Upper respiratory allergy is an allergic condition in which the airway from the nose down to the voice box overreacts to substances such as pollen, house dust mites, mold and pet dander, and it is rarely limited to a single organ. Alongside a runny nose and sneezing, it can cause sinus pressure, postnasal drip, an itchy throat, hoarseness and a stubborn cough. Looking at the whole picture also makes it possible to recognize accompanying asthma in time.
What Is Upper Respiratory Allergy?
The respiratory tract can be pictured as one continuous tube running from the nostrils to the tiny air sacs in the lungs. The upper respiratory tract consists of the nasal cavity, the sinuses surrounding the nose, the area behind the nose (nasopharynx), the throat (pharynx) and the voice box (larynx), which houses the vocal cords. All of these areas are covered by a similar lining (mucosa) that contains the same immune cells.
In a person with an allergic tendency, an inhaled allergen first comes into contact with this lining. The immune system mistakes the harmless substance for a threat and produces IgE antibodies; on later exposures, histamine and similar chemicals are released and an inflammatory reaction begins. This reaction often does not stay in the nose; it shows up as different complaints in different parts of the airway.
The United Airway Concept
It is now widely accepted that the upper and lower airways should be considered as a single unit. According to this “united airway” approach, allergic inflammation in the nose and allergic inflammation in the bronchi are two sides of the same process. In a patient whose nose is poorly controlled, asthma control can also become harder; regular treatment of the nose, on the other hand, helps ease lower airway symptoms in many patients.
Studies show that most people with asthma also have nasal allergy, and that a significant share of people with allergic rhinitis either develop asthma or already have it. For this reason, every patient with nose and throat allergies should also be asked about shortness of breath and wheezing.
The condition can appear at any age. A course that begins with eczema in childhood and continues with nasal allergy and asthma is described as the “allergic march.” People with a family history of allergy, those living in polluted urban air and children exposed to cigarette smoke are at greater risk.
Causes of Upper Respiratory Allergy
Allergy is triggered by environmental factors on a background of inherited tendency. Where a person lives, the season, home conditions and occupation determine which allergens they encounter and how much.
The main inhaled allergens are:
- Pollen: Tree pollen dominates in spring, grass pollen in early summer and weed pollen in late summer.
- House dust mites: Microscopic creatures living in mattresses, pillows and carpets; they cause symptoms all year round.
- Mold: Grows in damp bathrooms, basements and walls.
- Animal allergens: Proteins in the skin flakes, saliva and urine of cats and dogs.
- Occupational substances: Flour, latex, wood dust and certain chemicals.
Some factors do not cause allergy but irritate the airway and make the condition worse. Cigarette smoke, air pollution, vehicle exhaust, cold and dry air, strong odors and viral infections easily stimulate a sensitized lining. Stomach acid flowing back up the esophagus (reflux) can also cause allergy-like complaints in the voice box, and the two conditions are frequently confused.
Symptoms of Upper Respiratory Allergy
Symptoms vary depending on which part of the airway the allergy affects most. In a single patient, several areas may be involved at the same time.
In the Nose and Sinuses
- Sneezing, watery discharge, itching and congestion
- Fullness and pressure in the forehead, cheeks and around the eyes
- A reduced sense of smell
- Recurrent sinusitis episodes
In the Nasopharynx, Throat and Voice Box
- Mucus dripping down the back of the throat and a constant need to clear the throat
- Itching and a tickling sensation in the throat and on the roof of the mouth
- A dry cough that tends to worsen at night and in the morning
- Hoarseness, a voice that tires quickly and sounds rough
- A sensation of a lump or something stuck in the throat
Ear, Eye and General Symptoms
Allergic swelling can narrow the opening of the Eustachian tube, which connects the middle ear to the back of the nose; this can lead to a feeling of fullness and crackling in the ear and, especially in children, fluid buildup in the middle ear. Itchy, watery and red eyes are also common; nerve reflexes between the eye and the nose and the connection through the tear duct help explain why these two areas are affected together. Patients whose sleep is disrupted may experience daytime tiredness, poor concentration and reduced performance at work or school.
Some people with pollen allergy develop itching of the lips, tongue and throat right after eating raw foods such as apples, peaches, cherries or hazelnuts. Known as “oral allergy syndrome,” this happens because pollen proteins and certain food proteins resemble each other, and it is usually mild.
Wheezing, chest tightness, shortness of breath on exertion and a cough that wakes the person at night suggest that the allergy is also affecting the lower airways, meaning asthma may have developed.
How Is Upper Respiratory Allergy Diagnosed?
Diagnosis begins with a careful listen to the patient’s complaints. The link between symptoms and the seasons, the home and work environment, contact with pets, current medications, smoking and any family history of allergy or asthma are all important.
During the ENT (ear, nose and throat) examination, the nose, nasopharynx, throat and voice box are examined as a whole. Evaluation with flexible or rigid endoscopes shows the appearance of the nasal lining, the sinus openings, the adenoids and the vocal cords. This examination also offers clues as to whether swelling and redness in the voice box are related to allergy or to reflux.
When needed, the following tests are used:
- Skin prick test: A commonly used, quick method for identifying the allergens behind the symptoms.
- Total and specific IgE blood tests: Preferred when skin testing is not suitable.
- Lung function test: Measures airflow capacity of the lungs when asthma is suspected; if necessary, the results are reviewed together with a pulmonologist.
- Sinus CT scan: May be requested for patients with suspected chronic or recurrent sinusitis.
- Ear tests: In those with ear fullness and reduced hearing, tympanometry, which measures middle ear pressure, may be performed.
During diagnosis, it is important to distinguish conditions that cause similar complaints, such as viral infections, reflux, non-allergic rhinitis and smoking-related irritation, so that treatment is directed correctly. Patients coming from abroad may find it helpful to bring earlier allergy test results, lung function reports, imaging and a list of their medications.
Treatment of Upper Respiratory Allergy
The goal of treatment is to control not just the nose but the entire airway. The plan therefore includes avoiding allergens, appropriate medications, allergy immunotherapy if needed and coordinated follow-up of any accompanying asthma.
Allergen Avoidance and Environmental Changes
Once the allergen has been identified, reducing exposure to it also reduces the need for medication. Keeping windows closed during pollen season, using mattress covers for dust mite allergy, balancing indoor humidity and avoiding cigarette smoke are basic measures. On high-pollen days, limiting time outdoors and washing the face and nose after coming in also help.
Medication
- Corticosteroid nasal sprays: Reduce inflammation in the lining of the nose and sinuses and can also ease postnasal drip and cough.
- Antihistamines: Relieve sneezing, itching, runny nose and eye symptoms.
- Leukotriene modifiers: May be preferred especially in patients who have both allergic rhinitis and asthma.
- Saline nasal rinsing: Clears mucus and allergens and boosts the effect of other medications.
- Inhaled medications: Added for patients diagnosed with asthma, on the recommendation of the relevant specialist.
When voice box complaints are prominent, voice care, adequate fluid intake and, if needed, reflux treatment are also included in the plan.
Allergy Shots (Immunotherapy)
Allergy immunotherapy may be offered to patients with proven sensitivity to a specific allergen who do not get enough relief from medication. Given as injections under the skin or as drops or tablets under the tongue, this treatment usually lasts 3–5 years and aims to increase the immune system’s tolerance to the allergen. In suitable patients, it has been reported to help reduce asthma symptoms as well as nasal complaints.
Treatment Approach in Children
In children, allergy often shows up as repeated “colds,” mouth breathing, snoring and a nighttime cough. Because enlarged adenoids and middle ear fluid frequently accompany allergy in this age group, the examination should cover these areas too. The choice and dose of medication depend on the child’s age. In suitable children, immunotherapy can usually be planned from school age onward and is thought to help slow the progression of the allergic march.
The Role of Surgery
Allergy is not treated with surgery. However, if structural problems such as permanently enlarged turbinates, a deviated septum, polyps or chronic sinusitis accompany the allergy, correcting them improves airflow and makes it easier for medications to reach the target tissue.
Possible Risks and Important Considerations
Uncontrolled upper respiratory allergy can set the stage for chronic sinusitis, middle ear fluid, voice problems, sleep disturbance and worsening asthma. It can affect school performance and sleep patterns in children and work productivity in adults. That is why it is important not to dismiss the symptoms as “just seasonal.”
Long-term use of over-the-counter decongestant sprays, taking steroid tablets without a prescription and stopping asthma medication once symptoms ease are common mistakes. Continuing treatment regularly and attending check-ups at set intervals provides better control in the long run.
Seek medical care promptly in the following situations:
- Shortness of breath that makes speaking difficult, or bluish lips
- Rapidly developing swelling of the tongue, lips or throat, or difficulty swallowing
- Wheezing that worsens despite medication
- Hoarseness lasting more than three weeks
- Facial pain and swelling with a high fever
Upper Respiratory Allergy: Frequently Asked Questions
Can allergies cause a cough?
Yes. Mucus dripping down the back of the throat, allergic sensitivity in the throat and voice box, or accompanying asthma can lead to a dry, persistent cough. With a long-lasting cough, allergy, reflux and asthma should be evaluated together.
Can nasal allergy turn into asthma?
Allergic rhinitis is not asthma itself, but it is an important risk factor for developing asthma. Regular treatment of nasal symptoms and, in suitable patients, allergy immunotherapy may help protect the lower airways.
Can allergies cause hoarseness?
Allergic inflammation, postnasal drip, frequent throat clearing and coughing can irritate the vocal cords and cause a rough voice that tires easily. Hoarseness lasting longer than three weeks always calls for an examination of the voice box.
How can I tell an allergy from a cold?
A cold brings a mild fever, muscle aches and fatigue, and the symptoms usually clear within 7–10 days. Allergy does not cause fever, itching is prominent and the symptoms continue for weeks as long as contact with the allergen continues.
Can I stop my medication when the season is over?
For patients who have symptoms only during pollen season, medication can be reduced after the season ends and the symptoms settle, in discussion with the doctor. For year-round allergies and for patients with asthma, stopping treatment on your own can bring the symptoms back quickly.
Conclusion
Op. Dr. Tayfun Demirel, ENT specialist, evaluates the nose, sinuses, nasopharynx, throat and voice box as a whole in patients who come to the practice in Ataşehir, Istanbul, with allergic complaints. After the necessary tests, allergen avoidance, medication and options for any accompanying problems are planned individually, with input from other specialists when needed. Please contact the clinic to book an appointment. This article is for informational purposes only; an in-person examination is required for diagnosis and treatment.
