Effects of Sequential Dermatophagoides Pteronyssinus Antigen Stimulation on Anatomy and Physiology of the Larynx

Abstract

The goal of this investigation was to study the effects of sequential dust mite antigen stimulation on the appearanceandfunction ofthelarynx. To that end,wedesigned a randomized, placebo-controlled, double-blind, prospective analysis of adults who had tested positive for perennial dust mite allergy. The larynx ofpatients who received the active antigen waschallenged directly with a low (1:100) and a high (1:40) concentration of the dust mite allergen via an oral nebulizer. Voice laboratory assessment tools included voice and allergy questionnaires, videostroboscopic examination of the larynx, acoustic and speech aerodynamic analyses, and digitalaudiovoice recordings. The study was prematurely terminated after 2 patients had been treated with the highest concentration of the antigenic suspension because of adverse effects, including chest tightness, coughing, and voice difficulties. Both of these patients had.demonstrated viscous endolaryngeal secretions and vocal fold edema on videostroboscopy. No reactions were noted at the lower concentration of antigen exposure or in 1 control patient who completed the study. We believe that ourfindings, aspreliminaryas they are, may serve as an initial templatefor the differential diagnosis and treatment of otherpatients with inhalant allergies who presentwith chief complaints suggestive of allergic laryngitis.

Predictive findings of allergic disease in fiberoptic nasolaryngoscopy

“…Allergic disease is not limited to the nasal passages, and the concept of the unified airway suggests that inflammation in one area can affect other areas of the aerodigestive tract as well, including the lower airways . Increasing evidence is mounting that laryngeal and vocal symptoms can be attributable to allergic laryngitis, and that introduction of allergens into the larynx can result in vocal fold edema, an increase in laryngeal symptoms, resulting in increases in the subglottic pressure needed to phonate . Laryngeal symptoms that have been attributed to allergic disease are nonspecific and include hoarseness, cough, throat clearing, globus sensation, excessive mucous, and sore throat or throat discomfort .…”

Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis

“…b-e Videostroboscopic laryngeal images of an allergic singer at diVerent time points in relation to provocation and during the pollen season: at baseline (b), 1 h after grass pollen provocation (c), 24 h after grass pollen provocation (d), during the pollen season (e) study of Reidy et al [11], where no diVerence in laryngostroboscopic assessment was found before and at 30 min after nasal provocation with house dust mite allergen. In contrast to these Wndings, Dworkin et al [12] observed in their study an induction of endolaryngeal secretions and vocal fold edema after provocation with the highest concentration of allergen (1/40). In our study, a nasal provocation with grass pollen allergen in high concentrations (minimum 1/10) was performed and all allergic subjects had a reduction in PNIF and induction of nasal complaints after provocation.…”

“…Here, no diVerence in subjective and objective voice assessment was found after 30 min. The same group recently described an experiment using high-dose house dust mite allergen (concentration 1/40) [12]. Endolaryngeal secretions and vocal fold edema were described on videolaryngostroboscopy after provocation with the higher concentration, while no eVect was seen after provocation with a lower concentration.…”

Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model

“…Similarly, Randhawa et al found that patients with a greater number of allergies had worse subjective report of dysphonia . These studies and others begin to establish a link between the environment and laryngitis …”

“…Leonard et al (1995) identified histologic evidence of CL in bonnet monkeys exposed to daily ozone for 3 months . Translating this work to humans, Dworkin et al induced laryngitis in individuals exposed to HDMA and Naito et al found that individuals with allergy and pollution exposure had more throat symptoms than patients with only allergies . Similarly, Randhawa et al found that patients with a greater number of allergies had worse subjective report of dysphonia .…”