 , 24-26 ].
Over the past two decades, the notion of Allergic Laryngitis (AL) as a
distinct laryngopharyngeal allergic disease phenotype has gained
scholarly attention. Emerging data substantiate AL as a plausible and
potentially under diagnosed entity in UCTS patients with concomitant
airway allergies[14-21 , 23 ]. Nevertheless, the
clinical implications of the elevated incidence of UCTS among patients
with respiratory allergies remain unclear, particularly regarding
therapeutic strategies.
This review aims to coherently synthesize extant evidence on the complex
interrelationship between respiratory allergies and UCTS when other
aetiologies are absent. Additionally, we critically appraise the
literature for the impact of current allergy therapies on chronic throat
symptoms in respiratory allergy patients. The overarching goal is to
equip healthcare practitioners with a rational basis for considering
allergies as a potential aetiological contributor in UCTS, while
offering evidence-based therapeutic guidance for such cases.