As a singing teacher, I spend a reasonable amount of time talking about the perils of too much and too little mucus (not as gross as it sounds, trust me). It is currently spring in Canberra, so the mucosal conversation has once again turned to hay fever.
Hay fever is a common term used for allergic rhinitis, an allergic condition which irritates the upper respiratory tract, including eyes, sinuses, nose, throat and sometimes lungs. We usually think of it as being seasonal in the case of grasses and pollens, however perennial hay fever may be triggered by environmental factors like dust or animals.
It is probably the most interfering allergic reaction to plague singers. In fact, I would rank it in the top 5 problematic upper respiratory tract conditions to impact singers, sharing prime position alongside asthma and the common cold.
However, it is only one type of allergy that can affect the vocal instrument. So, if you are a sufferer, understanding your own allergies and their treatment is a must in order to develop as a singer.
To save you reading the details, here’s a list of key points:
- Be a detective…figure out what you’re allergic to.
- Run some experiments…can you remove it from your life or can you learn to live with it?
- Remain inquisitive…have conversations with your GP and pharmacist to understand the treatment options in order to manage your symptoms.
- Check in daily…honestly assess your own body, voice and mind in order to balance attitude, medication and symptoms for healthy vocalisation.
- Staying alive trumps singing (ok, barely 😉 – if your medication is lifesaving but affects your voice, then life comes first.
Now, if you still want to read some details, the following is a brief synthesis of the information gleaned from the source materials listed at the end of this blog.
WHAT IS AN ALLERGY?
An allergy is a “specific hypersensitive response of the immune system to antigens (invading microbes) that normally are harmless” (Thurman & Welch). The onset of allergic reactions can be at any age and are often triggered by a stressful environmental incident like a viral infection, physical or emotional trauma.
Broadly speaking, an allergy could reveal itself as rhinitis (hay fever), sinusitis or asthma. Some of the triggers in the list below are not allergens in themselves, but they might produce a “hypersensitivity reaction” in allergic people.
“In the case of allergies, there is a problem with cataloguing the first time the immune system encounters the allergen. Because this is an immune system cataloguing error, to be allergic requires that the person has encountered the allergen before and filed it incorrectly as invader rather than an uninteresting bystander. This is different from viruses and infections that are catalogued correctly, conferring immunity to the invader through a specific antibody taken from the existing antibody arsenal.” (Scearce)
POTENTIAL ALLERGENS
Sources:
- Animals and insects (eg cats, dogs, horses, bees, cockroaches)
- Environmental (eg cigarette/fire smoke, dust, grass, pollen, mould, perfume, cleaning products)
- Food (eg nuts, fruit, shellfish)
- Medications (eg aspirin, beta blockers, food preservatives)
- Stress – the immune system responds to the limbic-hypothalamic-pituitary-adrenal axis.
Pathways:
- Inhalation (eg animal and environmental)
- Ingestion (eg food and medication)
- Skin penetration (eg bee sting)
“Start trying to find out what you’re allergic to, and stop eating it, drinking it, wearing it or breathing it…”
Pat Wilson
SYMPTOMS
This physiological chain reaction results in us experiencing a wide range of symptoms, ranging from mildly inconvenient to life threatening.
Antigen -> hypersensitivity -> release of antibodies from lymphocytes -> tissue inflammation -> histamine release
Often within two hours of exposure, a person having an allergic reaction might experience one or more of these reactions:
- Sneezing
- Inflammation of respiratory mucosa
- Runny nose
- Nasal congestion
- Postnasal drip
- Itchy-watery eyes
- Flushing
- Diarrhea
- Hives
- Dizziness
- Fast heart rate
- Pressure-pain in the ears
- Headaches
- Gastrointestinal distress
- General fatigue
- Swelling
HOW WILL IT AFFECT SINGING?
A healthy and musical voice depends on a vocal tract that is able to channel airflow along pathways of soft tissue and freely produce and reflect sound waves, shaping them into pleasing and accurate shapes to convey melody and lyric. It is important to understand how symptoms affect your singing.
The symptoms of hay fever can:
- constrict your airways and have a detrimental effect on breath management, tone volume and phrase length.
- change the way that sound waves resonate off your soft tissue, resulting in a dampened timbre and difficulty achieving full range of tone colour and expression.
- flair up when you are in unfamiliar environments, such as theatres or rehearsal spaces.
- lead to irritation from postnasal drip and throat-clearing (often subconscious), culminating in vocal fold swelling. This will limit vocal range, tone quality and, if chronic and untreated, even result in dysphonia or laryngitis.
TOP TIPS FOR TREATMENT
It can take nearly 18 hours to resolve your reaction after commencing treatment, so adopting a daily management strategy is vital.
There are four main treatment strategies:
- Non-medicated (for mild reactions and to counteract dehydration as a result of antihistamine medication)
- Hydration
- Steam inhalation
- Saline nasal spray (eg Fess) – works to cleanse the nose of irritants and provide moisture to the nasal passage
- Sinus/nasal irrigation eg Neti Pot or Fess Flo Sinus Care
- Stress management such as exercise, meditation, massage, homeopathy
- Avoidance or removal of allergen sources, including elimination
- Allergy testing
If your voice is regularly affected by allergies, it is worth investigating your triggers as well as developing robust methods for managing your symptoms. Ask your GP for a referral to an allergy specialist. Be patient, it may take more than one consultation. - Geographical awareness
If you know you are likely to respond to certain grasses or pollens, for instance, have a management plan ready if you are travelling. - Removal of sources
In the case of allergy to dust mites, choose your bedding carefully. And consider taking it with you, or at least your pillow, when you travel. Uncarpeted flooring is also better for people with dust allergies.
- Allergy testing
- Medications
- Temporary or emergency alleviation of symptoms
- Decongestant nasal spray (use only for 3 days)
- Epinephrine – in the case of severe food allergies.
- Preventative approach to symptom management
- Topical corticosteroid nasal spray, often sufficient for reactions confined to nose and throat
- Antihistamine nasal spray – can be used in addition to a nasal steroid spray
- Antihistamine tablet – works by blocking the release of histamines which trigger the inflammatory response, best for use in people with systemic symptoms beyond the nose and throat.
- Temporary or emergency alleviation of symptoms
- Immunotherapy – injecting gradually increasing amounts of the allergens. “The immune system, then, may develop the means of neutralising the allergen/s once the ‘desensitisation’ takes effect.” (Thurman & Welch)
“The advantage of nasal sprays is that they work topically, usually are not systemically drying, and have minimal (if any) systemic side effects.”
Leda Scearce
WHAT TO WATCH OUT FOR
- Antihistamine tablets
- Fatigue – be sure to ask your chemist for help to find a brand/active ingredient that doesn’t have a sedating effect, eg loratadine, fexofenadine and astemizole
- Dehydration of mucus membranes in mouth, throat and vocal folds – some sources recommend using saline spray or a decongestant to combat dehydration.
- Need to be taken on a regular basis rather than as needed. It will take about 3-5 days for these medications to get to a consistent therapeutic level.
- Corticosteroid nasal spray – this treatment is intended to be aimed at the nasal passages, so be careful not to inhale so fiercely that the particles of the spray reach your throat and vocal folds.
- Decongestant sprays – prolonged use can lead to problems with ongoing nasal congestion.
- Understand how your medication impacts your voice (this reference is usually available through www.ncvs.org)
As a singing teacher, I am always conscious that I am not a qualified health professional. However, I work with instruments that are not man-made…so it is natural to discover that the pedagogical and scientific voice teaching books on my shelf are literally brimming with medical information like this to help us know ourselves more. I hope it has helped you!
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SOURCES
LeBorgne, W.D. & Rosenberg, M. (2014). The Vocal Athlete. Plural Publishing, San Diego.
Photo by Lukasz Szmigiel on Unsplash
Scearce, L. (2016). Manual of Singing Voice Rehabilitation: A practical approach to vocal health and wellness. Plural Publishing, San Diego.
Thurman, L. & Welch, G. (Eds). (2000). Bodymind & Voice: Foundations of voice education. The VoiceCare Network, Minnesota.
Titze, I. R. & Verdolini-Abbott, K. (2012). Vocology: The Science and Practice of Voice Habilitation. National Center for Voice & Speech, Utah.
Wilson, P. H. (2013). The Singing Voice: An Owner’s Manual (2nd Ed.). Lazy O’Rhinus Press, Sydney.