European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 3, pp 419–427 | Cite as

Laryngeal effects of nasal allergen provocation in singers with allergic rhinitis

  • Monique M. L. Verguts
  • Anita Eggermont
  • Wivine Decoster
  • Felix I. C. R. S. de Jong
  • Peter W. Hellings


In spite of our recent insight into nasobronchial interaction mechanisms in allergic airway disease, the association between allergic rhinitis and voice complaints remains obscure. To evaluate the effects of nasal allergen provocation and seasonal grass pollen exposure on subjective and objective laryngeal parameters in singers with and without allergic rhinitis, an observational case control study was conducted. Prior to the pollen season, six grass pollen allergic and six non-allergic semiprofessional singers were exposed to nebulized sham solution and grass pollen extract (HAL°) in rising concentrations. After 3 min, 60 min and 24 h, nasal and laryngeal complaints were evaluated by the use of a visual analog scale (VAS). Laryngeal parameters like voice appearance (video stroboscopic images), voice range profile and subjective (GRBAS) and objective (jitter, shimmer, H/N, DSI) voice quality were evaluated before provocation, after 60 min and 24 h. During the pollen season, the allergic singers were re-evaluated. Results showed that in allergic singers both nasal (TNS of 4.0 ± 2.4 vs. 0.0 ± 0.0, p < 0.05) and laryngeal complaints (TLS of 1.4 ± 1.1 vs. 0.0 ± 0.2, p < 0.05) were induced at 3 min after the provocation. The induced laryngeal complaints were the feeling of laryngeal irritation, secretions and globus. No change in voice quality or stroboscopy score was measured. During the pollen season, laryngeal complaints were present (TLS of 2.4 ± 2.4) in allergic singers, without evidence for objective voice and laryngeal changes. In conclusion, we here demonstrate the rapid induction of laryngeal complaints in allergic singers by nasal allergen provocation and during the pollen season. There was no subject reported or investigator measured change in voice quality. No change in stroboscopy score was measured.


Allergy Allergic rhinitis Allergic laryngitis Nasal provocation Voice disorders Hoarseness Globus 


  1. 1.
    Bousquet J, Khaltaev N, Cruz A et al (2008) Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 63(Suppl 86):8–160CrossRefPubMedGoogle Scholar
  2. 2.
    Hellings P, Fokkens W (2006) Allergic rhinitis and its impact on otorhinolaryngology. Allergy 61(6):656–664CrossRefPubMedGoogle Scholar
  3. 3.
    Passalacqua G, Ciprandi G, Canonica G (2001) The nose-lung interaction in allergic rhinitis and asthma: united airways disease. Curr Opin Allergy Clin Immunol 1(1):7–13PubMedGoogle Scholar
  4. 4.
    Rubin JS (2006) Diagnosis and treatment of voice disorders. Third edition. Plural Publishing, Inc, Oxford, pp 76–78Google Scholar
  5. 5.
    Ceuppens J (2000) Urticaria, angio-oedeem en anafylaxie. Allergische aandoeningen: een multidisciplinaire aanpak. Leuven: Katholieke Universiteit Leuven Universitaire ziekenhuizen, pp 265–285Google Scholar
  6. 6.
    Domeij S, Dahlqvist A, Eriksson A (1996) Similar distribution of mast cells and substance P- and calcitonin gene-related peptide- immunoreactive nerve fibers in the adult human larynx. Ann Otol Rhinol Laryngol 105:825–831PubMedGoogle Scholar
  7. 7.
    Emerich K, Sataloff R, Spiegel J (1997) The young adult voice. J Voice 11(2):138–143CrossRefPubMedGoogle Scholar
  8. 8.
    Williams R (1972) Allergic laryngitis. Ann Otol Rhinol Laryngol 81(4):558–565PubMedGoogle Scholar
  9. 9.
    Dixon H (1992) Allergy and laryngeal disease. Otolaryngol Clin North Am 25(1):239–250PubMedGoogle Scholar
  10. 10.
    Pang L (1974) Allergy of the larynx, trachea, and bronchial tree. Otolaryngol Clin North Am 7:719–733PubMedGoogle Scholar
  11. 11.
    Reidy P, Dworkin J, Krouse J (2003) Laryngeal effects of antigen stimulation challenge with perennial allergen Dermatophagoides pteronyssinus. Otolaryngol Head Neck Surg 128(4):455–462CrossRefPubMedGoogle Scholar
  12. 12.
    Dworkin J, Reidy P, Stachler R, Krouse J (2009) Effects of sequential Dermatophagoides pteronyssinus antigen stimulation on anatomy and physiology of the larynx. Ear Nose Throat J 88(2):793–799PubMedGoogle Scholar
  13. 13.
    Krouse J, Dworkin J, Carron M, Stachler R (2008) Baseline laryngeal effects among individuals with dust mite allergy. Otolaryngol Head Neck Surg 139(1):149–151CrossRefPubMedGoogle Scholar
  14. 14.
    Leinonen L, Poppius H (1997) Voice reactions to histamine inhalation in asthma. Allergy 52(1):27–31CrossRefPubMedGoogle Scholar
  15. 15.
    Millqvist E, Bende M, Brynnel M, Johansson I, Kappel S, Ohlsson A (2008) Voice change in seasonal allergic rhinitis. J Voice 22(4):512–515CrossRefPubMedGoogle Scholar
  16. 16.
    Cohn J, Spiegel J, Sataloff R (1995) Vocal disorders and the professional voice user: the allergist’s role. Ann Allergy Asthma Immunol 74(5):363–373PubMedGoogle Scholar
  17. 17.
    Timmermans B, Vanderwegen J, Bodt MD (2005) Outcome of vocal hygiene in singers. Curr Opin Otolaryngol Head Neck Surg 13(3):138–142CrossRefPubMedGoogle Scholar
  18. 18.
    Jackson-Menaldi C, Dzul A, Holland R (2002) Hidden respiratory allergies in voice users: treatment strategies. Logoped Phoniatr Vocol 27(2):74–79CrossRefPubMedGoogle Scholar
  19. 19.
    Bullens D, Truyen E, Coteur L et al (2006) IL-17 mRNA in sputum of asthmatic patients: linking T cell driven inflammation and granulocytic influx. Respir Res 7:135CrossRefPubMedGoogle Scholar
  20. 20.
    Hirano M, Bless D (1993) Videostroboscopic examination of the larynx. Singular Publishing Group, Inc, San Diego, pp 167–169Google Scholar
  21. 21.
    Rosen C (2005) Stroboscopy as a research instrument: development of a perceptual evaluation tool. Laryngoscope 115(3):423–428CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Monique M. L. Verguts
    • 1
  • Anita Eggermont
    • 2
  • Wivine Decoster
    • 2
  • Felix I. C. R. S. de Jong
    • 1
    • 2
  • Peter W. Hellings
    • 1
    • 3
  1. 1.Division of Otorhinolaryngology, Head and Neck Surgery, University Hospitals LeuvenCatholic University LeuvenLeuvenBelgium
  2. 2.Laboratory of Experimental Otorhinolaryngology, Centre of Excellence for VoiceCatholic University LeuvenLeuvenBelgium
  3. 3.Laboratory of Experimental Immunology, University Hospitals LeuvenCatholic University LeuvenLeuvenBelgium

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