Spring has sprung, which means pollen has too! Read on to learn from Dr. Paul Kwak the best ways to manage your spring allergies.
Spring is here, and with the warmer weather and new blossoms comes something that strikes fear into the heart of any singer: seasonal allergies. The upper respiratory symptoms that often accompany allergy season—stuffy nose, post-nasal drip, coughing, sore throat, and more—can make singing difficult, if not downright impossible. I don’t know a single singer who doesn’t have an arsenal of remedies, both traditional and homeopathic—but treating seasonal allergies can make you feel like you’re trying to hit a moving target.
To help understand how allergies affect us, I sat down with Dr. Paul Kwak, ENT-otolaryngologist at NYU Langone’s Voice Center. Dr. Kwak has dedicated much of his work to helping singers—in more ways than one! He has a master’s degree in collaborative piano from The Juilliard School, where he studied vocal accompanying and opera coaching. It was working with opera singers that inspired him to pursue otolaryngology, merging his interest in medicine with his passion for the human voice.
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His compassionate, expert care has led to collaborations with The Metropolitan Opera, Houston Grand Opera, and The Julliard School, and he has helped thousands of singers (including this writer!) improve and maintain their vocal health.
There’s a reason Dr. Kwak is so in demand: he gets us. And he generously took time out of his packed schedule to share his tips for surviving allergy season with your voice (and your sanity) intact.
Spring has a (deserved) reputation for being “allergy season.” What kinds of complaints do singers bring into your office this time of year?
Spring does have a reputation for being allergy season—but with significant climate change, the “season” is starting earlier each year and lasting longer each year, much to the chagrin of all who suffer from allergies.
Allergies can cause all manners of symptoms in the nose and throat; perhaps the most common one that afflicts singers can be post-nasal drip. People experience this differently: often people feel a drip down the back of the throat, and sometimes it manifests in increased throat clearing. Allergies can also increase the feeling that something is “stuck” in the throat (called “globus sensation”).
I think it can be easy to dismiss allergy symptoms. What symptoms of allergies should we definitely not ignore?
Certainly any kind of breathing issue that arises should be evaluated. When allergies are severe, they can induce bronchoconstriction—and it is important to treat that quickly and effectively (often with an inhaler and/or systemic medicines).
I also think anytime a singer feels the voice is being compromised, it’s worth coming in. It may not be that there is an actual issue with the vocal cords, but we can take a look to clarify that question and to figure out what else might be causing the vocal issue. For instance, sometimes increased congestion in the nose can alter the vocal mechanics in a way that creates an issue with the voice, even if the vocal folds themselves are doing fine!
The inner “is it allergies, a cold, the flu, or COVID?” debate is real. How can singers tell the difference?
Generally, for lack of a better phrase, a cold or flu tends to make you feel sick in your whole body, whereas symptoms of allergies tend to be more localized. Respiratory viruses that cause what we refer to as the common cold, the flu, or COVID typically manifest with some manner of fever—often body aches and chills, headaches, fatigue, and malaise. Allergies can make you feel miserable, but in a somewhat different way. Classic symptoms are itchiness and runniness, whether in the nose or eyes, nasal congestion, and post-nasal drip—but they should not be associated with the systemic symptoms like fevers, chills, or fatigue.
When we do experience allergy symptoms, what treatments do you recommend? And which should we stay away from?
There are two main categories of treatment that I think about: oral (systemic) treatments and nasal (topical) treatments. When you have multiple symptoms—itchy, watery eyes, plus nasal congestion, plus post-nasal drip, plus perhaps throat tightness/feeling of constriction—then I think an oral antihistamine can be very helpful because it generally blunts the body’s histamine (allergic) response. These are commonly available, over-the-counter drugs like Claritin, Zyrtec, Allegra, or Xyzal.
If the symptoms are primarily nasal, without much other systemic response, then sometimes a nasal steroid spray alone, like Flonase, Nasonex, or Rhinocort, can be helpful while avoiding some of the side effects of oral antihistamine. Often, we use oral antihistamines and nasal steroid sprays together, so the treatment plan is really tailored to the singer’s specific experience and symptoms. There are many additional medications in our armamentarium, but these are good starters!
Regarding homeopathic treatments, I tend to have no definitive opinion about them because they are so varied and unregulated. I’m not opposed to them, but I generally advise people to be careful because it is not always clear what strength/dosage of the particular component is in what you are receiving.
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The only treatment that I have a specific recommendation about is nasal decongestant sprays with phenylephrine, often sold under the name Afrin. These can feel extremely effective when you use them to treat nasal congestion, but when they are used for more than about 5–7 days consecutively, they can create a rebound congestion that is much worse than the original symptoms and much harder to treat. Nasal decongestants are very useful in the setting of a cold, but not so great for long-term use for allergies. Otherwise, in general, I recommend discussing all treatments you might consider using with your doctor.
What about allergy testing?
Allergy testing can be helpful to pinpoint what specific allergies you might have. If they are severe, allergists can work with you to administer immunotherapy in various forms (like shots or sublingual treatments) to reduce your body’s allergic response to that specific allergen. I don’t know that I’d necessarily say that all singers need to get allergy tested, but if you are suffering with multiple or recurrent or severe allergies, it’s certainly worth considering.
When should singers make a decision to see an ENT/voice specialist for treatment?
Anytime, really—that’s what we’re here for! I tend to think it’s best if we actually can see you before things get terrible and try some treatments, ideally well in advance of important vocal obligations.
Each medication can have varying side effects, and they are notoriously variable across individuals. Some people find these side effects quite mild; others find some medications intolerable. It takes at least a few days to understand what your response to these treatments will be, so it’s ideal if we have some lead time to assess your response to medications and their potential side effects.
In general, I like seeing singers sooner rather than later; it gives us the time, energy, and space to think through effective treatment plans in a way that is not always easy if we are backed up against an impending performance immediately.
Got it—that makes total sense! I do have to ask this question, because it’s one of the most difficult. When we are dealing with allergy symptoms on a show day, how do we make the decision to perform—or not?
Most of my days are spent navigating this issue with singers: assessing their symptoms, examining their vocal folds, and weighing the costs of canceling versus the challenges of trying to perform. This is often an incredibly difficult and deeply personal but, above all, an individual and specific decision-making process, so it is hard to provide blanket recommendations here.
I suppose the only recommendation I might try to make is the most obvious one: try to see and have a discussion with your trusted voice squad (your laryngologist, speech-language pathologist, and voice teacher or coach). We can really help navigate these tough situations and advocate for you! Yet another reason to have your squad in place before allergies—or colds or injuries or whatever—arise!
Is there anything else you wish singers knew about allergies?
Because of this very question, and because so many singers have questions about allergies, I recorded an episode on my podcast all about allergies! The podcast is called KwakTalks, and the one on allergies is a conversation with my friend and colleague, Dr. Nathanael Horne, who is an allergist! So, lots of good tidbits there.
When the spring gunk strikes, don’t panic! Follow Dr. Kwak’s advice and create a treatment plan with your doctor early, especially if you’ve been susceptible to allergies in the past. A “vocal squad,” as Dr. Kwak calls it, is essential for every singer, so if you don’t yet have a trusted ENT in your area, this article is your sign to find one. We’re vocal athletes, after all, and we need the same kind of support!
If you’re in the New York City metro area, you can make an appointment with Dr. Kwak by contacting NYU Langone Health. Learn more about him at www.paulekwak.com and check out KwakTalks on your favorite podcast app (links to the “talks” are also found right on his website)!
