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.