Experimental and clinical studies were performed in the allergic laryngitis. In this experiments, Ginea pigs(Hertly) were sensitized by OA alum senitaizations, After that, some of them were desensitization by the use of TAKAGI'method. We had designed 3 different groups: (1)normal group,(2)OA evaporation after sensitization, and (3)Desensitaization group. Before tissues extraction, tolerance of OA inhalation tests and PCA titers after 7 days, and IgG₁ and IgG₂ in the blood serum were measured. Histopathological findings were examined by the staining of HE, and TB, and Electro microscopic for allergic changes, especially for the inflammatory cell infiltration both in the larynx and in nasal mucosa. According to these experiments, These experimental animals were completely sensitized by OA alum so that revealed to increase the mean values of PCA titers(75.0 in group 2, 270 in group 3) and mean values of IgG₁(2.27 in group 1, 3.19 in group 2) and of IgG₂(2.90 in group 1, 2.57 in group 3) in the blood serum. Histopathological findings showed that infiltration of the Eosinophils, the basophils and the lymphocytes in the laryngeal mucosa, especially in the arvtenoid, were observed modaretely in the group 2, next in group 3, but no infiltrations in normal group. These changes were more characterized in the nasal mucosa rather than that of the larynx. These findings might be suggestive of occurrence of allergic reaction not only in nasal and tracheal mucosa but also in the larvnaeal mucosa. Clinical findings were searched for the subjective complains and objective findings from the 137 patients during the cedar season and other seasons for 5 years. From these data, allergic laryngitis might be classified into two categolies such as 1) acute type ; anaphiractic reaction with strong edematous swelling in the glottic space, 2) chronic type ; mild reaction for the antigens, including in Arthus type. Clinical diagnosis for allergic laryngitis may be fllowing: 1) Subjective complains are consisted in the itching, fullness, forgin body sensation in the throat, and characteristic dry cough especially in night withouthoarseness and dyspnea. 2) Laryngeal mucosa in allergic changes were characterized by the edematous, pale and glimmer swelling in the arytenoid region and / or in the epiglottic region, and 3) they have allergic disposition as shown the skin test or RAST positive.

View full abstract

It has been well known that various neuropeptides partcipate in elicitation of the clinical symptoms of the allergic diseases. However, the pathophysiologic role of the neuropeptides in laryngeal allergy is not well elucidated. We investigated the distribution of the peptidergic nerve fibers in the canine and feline laryngeal mucosa with immunohistochemical method and performed electrophysiological observation of the responses caused by stimulation of the feline laryngeal mucosa with histamine to clarify the neural mechanism of the laryngeal allergy. Substance P(SP) immunoreactive(IR) intraepithelial nerve fibers were observed in the laryngeal mucosa. They densely distributed in epiglottis and arytenoid region, and rarely seen in vocal fold. A few SP-IR fibers was existed around blood vessels and laryngeal gland. Probably, they are collaterals of the unmyelinated sensory nerve fiber(C-fiber) related to axon reflex. Afferent discharges in the superior laryngeal nerve increased after stimulation of the laryngeal mucosa with histamine. It may be likely that SP-IR intraepithelial nerve fibers respond to histamine and generate afferent discharges, and couse the neurogenic inflammation in laryngeal allergy. Cough was successively elicited and the activity of the vocalis muscle markedly increased by stimulation with histamine, Almost all patients with laryngeal allergy complain cough attack. Vasoactive intestinal polypeptide IR fibers were observed around blood vessels and glands. They may be involved in nonadrenergic inhibitory nervous system. It is surggested that the symptoms are modulated by peptidergic nerve fivers in laryngeal allergy.

View full abstract

As laryngeal type I allergy has rarely been reported, this study was designed to show type I allergic reaction in the laryngeal mucosa. We investigated the distribution of mast cells(MC) in human laryngeal mucosa. The number of mucosa mast cells(MMC) was significantly greater than that of connective tissue mast cells(CTMC) in the epithelial layer and the shallow layer of the lamina propria in the arytenoid portion of the larynx. The difference between the number of MMC and that of CTMC was not significant in the epiglottis or the vocal cord mucosa. Furthermore we showed that most of MCs had the receptors fot IgE antibody. We also investigated the distribution of MCs in the laryngeal mucosa of sensitized and nonsensitized guinea pig. The number of MCs in the subglottic epithelial layer of sensitized guinea pigs was higher than of nonsensitized guinea pigs. Histamine concentration was measured by radioimmunoassay in lavage fluid collected before and after topical antigen challende to the larynx of sensitized guinea pig. Antigen challenge immediately induced a significant increase in histamine concetration. These findings suggest that type I allergic reaction can be induced in the larynx.

View full abstract

Recently, the society of study for laryngeal allergy in Japan has proposed new criteria for laryngeal allergy. We studied the patients diagnosed as laryngeal allergy according to this criteria. The subjects consisted of one male and eighteen females with abnormal sensation in throat. Their ages ranged from 23 to 71 years, with an average age of 48.5 years. Antiallergic drug(Azelastine hydrochloride) was administered for 14 days, and we evaluated effectiveness of this drug and the change of clinical symptom. As a result, the drug was effective in 79% of the subjects. We discussed the relationship between abnormal sensation in throat and laryngeal allergy.

View full abstract

A series of animal studies were performed to investigate the histopathological and pathophysiological characteristics of laryngeal allergy. First, guinea pigs were sensitized by ovalbumin. The histological sections were made and stained with hematoxylin-eosin, toluidine blue and IgE. Allergic reactions were observed in the laryngeal mucosa of these sections. Secondly, nebulized particles of Pyoktanin blue were inhales under quiet respiration and the degree of staining in the respiratory tract was visually inspected after removal of the laynx. Laryngeal surface and trachea were stained blue suggesting the possible. contact of the antigen to the laryngeal mucosa. Thirdly, the effect of the histamine on mucosa blood flow of the larynx was evaluated with the spectrophotometric analyzer. The results revealed that the O₂ saturation decreasedand the hemoglobin concentration increased. These phenomena accounted for the clinical findings of the allergic mucosa, being edematous and pale in colour. To detect latent laryngeal allergy among patients who complained of the lump sensation in the throat, a screening prescription consisting of an anti-allergic drug was administered to them. The complaines of 68% of the patients were improved and some of them showed disappearance of the edema in the arytenoid region. Possble diagnostic methods for laryngeal allergy including a provocation test were discussed. It was considered clinically important to establish criteria for laryngeal allergy.

View full abstract