Allergic and nonallergic factors in upper and lower airway disease1
The specific allergic and nonallergic mechanisms that prevail in diseases of the upper and lower airways, e.g., rhinitis and asthma, are reviewed. These mechanisms and diseases are probably not more prevalent in wind players than in others, but they may significantly impair a musician’s capabilities. Specific allergic triggers include pollens, molds, dusts, and danders; and the typical immediate inflammatory response to these is mediated by IgE. There is a growing understanding of late-phase reactions, which are triggered by IgE but which occur four to 12 hours after antigen exposure. Specific allergic responses may occur with or without nonspecific, non-IgE reactions, which include responses to a wide variety of irritants including cold air, particulates, and infections. There is a growing realization that host responses to specific allergens and nonspecific irritant factors can influence and accentuate each other. Treatment should be directed toward identification and avoidance of both kinds of triggers. Immunotherapy is sometimes required.