Laryngeal allergy: a commentary

Association of Sinonasal Factors With Chronic Laryngitis in Korean Adults

Importance

Allergic laryngitis is underdiagnosed owing to overlapping clinical manifestations that arise from other causes of laryngitis. Sinonasal conditions associated with chronic laryngitis, including allergic laryngitis, have not been reported using population-based epidemiologic data.

Objective

To estimate the association of the prevalence of chronic laryngitis with various sinonasal symptoms and endoscopic findings, and to identify which of the sinonasal factors are particularly associated with allergic cause of chronic laryngitis.

Design, Setting, and Participants

This cross-sectional, population-based study of 11 283 participants 18 years and older who had undergone laryngoscopic and nasal endoscopic examination used data from 2010 through 2012 in the fifth edition of the Korea National Health and Nutrition Examination Survey, a nationwide survey of South Korea. Participants were extracted by stratified, multistage, clustered sampling to comprise a nationally representative sample. Data were analyzed in September 2017.

Exposures

Sociodemographic characteristics, smoking status, alcohol use, questionnaires for voice change and sinonasal symptoms, and nasal endoscopic examinations before and after shrinkage of the nasal mucosa.

Main Outcomes and Measures

Chronic laryngitis diagnosed by laryngoscopic examination, and allergic cause of laryngitis determined by specific serum immunoglobulin E tests.

Results

Of the 11 283 participants included in the study, the mean (SD) age was 50.1 (16.6) years, and 6365 (56.4%) were women. In total, 343 participants (3.0%) were diagnosed with chronic laryngitis through results of laryngoscopic examination. Chronic laryngitis was associated with a higher rate of rhinitis symptoms (odds ratio [OR], 1.54; 95% CI, 1.21-1.96), anterior/posterior nasal drip (OR, 2.03; 95% CI, 1.38-2.98), nasal congestion (OR, 1.49; 95% CI, 0.99-2.25), endoscopic findings of pale mucosa (OR, 1.74; 95% CI, 1.33-2.28), mucous or puslike discharge (OR, 1.53; 95% CI, 1.08-2.18), and puslike discharge in the middle meatus (OR, 1.85; 95% CI, 1.19-2.88), especially in female participants and participants older than 50 years. Subgroup analysis revealed that all participants with allergic laryngitis showed sensitization to Dermatophagoides farinae, and the allergic laryngitis group (n = 9) had a higher presence of rhinitis symptoms (n = 5; 56%) than did the nonallergic laryngitis group (n = 1 of 12; 8%) among participants younger than 50 years (risk difference, 47%; 95% CI, 4%-78%).

Conclusions and Relevance

The association of various sinonasal factors with chronic laryngitis were prominent in female participants, as well as those 50 years and older. Nevertheless, the presence of rhinitis symptoms in patients with chronic laryngitis was associated with allergic cause of laryngitis solely in participants younger than 50 years. In young adults, presence of rhinitis symptoms might aid in considering allergic laryngitis.

Differential diagnosis in allergy

The otolaryngic allergist must be able to distinguish between common nonallergic diagnoses that present very similarly to allergic conditions. This article describes a few of the vast myriad of conditions that must be ruled out before a diagnosis of allergy may be made. After reading this article clinicians will be able to identify various conditions, which will enhance their ability to appropriately make correct decisions for prompt and efficient management of their patients with allergic or nonallergic diseases of the head and neck.

Rhinogenic laryngitis, cough, and the unified airway

Over the past 10 years, there has been increasing recognition of the interaction between the upper and lower airways in patients with a variety of infectious and inflammatory illnesses, including allergic rhinitis, rhinosinusitis, and asthma. Epidemiologic and mechanistic links have been proposed to demonstrate these relationships and to offer possible etiologic explanations to account for these observations. Among patients with upper respiratory illnesses, cough can be seen as a common symptom, both from the direct influences of upper airway inflammation, which incite reflex changes and bronchospasm, and from the exacerbation of associated pulmonary processes, such as asthma. Despite this increasing awareness of interaction between the upper and lower airways, the influence of both upstream and downstream respiratory inflammatory processes on laryngeal pathophysiology has not been extensively studied. Research suggests, however, that both direct stimulatory effects on the larynx and secondary effects of mucus production and mucus trafficking can create a range of laryngeal symptoms, including cough. This review discusses the interaction of the upper and lower airway in respiratory disease, and focuses on the effect of these respiratory processes on laryngeal inflammation, function, and symptoms.

Immunohistochemical study on distribution of mast cell phenotypes in human laryngeal mucosa: evidence for laryngeal type I allergy

It is controversial whether or not type I allergic reactions can occur in the human laryngeal mucosa. To clarify this issue, we studied the distribution of mast cell phenotypes in the human laryngeal mucosa using the immunohistochemical staining method with antihuman tryptase and chymase antibodies. A large number of mast cells are present in the superficial layer of subepithelial connective tissue (SECT) of the epiglottis, arytenoid, and subglottis. Although mast cells containing both tryptase and chymase are predominant in the deep layer of the SECT, the majority of mast cells containing tryptase alone are located in both the epithelial layer and the superficial layer of the SECT. We conclude that the human laryngeal mucosa has the potential to induce type I allergic reaction.