If there is always thick phlegm in your throat, be careful that you may have allergic pharyngitis!

Author: Lin Lin, Chief Physician, Huashan Hospital Affiliated to Fudan University

Reviewer: Tang Qin, Deputy Secretary-General of the Science Popularization Expert Committee of the Chinese Medical Association, Researcher

Some people in life feel that there is always thick and sticky phlegm in their throats, which they can neither cough out nor swallow. This may be related to allergic pharyngitis.

1. What is allergic pharyngitis?

As the name suggests, the onset of allergic pharyngitis may be related to one's own allergy to certain external substances (such as pollen, dust mites, etc.). But it is worth noting that this "allergy" refers to the disease state caused by allergic inflammation, not "oversensitivity" in the ordinary sense. At present, relevant studies have confirmed that patients with allergic rhinitis (the medical standard term is "allergic rhinitis") are more likely to have functional disorders in the throat.

2. What are the clinical manifestations of allergic pharyngitis?

1. Allergic symptoms of the respiratory tract (including upper and lower respiratory tract) : Upper respiratory tract symptoms include sneezing, clear runny nose, nasal itching and nasal congestion; some patients may also experience lower respiratory tract symptoms such as chest tightness and wheezing.

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2. Throat symptoms : mainly include foreign body sensation in the throat, irritating cough, hoarseness, and the feeling that there is always thick and sticky phlegm that cannot be coughed out.

3. How to diagnose allergic pharyngitis?

1. Signs : Indirect laryngoscopy or electronic laryngoscopy reveals congestion and erythema of the laryngeal mucosa, with thick mucous secretions attached to the surface, nodules on the vocal cords (mostly located at the junction of the anterior and middle 1/3 of the bilateral or unilateral vocal cords), polyps (bilateral or unilateral vocal cords, with pedunculated or extensive growth at the base), or edema of the Reinck layer (superficial part of the vocal cords). Some patients may also develop epiglottic cysts.

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2. Diagnosis : The diagnosis of allergic pharyngitis is mainly based on the method of exclusion. First, based on the patient's clinical manifestations and signs, combined with relevant allergen tests (including skin prick tests and/or serum specific antibody tests), the atopic constitution is determined.

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3. Differential diagnosis:

(1) Allergic pharyngitis must be differentiated from reflux pharyngitis, which may also present similar symptoms and signs as mentioned above, but can usually be diagnosed through 24-hour esophageal pH monitoring or gastroscopy.

(2) Occupational laryngitis may also occur in teachers, singers or workers who are exposed to heavy air pollution for a long time. Similar symptoms also need to be identified. Usually, the diagnosis can be confirmed by asking about the relevant medical history and performing necessary laryngeal examinations.

4. How to treat allergic pharyngitis?

The treatment principle of allergic pharyngitis is: if the symptoms are chronic and persistent, actively look for the cause and control the disease based on the cause. If the symptoms are acute, control the related symptoms first, then look for the cause and treat it.

1. Cause treatment : mainly to find specific allergens (also known as "allergens") and try to avoid contact. If it is really unavoidable to contact the allergen, corresponding immunotherapy (i.e. desensitization therapy) can be carried out for the allergen, including subcutaneous injection and sublingual administration. The course of desensitization therapy is at least 3 years.

2. Symptomatic treatment : mainly control related symptoms to minimize the impact on the patient's quality of life. The following methods can be used for treatment according to the doctor's advice.

(1) Nasal spray corticosteroids: such as fluticasone propionate, mometasone furoate, budesonide, etc., are used to treat allergic rhinitis, and the throat symptoms of some patients will be relieved accordingly.

(2) Oral second-generation or third-generation antihistamines: such as loratadine, cetirizine, fexofenadine, etc., to relieve throat irritation symptoms.

(3) Oral mucus thinners: such as eucalyptus pinane, erdosteine, carbosteine, etc., to promote the dilution and discharge of thick mucus in the throat.

(4) Nebulizer inhalation: such as inhalation of normal saline, budesonide suspension, α-chymotrypsin and antibiotics for treatment.

(5) Traditional Chinese Medicine and Chinese Herbal Medicine: Traditional Chinese Medicine also has a deep understanding of this disease and has relevant theories on the cause and pathogenesis of the disease. It needs to be diagnosed and treated by a professional traditional Chinese medicine physician.

5. What should patients with allergic pharyngitis pay attention to in their eating habits and daily life?

1. Try to avoid contact with allergens : For those who are allergic to house dust mites, physical or chemical methods can be used to kill mites, and try to use anti-mite bedding, etc.; for those who are allergic to pollen, try to reduce going out during the pollen spreading season. If you need to go out, you can wear a protective mask, nasal filter, or apply pollen barrier agents, inert cellulose powder, etc. into the nose.

2. Reduce the intake of irritating foods : to avoid aggravating throat inflammation. In addition, it is necessary to reduce the intake of coarse grains and acidic foods, as well as caffeinated beverages, to avoid aggravating symptoms due to gastroesophageal reflux, frequent hiccups, belching, etc.

3. Change bad habits such as smoking and drinking.

References

1.Brodnitz F S. Allergy of the Larynx[J]. Otololarygol Clinic North Am, 1971, 4:579–582.

2.Krouse JH, Altman K W. Rhinogenic laryngitis, cough, and the united airway[J]. Otolarnygo Clin of North Am, 2010, 43:111–121.

3.Millqvist E, Bende M, Brynnel M, et al. Voice change in seasonal allergic rhinitis[J]. J Voice, 2008, 22:512–515.

4.Krouse J H. Allergy and laryngeal disorders[J]. Curr Opin Otolarngol Head Neck Surg, 2016, 24:221–225.

5.Brook CD, Platt MP, Reese S, et al. Utility of allergy testing in patients with chronic laryngopharyngeal symptoms: is it allergic laryngitis?[J]. Otolaryngol Head Neck Surg, 2016, 154:41–45.