Type 2 Inflammation of the Nasal Airway: impacts on the
Laryngopharynx
Allergic rhinitis (AR) impacts approximately 40% of the general
population [27 , 28 ]. In sensitised patients, exposure
to airborne allergens triggers an IgE-mediated immune response, leading
to mast cell de-granulation and release of inflammatory mediators like
histamine. This culminates in nasal mucosal inflammation, resulting in
clinical symptoms such as rhinorrhoea, sneezing, and nasal congestion.
In patients with allergic rhinosinusitis (ARS), this reaction extends to
the paranasal sinuses, and may result in additional symptoms of
headache, facial pain and or fullness.
Table 1 summarises research data reporting the prevalence of
chronic throat symptoms in this population. Beyond the nose, chronic
cough is recognised as a potential sequelae of inflammatory nasal
disease, including allergic nasal phenotypes. Refractory cough in this
setting is often enveloped under the Upper Airway Cough Syndrome (UACS)
umbrella, which links refractory cough without structural or other
disease explanations with chronic nasal inflammation, of which allergy
is a key aetiology[24-26 , 29 ]. We found non-cough
aerodigestive symptoms are infrequently sought and minimally reported in
the setting of allergic nasal disease, despite observations that
refractory cough is often accompanied by additional localised throat
symptoms[30 , 31 ]. Considering this limitation, it
nonetheless would appear that non-specific complaints involving
unexplained dysphonia, globus, mucus sensation, throat clearing and
other irritative UCTS are equally prevalent in this cohort.