Treatment of Itchy Throat
For a patient with an itchy throat, start with oral second-generation antihistamines (such as cetirizine) as first-line therapy, as itching is a hallmark symptom of allergic rhinitis and responds best to antihistamine therapy. 1
Initial Diagnostic Approach
An itchy throat is most commonly associated with allergic rhinitis, which presents with one or more of the following: nasal congestion, runny nose, itchy nose, or sneezing. 1 The clinical diagnosis can be made based on history and physical examination alone when findings are consistent with an allergic cause, including clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. 1
Key symptoms to document include:
- Itching of nose, ears, or throat 1
- Throat symptoms of soreness, dryness, and postnasal drainage 1
- Sneezing, rhinorrhea, and nasal congestion 1
- Ocular redness, tearing, and itching 1
First-Line Pharmacologic Treatment
The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends oral second-generation/less sedating antihistamines for patients with allergic rhinitis whose primary complaints include sneezing and itching. 1 Cetirizine 10 mg provides 24-hour relief of sneezing, runny nose, itchy watery eyes, and itchy throat or nose. 2
This recommendation is based on the fact that itching is an IgE-mediated histamine response, making antihistamines the most targeted and effective therapy for this specific symptom. 1
When Symptoms Affect Quality of Life
If the itchy throat is accompanied by other symptoms that affect quality of life (such as nasal congestion, sleep disturbance, or work impairment), intranasal corticosteroids should be added or used as primary therapy. 1 Intranasal steroids are the most effective single agent for allergic rhinitis overall, though antihistamines remain superior specifically for itching symptoms. 1
Combination Therapy for Inadequate Response
If monotherapy with antihistamines does not adequately control symptoms, combination pharmacologic therapy should be offered, typically pairing oral antihistamines with intranasal corticosteroids. 1 This combination provides greater relief for mixed symptoms than either agent alone. 3
Intranasal antihistamines (such as azelastine) may also be offered for seasonal, perennial, or episodic allergic rhinitis as an alternative or adjunctive option. 1
Important Considerations and Pitfalls
Avoid oral leukotriene receptor antagonists as primary therapy - these should not be offered as first-line treatment for allergic rhinitis. 1
Do not use topical decongestants for more than 3 days to prevent rhinitis medicamentosa (rebound congestion). 3, 4
Nonsedating oral antihistamines are ineffective for non-allergic rhinitis - if the patient has non-allergic rhinitis (no clear allergen trigger, negative allergy testing), antihistamines should be avoided and intranasal corticosteroids or anticholinergics used instead. 3
When to Consider Further Evaluation
Perform or refer for specific IgE allergy testing (skin or blood) if:
- The patient does not respond to empiric antihistamine treatment 1
- The diagnosis is uncertain 1
- Knowledge of the specific causative allergen is needed to target therapy or implement environmental controls 1
Assess for and document associated conditions including asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. 1
Adjunctive Measures
Environmental allergen avoidance should be advised when specific allergens correlating with symptoms are identified (removal of pets, air filtration systems, bed covers, dust mite control). 1
Nasal saline irrigation can be beneficial as adjunctive therapy to help remove allergens and reduce symptoms. 3, 4
When to Refer for Immunotherapy
Offer or refer for immunotherapy (sublingual or subcutaneous) if the patient has inadequate response to pharmacologic therapy with or without environmental controls. 1 This represents a disease-modifying approach for patients with persistent symptoms despite optimal medical management.