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Wise et al.

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between the 2. Three studies with similar design evaluated the symptoms and laryngeal appearance and function in patients with proven allergies exposed to direct laryngeal stimulationship by the nebulized allergen D. pteronyssinus. 2008 - 2010 Initially, Reidy et al. 2009 were unable to find any significant difference between antigen-challenged and placebo challenged subjects on any of the evaluated measures, including VHI, Sinus Symptoms Questionnaire, laryngoscopic findings, and acoustic and speech aerodynamic testing. In a subsequent study, Dworkin et al. 2010 increased the concentration of allergen in the antigenic suspension and noted an increase in endolaryngeal mucus in addition to coughing and throat clearing. The study was terminated prematurely due to adverse pulmonary reactions attributed to the higher antigen concentration, and it is possible that the lower airway reactivity contributed to the visualized endolaryngeal mucus. 2010 Roth et al. 2008 then performed a study using similar methods but isolated the larynx by utilizing a nose clip to ensure oral inhalation and by eliminating patients with reactive airways based on methacholine challenge testing. They demonstrate an apparent causal relationship between allergen stimulation and impaired vocal function. 2008 There is mounting evidence suggesting a relationship between AR and laryngeal dysfunction. There have not been consistently reported laryngeal findings specific to allergic laryngitis, though thick endolaryngeal mucous should raise suspicion for allergy as a cause. Although its exact role in the pathophysiology of laryngitis has yet to be fully elucidated, AR should be considered in the differential diagnosis of patients with vocal complaints as it may have implications on treatment of laryngeal disease. • Aggregate Grade of Evidence: C (Level 2b: 8 studies; Level 3a: 1 study; Level 3b: 4 studies; Level 4: 5 studies; Table X.I). Eosinophilic esophagitis is an allergic inflammatory condition of the esophagus with infiltration of eosinophils. Symptoms include dysphagia, heartburn, and vomiting. Several studies have examined the prevalence of clinician-diagnosed AR and aeroallergen sensitization in patients with eosinophilic esophagitis (EoE) (Table X.J). Among both pediatric and adult patients with EoE, it has consistently been found that 50% to 75% have AR. 2013-2020 Although many of these studies were case series, the consistency of the findings strongly suggests that most patients with EoE have comorbid AR. The evidence for an association between environmental allergies and EoE pathogenesis is less clear. A few case series, among both children and adults, have observed seasonal peaks of EoE diagnosis in the spring and summer. 2021-2023 One of these studies found that EoE diagnosis was correlated with grass pollen counts. 2021 Another showed that esophageal eosinophilia on biopsies was least intense in the winter. 2023 There is 1 reported case of a pediatric EoE patient whose symptoms flared seasonally, in whom biopsies revealed moderate to severe esophageal eosinophilia during pollen seasons with no or mild inflammation in winter months, with no change in diet. 2024 Another case report described resolution of esophageal eosinophilia in a pediatric patient with EoE and dust mite sensitization after a course of high-dose dust mite immunotherapy. 2025 Therefore, there is

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X.J. Eosinophilic esophagitis (EoE)

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.