Diagnostic and Therapeutic Outcomes Following Systematic Assessment of Patients with Concurrent Suspected Vocal Cord Dysfunction and Asthma

Laryngoscopy diagnosis of inducible laryngeal obstruction during supervised challenge for suspected anaphylaxis

“…We describe four patients with ILO presenting to our allergy service with latex, food or drug‐induced “anaphylaxis” (Table 1). In each case, we established the diagnosis on flexible laryngoscopy after deliberately provoking an event by supervised challenge to the relevant “allergen.” As reported previously, 1,2 confirmation of ILO either at baseline or following provocation was achieved by laryngoscopic visualization of paradoxical vocal fold motion, defined by either (i) any vocal cord adduction during inspiration or (ii) >50% reduction in the area of the rima glottidis; laryngeal inlet airspace between the edges of true vocal cords or angle at the anterior commissure from the position of the vocal processes during expiration. Provocation was performed using standardized graded or direct allergen challenge protocols.…”

“…Optimal diagnosis and management requires multidisciplinary expertise in both allergic disease and laryngeal dysfunction 1,2,7 . Close liaison with Speech Pathology is critical 8 .…”

“…For maximum safety and effectiveness, such challenges should be performed with expertise and facilities to diagnose and treat both (i) anaphylaxis; continuous pulse oximetry, peak expiratory flow and blood pressure monitoring, capabilities for intravenous access, emergency medications including adrenaline, resuscitation personnel and equipment and (ii) ILO; flexible laryngoscopy with capacity for video recordings and immediate Rescue Breathing techniques. Our Allergy team has extensive expertise in functional laryngoscopy following irritant and odour provocation 1,2,5 ; units without such experience must liaise closely with Otolaryngology, as laryngoscopy performed acutely is essential to confirm ILO and exclude laryngeal oedema.…”

“…Inducible Laryngeal Obstruction (ILO), also known as Vocal cord dysfunction (VCD) ─ episodic, paradoxical glottic closure during respiration ─ can mimic or even co‐exist with asthma 1–3 . Common triggers include inhaled irritants, odours and exercise 4 .…”

“…Inducible Laryngeal Obstruction (ILO), also known as Vocal cord dysfunction (VCD) ─ episodic, paradoxical glottic closure during respiration ─ can mimic or even co-exist with asthma. [1][2][3] Common triggers include inhaled irritants, odours and exercise. 4 Proposed mechanisms include sensory neural dysfunction resulting in accentuation of the glottic closure reflex, which may be both irritant and stress mediated.…”