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Extranasal Manifestations of Allergy in the Head and Neck

  • Otitis (D Skoner, Section Editor)
  • Published:
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Abstract

Purpose of Review

Allergic rhinitis and allergic asthma are well-described disease entities with broad exposure in clinical and research allergy forums. Associations between allergic inflammation and upper airway diseases of chronic laryngitis, otitis media, obstructive sleep apnea, and oral allergy syndrome are less well understood and described in the literature.

Recent Findings

This review discusses the relationship between atopy and diseases of the upper airway, oral cavity, larynx, and ear. The similar respiratory mucosal lining the upper aerodigestive tract, with sensitized mast cells and inflammatory mediators in the submucosa, results in a variety of extranasal manifestations of allergic diseases in the head and neck which are less well characterized.

Summary

Associations between allergic inflammation and upper airway diseases of chronic laryngitis, otitis media, obstructive sleep apnea, and oral allergy syndrome are less well understood and described in the literature. This review will summarize the relevant pathophysiology and symptomology, association with allergic sensitization, and clinical considerations of these disorders.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Krouse JH, Altman KW. Rhinogenic laryngitis, cough, and the unified airway. Otolaryng. Clin. N Am. 2010;43(1):111-21. An excellent review of laryngitis and its allergic causes.

  2. Belafsky PC, Peake J, Smiley-Jewell SM, Verma SP, Dworkin-Valenti J, Pinkerton KE. Soot and house dust mite allergen cause eosinophilic laryngitis in an animal model. Laryngoscope. 2016;126(1):108–12.

    Article  CAS  Google Scholar 

  3. Eren E, Arslanoğlu S, Aktaş A, Kopar A, Ciğer E, Önal K, et al. Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings. Eur Arch Oto-Rhino-L. 2014;271(4):743–7.

    Article  Google Scholar 

  4. Brook C, Noordzij JP, Russell K, Aliphas A, Platt M. Predictive findings of allergic disease in fiberoptic nasolaryngoscopy. Laryngoscope. 2015;125(2):286–90.

    Article  Google Scholar 

  5. Koç EA, Erbek S, Koç B. Comparison of acoustic and stroboscopic findings and voice handicap index between allergic rhinitis patients and controls. Balkan Med J. 2014;31(4):340–4.

    PubMed Central  Google Scholar 

  6. Lauriello M, Angelone AM, Businco DL, Passali D, Bellussi LM, Passali FM. Correlation between female sex and allergy was significant in patients presenting with dysphonia. Acta Otorhinolaryngo. 2011;31(3):161.

    CAS  Google Scholar 

  7. Brook CD, Platt MP, Reese S, Noordzij JP. Utility of allergy testing in patients with chronic laryngopharyngeal symptoms: is it allergic laryngitis? Otolaryngol Head Neck Surg. 2016;154(1):41–5.

    Article  Google Scholar 

  8. Thompson H, Tucker AS. Dual origin of the epithelium of the mammalian middle ear. Science. 2013;339(6126):1453–6.

    Article  CAS  Google Scholar 

  9. Smirnova MG, Birchall JP, Pearson JP. The immunoregulatory and allergy-associated cytokines in the aetiology of the otitis media with effusion. Mediat Inflamm. 2004;13(2):75–88.

    Article  CAS  Google Scholar 

  10. Corey JP, Adham RE, Abbass AH, Seligman I. The role of IgE-mediated hypersensitivity in otitis media with effusion. Am J Otolaryng. 1994;15(2):138–44.

    Article  CAS  Google Scholar 

  11. • Zhang Y, Xu M, Zhang J, Zeng L, Wang Y, Zheng QY. Risk factors for chronic and recurrent otitis media–a meta-analysis. PLoS One. 2014;9(1). An excellent meta-analysis for chronic and recurrent otitis media.

  12. Kreiner-Møller E, Chawes BL, Caye-Thomasen P, Bønnelykke K, Bisgaard H. Allergic rhinitis is associated with otitis media with effusion: a birth cohort study. Clin Exp Allergy. 2012;42(11):1615–20.

    Article  Google Scholar 

  13. Roditi RE, Veling M, Shin JJ. Age: an effect modifier of the association between allergic rhinitis and otitis media with effusion. Laryngoscope. 2016;126(7):1687–92.

    Article  Google Scholar 

  14. Midgley EJ, Dewey C, Pryce K, Maw AR, ALSPAC Study Team. The frequency of otitis media with effusion in British pre-school children: a guide for treatment. Clin. Otolaryngol. 2000;25(6):485–491.

  15. Lin SY, Melvin TAN, Boss EF, Ishman SL. The association between allergic rhinitis and sleep-disordered breathing in children: a systematic review. Int Forum Allergy RH. 2013;3(6):504–9.

    Article  Google Scholar 

  16. Stuck BA, Czajkowski J, Hagner AE, Klimek L, Verse T, Hörmann K, et al. Changes in daytime sleepiness, quality of life, and objective sleep patterns in seasonal allergic rhinitis: a controlled clinical trial. J Allergy Clin Immun. 2004;113(4):663–8.

    Article  Google Scholar 

  17. • Ni K, Zhao L, Wu J, Chen W, Li X. Th17/Treg balance in children with obstructive sleep apnea syndrome and the relationship with allergic rhinitis. Int J of Pediatr. Otorhi. 2015;79(9):1448-54. Adequately summarizes OSA and AR.

  18. Chan CC, Au CT, Lam HS, Lee DL, Wing YK, Li AM. Intranasal corticosteroids for mild childhood obstructive sleep apnea–a randomized, placebo-controlled study. Sleep Med. 2015;16(3):358–63.

    Article  Google Scholar 

  19. Liu HT, Lin YC, Kuan YC, Huang YH, Hou WH, Liou TH, et al. Intranasal corticosteroid therapy in the treatment of obstructive sleep apnea: a meta-analysis of randomized controlled trials. Am J Rhinol Allergy. 2016;30(3):215–21.

    Article  Google Scholar 

  20. Ma S, Sicherer SH, Nowak-Wegrzyn A. A survey on the management of pollen-food allergy syndrome in allergy practices. J Allergy Clin Immunol. 2003;112(4):784–8.

    Article  Google Scholar 

  21. Andersen KE, Løwenstein H. An investigation of the possible immunological relationship between allergen extracts from birch pollen, hazelnut, potato and apple. Contact Dermatitis. 1978;4(2):73–9.

    Article  CAS  Google Scholar 

  22. Kazemi-Shirazi L, Pauli G, Purohit A, Spitzauer S, Fröschlc R, Hoffmann-Sommergruber K, et al. Quantitative IgE inhibition experiments with purified recombinant allergens indicate pollen-derived allergens as the sensitizing agents responsible for many forms of plant food allergy. J Allergy Clin Immunol. 2000;105(1):116–25.

    Article  CAS  Google Scholar 

  23. Rodriguez J, Crespo JF, Burks W, Rivas-Plata C, Fernandez-Anaya S, Vives R, et al. Randomized, double-blind, crossover challenge study in 53 subjects reporting adverse reactions to melon (Cucumis melo). J Allergy Clin Immunol. 2000;106(5):968–72.

    Article  CAS  Google Scholar 

  24. Webber CM, England RW. Oral allergy syndrome: a clinical, diagnostic, and therapeutic challenge. Ann Allergy Asthma Immunol. 2010;104(2):101–8.

    Article  Google Scholar 

  25. Asero R, Fernandez-Rivas M, Knulst AC, Bruijnzeel-Koomen CA. Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications. Curr Opin Allergy Clin Immunol. 2009;9(4):379–85.

    Article  Google Scholar 

  26. Kelso JM, Jones RT, Tellez R, Yunginger JW. Oral allergy syndrome successfully treated with pollen immunotherapy. Ann Allergy Asthma Immunol. 1995;74(5):391–6.

    CAS  Google Scholar 

  27. Czarnecka-Operacz M, Jenerowicz D, Silny W. Oral allergy syndrome in patients with airborne pollen allergy treated with specific immunotherapy. Acta Dermatovenerol Croat. 2008;16(1):0-.

  28. Bergmann KC, Wolf H, Schnitker J. Effect of pollen-specific sublingual immunotherapy on oral allergy syndrome: an observational study. World Allergy Organization Journal. 2008;1(5):79–84.

    Article  Google Scholar 

  29. Asero R. Effects of birch pollen-specific immunotherapy on apple allergy in birch pollen-hypersensitive patients. Clin Exp Allergy. 1998;28(11):1368–73.

    Article  CAS  Google Scholar 

  30. Asero R. Fennel, cucumber, and melon allergy successfully treated with pollen-specific injection immunotherapy. Ann Allergy Asthma Immunol. 2000;84(4):460–2.

    Article  CAS  Google Scholar 

  31. Bucher X, Pichler WJ, Dahinden CA, Helbling A. Effect of tree pollen specific, subcutaneous immunotherapy on the oral allergy syndrome to apple and hazelnut. Allergy. 2004;59(12):1272–6.

    Article  CAS  Google Scholar 

  32. Asero R. How long does the effect of birch pollen injection SIT on apple allergy last? Allergy. 2003;58(5):435–8.

    Article  CAS  Google Scholar 

  33. Kinaciyan T, Jahn-Schmid B, Radakovics A, Zwölfer B, Schreiber C, Francis JN, et al. Successful sublingual immunotherapy with birch pollen has limited effects on concomitant food allergy to apple and the immune response to the Bet v 1 homolog Mal d 1. J Allergy Clin Immunol. 2007;119(4):937–43.

    Article  CAS  Google Scholar 

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Correspondence to Michael Platt.

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Conflict of Interest

Dr. Platt and Dr. Brook are consultants for GI Reviewers, LLC, reading blinded studies for biologic therapies for nasal polyps. Dr. Mur declares no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Mur, T., Brook, C. & Platt, M. Extranasal Manifestations of Allergy in the Head and Neck. Curr Allergy Asthma Rep 20, 21 (2020). https://doi.org/10.1007/s11882-020-00914-8

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