Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis

Abstract

In spite of our recent insight into nasobronchial interaction mechanisms in allergic airway disease, the association between allergic rhinitis and voice complaints remains obscure. To evaluate the effects of nasal allergen provocation and seasonal grass pollen exposure on subjective and objective laryngeal parameters in singers with and without allergic rhinitis, an observational case control study was conducted. Prior to the pollen season, six grass pollen allergic and six non-allergic semiprofessional singers were exposed to nebulized sham solution and grass pollen extract (HAL°) in rising concentrations. After 3 min, 60 min and 24 h, nasal and laryngeal complaints were evaluated by the use of a visual analog scale (VAS). Laryngeal parameters like voice appearance (video stroboscopic images), voice range profile and subjective (GRBAS) and objective (jitter, shimmer, H/N, DSI) voice quality were evaluated before provocation, after 60 min and 24 h. During the pollen season, the allergic singers were re-evaluated. Results showed that in allergic singers both nasal (TNS of 4.0 ± 2.4 vs. 0.0 ± 0.0, p < 0.05) and laryngeal complaints (TLS of 1.4 ± 1.1 vs. 0.0 ± 0.2, p < 0.05) were induced at 3 min after the provocation. The induced laryngeal complaints were the feeling of laryngeal irritation, secretions and globus. No change in voice quality or stroboscopy score was measured. During the pollen season, laryngeal complaints were present (TLS of 2.4 ± 2.4) in allergic singers, without evidence for objective voice and laryngeal changes. In conclusion, we here demonstrate the rapid induction of laryngeal complaints in allergic singers by nasal allergen provocation and during the pollen season. There was no subject reported or investigator measured change in voice quality. No change in stroboscopy score was measured.

Multi-morbidities of allergic rhinitis in adults: European Academy of Allergy and Clinical Immunology Task Force Report

“…In a recent study on AR and laryngeal symptoms, involving six controls and six adult singers, nasal provocation with pollen extracts caused a rapid induction of laryngeal irritation and globus sensation. However, no objective changes occurred then, nor during the pollen season [90 ].…”

Histological Effects of Inhaled Corticosteroids and ß2‐agonists on Laryngeal Mucosa in an Allergic Rat Model

“…A previous clinical study with allergic singers reported the rapid induction of laryngeal complaints following allergen provocation and during pollen season. 1 In this study, a statistically significant increase in mast cell number and degranulation was detected in rat supraglottic laryngeal mucosal specimens upon allergen exposure. In addition, increased inflammatory cell infiltration in allergensensitized rat supraglottic laryngeal specimens was associated with inhaled corticosteroids.…”

“…However, the existing data regarding laryngeal mucosal response to allergy are limited and contradictory. A previous clinical study with allergic singers reported the rapid induction of laryngeal complaints following allergen provocation and during pollen season 1 …”

“…Due to its location between upper and lower airways, the larynx is exposed to environmental challenges, including inhaled house dust, pollens, and chemicals. 1 Despite intensive studies of allergic rhinitis, chronic laryngeal allergy is a rarely investigated phenomenon, and the effects of allergen exposure on the laryngeal mucosa are unknown. 2,3 Allergic laryngitis is considered a component of allergic rhinitis and asthma rather than an independent disease process.…”

Risk Factors for Voice Disorders among Fado Singers: A Cross-Sectional Study

“…This can be interpreted in the following two different ways: the cause may arise from the disorder or from the medication intake. This is not surprising since allergic rhinitis is commonly associated with voice changes [37][38][39][40][41]. Singers tend to be in environments, such as stages, that are more prone to air, dust, or pollutants, which trigger these kinds of disorders [42][43][44].…”