Laryngeal Effects of Antigen Stimulation Challenge with Perennial Allergen Dermatophagoides Pteronyssinus

Abstract

OBJECTIVE: We conducted a pilot study to assess the effects of antigen stimulation on the appearance and function of the larynx. STUDY DESIGN AND SUBJECTS: The prospective, double-blind, randomized study included 9 adult patients with a skin-prick test positive for Dermatophagoides pteronyssinus. MAIN OUTCOME MEASURES: Subjects were blindly challenged via nebulizer with either an active antigenic suspension or placebo. Baseline and 30-minute evaluations of the larynx were performed. Assessments included subjective voice and video-stroboscopic assessments, acoustic analysis of voice, speech aerodynamic testing, and allergy and voice handicap questionnaires. RESULTS: Although both inflammation and increased mucus were noted, there were no significant differences between the antigen- and placebo-exposed subjects on any of the measures obtained. CONCLUSIONS: Our preliminary investigation was not successful in demonstrating a direct causal relationship between antigen exposure and physical or functional changes in the larynx. Future studies will involve modifications to our current methodology, including increasing the concentration of antigen, prolonging the exposure time, and observing for late phase responses.

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…This section evaluates studies that examine the relationship between inhalant allergy and laryngeal disease, including allergic laryngitis. Allergic laryngitis is characterized by allergen‐induced laryngeal inflammation and can present with dysphonia, coughing, throat clearing, and globus 3251 . Some studies have evaluated laryngeal symptoms in individuals with AR while others have evaluated the direct effects of allergen exposure on the larynx (Table XIII.I).…”

“…Two studies from the same voice laboratory evaluated direct laryngeal stimulation by nebulized Dermatophagoides pteronyssinus in allergic patients to assess laryngeal symptoms, appearance, and function 3251,3270 . In the first study, Reidy et al 3251 . did not identify a significant difference between antigen‐ and placebo‐challenged subjects on any of the evaluated measures, such as VHI, Sinus Symptoms Questionnaire, laryngoscopy, and acoustic/aerodynamic testing.…”

“…examined Dermatophagoides farinae exposure to the laryngeal mucosa of guinea pigs and found an increase in eosinophilia compared to saline exposure, providing some support for allergens contributing to laryngeal disease. Two studies from the same voice laboratory evaluated direct laryngeal stimulation by nebulized Dermatophagoides pteronyssinus in allergic patients to assess laryngeal symptoms, appearance, and function 3251,3270 . In the first study, Reidy et al 3251 .…”

“…AR should be considered in the differential diagnosis of patients with vocal complaints. Additional studies are needed on the effect of AR treatment on associated laryngeal disease 3251 …”