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.