Mucus in back of throat may be allergic reaction

Q. I often feel like I have a lump of mucus in my throat. In the morning I spit some of it up, but the sensation doesn’t go away. What can I do about it?

A. Doctors sometimes use the term “globus sensation” for the feeling of a lump in the throat. The first question I ask when a patient says he has a lump in his throat is: Is it just a feeling that there is a lump there, or is there something you can spit up?

Because you say you have mucus that you cough up, the most likely explanation is that allergies are causing your nose and sinuses to produce extra mucus. At night, when you are lying flat, that mucus collects in the back of your throat; that’s why you tend to spit it up in the mornings. The treatment is allergy medications and inhalers.

Another common cause is the regular reflux of stomach contents up into your esophagus and throat. When this happens frequently, the back of your throat can become irritated, which can feel like a lump. If you sometimes notice a bitter taste in your mouth, that’s a clue that reflux could be the source of your problem. If that’s the case, avoid foods that worsen your symptoms, remain upright for several hours after eating and lose weight. If lifestyle changes don’t help, many heartburn medications are available over-the-counter or by prescription.

Irritation and swelling in the throat can also be part of an allergic reaction to certain medications. The blood pressure medicines called “ACE inhibitors” are particularly likely to cause swelling in the throat. Rarely, that swelling can become so severe that it threatens your ability to breathe and is a true medical emergency. If one of my patients on an ACE inhibitor has even a mild sensation of a lump in the throat, I switch the patient to another type of blood pressure medicine.

A food allergy is another possibility. I once had a patient who got a lump in her throat and swollen lips any time she ate a mango. This was sad, because she loved mangoes!

Finally, there is an unusual condition called Zenker’s diverticulum, when a pouch forms in the wall of the back of the throat. Food can collect in the pouch and may come back out before it is swallowed. Zenker’s diverticulum is easily diagnosed and treated, usually by an ear, nose and throat specialist.

In medical school we’re taught a lot about the major illnesses — the ones that can disable or kill you. But many of my patients suffer, instead, from one of the “minor maladies of man,” about which we know only a little. If we had more medical research on these minor maladies, I’ll bet we’d come up with treatments that would save a lot of people minor misery.

Ÿ Dr. Komaroff is a physician and professor at Harvard Medical School. Send questions to AskDoctorK.com.