Sofia Holmqvist-Jämsén, PhD, from the University of Helsinki

Sofia Holmqvist-Jämsén, PhD

Are Allergies Hurting Your Patients' Voice? Study Shows It Might

A recent study identified a link between respiratory allergies and frequent vocal symptoms, particularly among women. The population-based study of 1220 Finnish adults, led by Sofia Holmqvist-Jämsén, PhD, from the University of Helsinki, examined diagnosed 

 and their relationship to 6 self-reported vocal symptoms: hoarseness, strained or tired voice, voice breaks, difficulty being heard, throat clearing or coughing, and sensation of a lump in the throat.

Overall, 25.6% of participants reported a diagnosed respiratory allergy, with women slightly more affected than men (26.4% vs 24.1%). Across the sample, 19.8% reported ≥2 vocal symptoms occurring weekly or daily in the past year.

The most frequently reported symptom was coughing or throat clearing while talking (25.9%), followed by sensation of tension or a lump in the throat (14.3%), hoarse or low voice (12.5%), and strained or tired voice (11.3%). Less commonly reported symptoms were difficulty being heard (9.5%) and voice breaks (7.7%).

Women consistently reported greater rates of frequent symptoms compared with men: strained/tired voice (14.7% vs 4.6%), hoarse/low voice (15.6% vs 6.4%), lump in the throat (16.4% vs 10.1%), and voice breaks (9.4% vs 4.4%). Respiratory allergies were associated with a greater burden in females (P <.01%) but not in men.

, Holmqvist-Jämsén recommended clinicians ask targeted questions to assess vocal complaints in patients with allergies, such as “Do you get hoarse or lose vocal function or flexibility during allergy seasons? Do you feel that your voice gets tired or strained during the day? Do you need to clear your throat while speaking?” She emphasized particular attention for high voice-use professions such as teachers, singers, coaches, healthcare workers, and clergy, suggesting seasonal planning, preventive voice strategies, and lower thresholds for referral to voice specialists.

The study highlights the need for prospective and interventional research using objective voice measures, laryngoscopy, and biomarker assessment to clarify mechanisms.

“Ask about voice when managing allergy and consider allergy when evaluating voice,” Holmqvist-Jämsén said. “This kind of coordinated care might prevent a cycle of cough and throat clearing and phonotrauma that prolongs recovery.”

Part 1 of the interview with Holmqvist-Jämsén can be viewed 

Holmqvist-Jämsén has no reported disclosures.

Holmqvist-Jämsén S, Wakene H, Jern P, Simberg S. Association Between Respiratory Allergies and Vocal Symptoms: A Cross-sectional Population-Based Study. 

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A study shows that weekly or daily throat clearing, hoarseness, and voice strain are more common among those with diagnosed respiratory allergies, particularly among women.


Respiratory Allergies Linked to Frequent Vocal Symptoms, With Sofia Holmqvist-Jämsén, PhD

Respiratory Allergies Linked to Vocal Symptoms

may extend beyond nasal and pulmonary symptoms, contributing to a clinically meaningful burden of vocal dysfunction. In an interview with 

, Sofia Holmqvist-Jämsén, PhD, from the University of Helsinki, discussed findings from a cross-sectional study examining the relationship between diagnosed respiratory allergies and focal vocal symptoms, as well as potential gender differences in this association.

The cross-sectional analysis included 1220 Finnish adults aged 18 – 46 years, drawn from a twin cohort and adjusted to mitigate relatedness bias. Overall, 25.6% of participants reported a diagnosed respiratory allergy, and 19.8% experienced ≥ 2 vocal symptoms on a weekly or daily basis over the prior year. These findings highlight the substantial overlap between allergic disease and voice-related complaints in the general population.

Holmqvist-Jämsén noted that the study was motivated by two 2 gaps: a lack of large-scale epidemiologic data linking allergy flares to vocal symptoms, and limited evidence supporting the “unified airway” model in relation to laryngeal outcomes.

“Clinicians often observe that allergy flares coincide with hoarseness or throat clearing or voice fatigue, but large population-based data have been scarce,” she said.

The results demonstrated a significant association between respiratory allergies and increased vocal symptom burden. Individuals with diagnosed respiratory allergies were more likely to report ≥ 2 frequent vocal symptoms compared with nonallergic peers (24.6% vs 18.2%; 

 <.05). This association was particularly pronounced in women, among whom 30.2% of those with allergies reported greater symptom burden, compared with 20.4% without allergies (P <.01). The association was not observed among men.

From a symptom-level perspective, allergic individuals were significantly more likely to report hoarseness or low voice (16.1% vs 11.4%; 

 <.001), strained or tired voice (15.2% vs. 10.1%;

 <.001) and the sensation of a lump or tension in the throat (18.3% vs. 13.0%; 

 <.05). Although coughing and throat clearing were the most commonly reported symptoms overall (29.9%; n = 92), their association with allergy was less distinct statistically, though still clinically relevant.

These findings support the unified airway concept, which posits that inflammatory processes in 1 region of the respiratory tract can affect contiguous structures. According to Holmqvist-Jämsén, allergic inflammation may contribute to laryngeal symptoms through several mechanisms, including mucosal edema and altered vibratory function of the vocal folds.

“Allergic remedies can contribute to swelling and altered vibratory characteristics of the vocal folds, increasing phonatory effort and hoarseness, and then also postnasal drip and cough, where throat clearing can irritate the larynx and reinforce a cycle of tension and fauna trauma,” Holmqvist-Jämsén said.

The observed gender differences may warrant particular clinical attention. Women not only reported more frequent vocal symptoms overall but also demonstrated a stronger association between allergies and symptom burden (≥ 2 frequent symptoms: 22.8% vs 13.7%; 

 <.001). Potential explanations include anatomical and physiological differences, such as smaller vocal folds that may be more susceptible to edema, as well as heightened cough sensitivity and greater representation in voice-intensive professions.

“[The] bottom line that women with allergies may be at particular risk for clinically significant voice issues and deserve proactive screening and counseling more than men,” Holmqvist-Jämsén said.

Despite its strengths, including a large, population-based sample, the study has limitations. All data were self-reported without objective laryngoscopic or acoustic validation. Additionally, potential confounders such as corticosteroid use were not fully captured.

Nonetheless, the findings underscore the importance of integrating voice assessment into allergy management. For clinicians, this may include targeted history-taking around vocal symptoms, consideration of laryngeal irritation in patients with persistent throat complaints, and multidisciplinary approaches involving otolaryngology or speech-language pathology when appropriate.

Holmqvist-Jämsén S, Wakene H, Jern P, Simberg S. Association Between Respiratory Allergies and Vocal Symptoms: A Cross-sectional Population-Based Study. 

Population study links respiratory allergies to hoarseness, throat clearing, and vocal fatigue, with greater symptom burden in women and unified airway implications.

Sofia Holmqvist-Jämsén, PhD

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