What is the best treatment for a scratchy, itchy throat?

Treatment for Scratchy, Itchy Throat

For a scratchy, itchy throat, oral second-generation antihistamines (such as loratadine, cetirizine, or fexofenadine) are the first-line treatment, as itching and scratching sensations are hallmark symptoms of allergic rhinitis affecting the throat. 1

Understanding the Symptom

• Itching and scratching sensations in the throat are highly suggestive of allergic rhinitis, which commonly affects the posterior pharynx and causes these characteristic symptoms 1
• Pruritus (itching) and sneezing are much more common in allergic rhinitis than in nonallergic causes of throat symptoms 1
• This distinguishes allergic throat symptoms from infectious sore throat, which typically presents with pain rather than itching 1

Primary Treatment Algorithm

First-Line: Oral Second-Generation Antihistamines

• The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends oral second-generation antihistamines for patients with allergic rhinitis whose primary complaints are sneezing and itching 1
• Second-generation antihistamines (loratadine, cetirizine, desloratadine, fexofenadine) are preferred over first-generation antihistamines because they cause less sedation and fewer anticholinergic side effects 1
• These medications are generally effective in reducing itching associated with allergic rhinitis 1

Important distinction: Fexofenadine, loratadine, and desloratadine do not cause sedation at recommended doses, while cetirizine may cause sedation in some patients 1

Second-Line: Intranasal Corticosteroids

• If symptoms affect quality of life or antihistamines provide inadequate relief, intranasal corticosteroids should be added or substituted 1
• The American Academy of Otolaryngology-Head and Neck Surgery provides a strong recommendation for intranasal steroids when symptoms impact quality of life 1
• Intranasal corticosteroids are generally more efficacious than antihistamines alone for comprehensive symptom control 1

Alternative Options

• Intranasal antihistamines (such as azelastine) may be offered as an alternative to oral antihistamines for seasonal, perennial, or episodic allergic rhinitis 1
• These provide rapid relief but may cause sedation in some patients and have a bitter taste 1

Symptomatic Relief Measures

For Additional Throat Comfort

• Local anesthetics such as phenol-containing throat sprays or lozenges can provide temporary relief of throat irritation 2
• Medicated throat lozenges containing amylmetacresol/dichlorobenzyl alcohol provide analgesic effects lasting up to 2 hours 3
• Lozenges and tablets offer superior delivery to the throat compared to sprays or gargles, with prolonged contact time 4

Pain Relief (If Needed)

• If throat discomfort progresses to pain rather than just itching, ibuprofen is recommended as first-line analgesic therapy 5
• Paracetamol (acetaminophen) serves as an effective alternative when ibuprofen is contraindicated 5

What NOT to Use

• Do not use oral leukotriene receptor antagonists (LTRAs) as primary therapy for allergic rhinitis symptoms 1
• Zinc gluconate is not recommended due to conflicting efficacy and increased adverse effects 1, 5
• Avoid local antibiotics or antiseptics, as they lack efficacy data for allergic throat symptoms 5
• Herbal treatments and acupuncture have inconsistent evidence and should not be routinely recommended 1, 5

Common Pitfalls to Avoid

• Do not confuse itchy throat with infectious sore throat: Itching strongly suggests allergic etiology, while pain suggests infection 1
• Continuous treatment is more effective than intermittent use for ongoing allergen exposure in allergic rhinitis 1
• First-generation antihistamines should be avoided due to sedation and performance impairment that patients may not subjectively perceive 1
• Topical decongestant sprays should not be used chronically, as they can cause rhinitis medicamentosa 1

When to Escalate Treatment

• Consider allergy testing if symptoms do not respond to empiric antihistamine treatment or when the diagnosis is uncertain 1
• Combination therapy may be offered when monotherapy provides inadequate response 1
• Immunotherapy (sublingual or subcutaneous) should be considered for patients with inadequate response to pharmacologic therapy 1