The Throat Doctor

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I am a 30-year old soprano and in June and September my allergies impair my singing. My symptoms are watery eyes, sinus irritation and coughing 20 to 30 times in a row, causing voice fatigue and slight dizziness. These symptoms usually last over a three to four-day period. What treatments do you recommend for singers with allergies? What are the side effects? Can I take anti allergy pills to prevent the onset of symptoms before a concert? I have heard that some anti-allergy pills can cause catastrophic reactions like liver failure. Is this true? What about homeopathic or natural remedies?

Response

The seasonal pattern of your symptoms suggests that you are allergic to pollens, grasses and trees in the spring and to moulds in the fall. Seasonal allergies can be treated by preventative therapy with systemic antihistamines and, or, intranasal topical steroid medication.

It is best to begin treatment at the very beginning of the season before symptoms appear. Thus, antihistamines will have a chance to block the release of the biochemical mediators of inflammation when exposure to the offending allergen occurs.

The severity and the sites of involvement of allergy symptoms vary with the individual. For isolated nasal symptoms (congestion, sneezing, runny nose) the use of intranasal topical steroid sprays is ideal. The newer preparations are highly effective and deliver micrograms of medication without systemic absorption and side effects (such as fungus growth in the throat).

For symptoms such as dizziness, headaches, itchy throat, tearing, a systemic anti-histamine and medication are recommended. There are many anti-allergy pills available. They vary in onset and duration of action, efficacy and potential side-effects. For example Cetirizine has a rapid onset which may be helpful to the singer about to perform. Certain antihistamines , such as Terfenadine, should not be taken in association with other medication (including antibiotics) or if you have pre existing heart or liver disease. Your response to antihistamines may also change with time, thus requiring different medication. The best therapies for allergies are those which are custom-designed for your symptoms and their fluctuations. You may require the assistance of an allergist, otolaryngologist and pharmacist to guide you in choosing a therapies.

As for homeopathic medications, despite anecdotal claims, there is no scientific evidence of their efficacy in treating allergies. The successful management of your allergies depends on the identification and control of the allergens in your environment. Pollen allergies can be curred by immunotherapy ("allergy shots"), a process by which your immune system is stimulated to produce antibodies against allergens before the allergy season. ­ Dr. Chagnon

Françoise P. Chagnon is the Director of the Voice Lab at the Montréal General Hospital

The Throat Doctor
Submit your questions about voice or vocal ailments to Doctor Françoise Chagnon c/o La Scena Musicale, 5411 Waverly, Montreal, Quebec, CANADA, H2T 2X8.