Diagnosis and Treatment of Allergic Cough – Indian Scenario

Treatment of Allergic Cough
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Diagnosis and Treatment of Allergic Cough pose a challenge for clinicians. In this post, Diagnosis and Treatment of Allergic Cough has been discussed in detail under the following heads:

What is Allergic Cough?

Cough is a vital protective reflex preventing aspiration and enhancing airway clearance. However, pathologically excessive and protracted cough is a common and disabling complaint, affecting perhaps 5–10% of the adult population (1). When severe, it causes a major decrement in the quality of life, with comorbidities such as incontinence, cough syncope and dysphonia leading to social isolation, depression and difficulties in relationships(2).

Allergic cough is a type of chronic cough wherein no infective etiology is elicited though accompanied with symptoms of allergic rhinitis, bronchial asthma or bronchitis.

Patients present with an irritating, paroxysmal dry cough that occurs during the day and night. Cough can be induced by smoke, dust, cold air, and talking, and is usually accompanied by itching of the throat. (3)

Indian Scenario

An increasing prevalence of allergic rhinitis and asthma has also been reported in the Indian subcontinent due to increasing air pollution. An Indian study reported that prevalence of allergic rhinitis was 11·3% in children aged 6–7 years, and 24·4% in children aged 13–14 years. (4, 5).

The burden of allergic rhinitis is enormous, constituting about 55% of all allergies. About 20-30% of Indian population suffers from at least one allergic diseases. Reported incidence of allergic rhinitis in India also ranges between 20% and 30 %( 6, 7). India has a substantial burden of respiratory disorders, with chronic obstructive pulmonary disease (COPD) and asthma comprising the vast majority. [8]

The Global Burden of Disease study 1990–2016 reported an estimate of 37.9 million (35·7–40·2) cases of asthma in 2016.7 The Death and Disability Associated Life Years (DALY) per case of asthma in India was 2.4-fold higher than the global average. [9]

The odds of reporting asthma was significantly higher amongst participants with lower literacy, lower socio-economic background, and those belonging to homes using unclean fuels. Out of an estimated 65 million cases a staggering burden of 80%, 78%, and 52% was attributable to use of fire wood, kerosene, and cow dung cakes as fuels, respectively [10]

What Is Allergy?

The term ‘allergy’ was coined by Clemens von Pirquet in 1906 to call attention to the unusual propensity of some individuals to develop signs and symptoms of reactivity, or ‘hypersensitivity reactions’, when exposed to certain substances. Although the statement quoted above pertained to the cause of serum sickness, allergic disorders (also known as atopic disorders, from the Greek atopos, meaning out of place) are also associated with the production of allergen-specific IgE and with the expansion of allergen-specific T-cell populations, both of which are reactive with what typically are otherwise harmless environmental substances. These disorders are increasingly prevalent in the developed world and include allergic rhinitis (also known as hay fever), atopic dermatitis (also known as eczema), allergic (or atopic) asthma and some food allergies. Some people develop a potentially fatal systemic allergic reaction, termed anaphylaxis, within seconds or minutes of exposure to allergens. [11]

Triggers for Allergic cough

Some of the common triggers that may cause an allergy cough include:
• seasonal pollen (hay fever/allergic rhinitis)
• mold spores
• animal dander, urine, or saliva
• dust and dust mites
• cockroaches
An allergic cough can occur from a reaction in the upper respiratory system, lower respiratory system, or both. [12]

Diagnosis Of Allergic Cough

Symptoms

Cough is frequently preceded by an urge-to-cough, a sensation of irritation or itching in the throat, which is also called laryngeal paresthesia. [13] Cough is usually dry, sometimes accompanied with whitish sputum. Association of tightness or congestion in the chest is present, cough being more anytime during the day/night. Quite often associated symptoms of allergic rhinitis like runny nose, sneezing, itching in the nose may be present.

Investigations


The condition is more of a clinical diagnosis than being confirmed on some investigations.
If in case of doubt, basic blood tests for allergies like Serum IgE and Absolute eosinophil count (AEC) can be done. Specific tests for triggers of allergy like Skin Prick tests or RAST’s can be done and appropriate measures shall be taken to control the exposure to them.

Treatment Of Allergic Cough

Home Remedies

  • Using a humidifier at home or office settings has shown some positive impact by reducing the inhalation allergen load.
  • Using a mask when exposed to dust or strong smells, at home or outside.
  • Avoid using diffusers at home or in the washrooms.
  • Shifting to unscented soaps and detergents.
  • Regular cleaning of winter wear, mattresses, carpets, bed linen, curtains/binds.
  • Saline nasal irrigations, breathing exercises. 
  • A good balanced diet rich in vitamin C, A and D

Allergen avoidance

Steps should be taken to identify and avoid allergy triggers. This is generally the most important step in preventing allergic reactions and reducing symptoms.

Medications for Allergic Cough

Depending on the allergy, medications can help reduce immune system reaction and ease symptoms.

  • Central cough suppressants- Help in reducing the bouts of cough. Less effect on the cause of the cough. Eg. – Dextromethorphan, Codeine.
  • Mast Cell Stabilizers- As allergy is Ige mediated disease which is released by Mast cells in our blood thus this class of drugs help in lowering the load of free IgE in the blood thus reducing the allergy. Ex- Montelukast.
  • Antihistaminics- help in controlling the acute symptoms of allergy and associated cough.
    • Eg. – Cetrizine, Bilastine, fexofenadine.
  • Bronchodilators- Mostly given in aerosol form due to its relative quick onset of action. These help in alleviating tightness in the chest and thus providing good breathing efficiency. Eg. – Salbutamol.
  • Decongestants- Oral and topical help in relieving congestion developing in the mucosa lining of the nose and the airways. Eg- pseudoephedrine, phenylephrine.
  • Steroids- are the only class of drugs helping in control long term effects of allergic cough and the progression of the disease. Eg.- Prednisolone, dexamethasone. [14]
  • Immunotherapy. For severe allergies or allergies not completely relieved by other treatment, allergen immunotherapy can be advised. This treatment involves a series of injections of purified allergen extracts, usually given over a period of a few years. Another form of immunotherapy is a tablet that’s placed under the tongue (sublingual) until it dissolves. Sublingual drugs are used to treat some pollen allergies. [15,16]

About the Authors

Dr. Manuj Jain

Dr Manuj Jain ENT Surgeon
Dr Manuj Jain

Dr. Manuj Jain is a tireless dynamic ENT surgeon with an active practice at both Delhi and Gurgaon, born and raised in Delhi. Dr. Jain has a deep connection to his hometown. Trained under the most prominent ENT surgeons in our country. He is known for his holistic approach towards his patients in his professional practice and keeps himself updated with the latest trends and developments in the field of ENT through journals, attending & conducting workshops and CME’s.

Graduated from KIMSDU, Karad and holds the postgraduate degree from NBE from the prestigious Balabhai NANAVATI HOSPITAL, MUMBAI/ MAX NANAVATI SUPERSECIALITY HOSPITAL, MUMBAI. Went on to train in ADVANCED ENT in MUMBAI, HISSAR, DELHI & JAIPUR. Completed his fellowship in minimal access endoscopic surgery and anterior skull base surgery from JAIN ENT HOSPITAL, JAIPUR under the guidance of the most prominent ENT surgeon of the modern era- Dr. SATISH JAIN.

His areas of interest include endoscopic surgeries for Ear, Nose and Throat along with treatment of Allergic cough/ Nasobronchial Allergies/Asthma, Snoring disorders, Facial aesthetic surgery (RHINOPLASTY), and vertigo/imbalance disorders. Believes in professional conduct with his patients yet having an interactive relationship with the patients in helping them provide the best possible treatment and care to his patients.

Dr Rachana Gaddipati

Dr Rachana Gaddipati ENT
Dr Rachana Gaddipati

Dr Rachana Gaddipati is a dedicated upcoming ENT surgeon in Gurugram, she underwent training from various institutes all across India which has made her more compassionate towards suffering and reformed her strong belief in charity and affordable health care.

Graduated MBBS from NARAYANA MEDICAL COLLEGE, NELLORE following which she worked in MAULANA AZAD MEDICAL COLLEGE, NEW DELHI as a Junior Resident. Completed her masters in ENT from MGM medical college, Mumbai and worked in various municipal hospitals in Mumbai as a senior resident. Followed up with working in Hissar as a fellow in ear surgery and head & neck surgery and completed her fellowship in minimal access surgeries, laryngeal surgeries, salivary gland surgery and Lateral skull base surgery.

She believes in providing excellent treatment to her patients irrespective of their social strata and within their economic constraints. Has operated >500 ENT operations free of cost for patients of economically weaker sections. Currently she is practicing in ARYAN HOSPITAL, UMKAL HOSPITAL, MAYOM HOSPITAL.

She is an avid animal lover, board’s two stray cats and helps out feeding strays anywhere feasible. She spends her free time with her furry friends/family, listening to music and updating her clinical knowledge by reading journals.

Read More Posts Related to “Diagnosis and Treatment of Allergic Cough? – Indian Scenario” :

REFERENCES

  1. Song WJ, Chang YS, Faruqi S, et al.  The global epidemiology of chronic cough in adults: a systematic review and meta-analysis. Eur Respir J 2015; 45: 1479–1481.
  2. Chamberlain SA, Garrod R, Douiri A, et al. The impact of chronic cough: a cross-sectional European survey. Lung 2015; 193: 401–408.
  3. Lai, K., Shen, H., Zhou, X., Qiu, Z., Cai, S., Huang, K., Wang, Q., Wang, C., Lin, J., Hao, C., Kong, L., Zhang, S., Chen, Y., Luo, W., Jiang, M., Xie, J., & Zhong, N. (2018). Clinical Practice Guidelines for Diagnosis and Management of Cough—Chinese Thoracic Society (CTS) Asthma Consortium. Journal of Thoracic Disease, 10(11), 6314-6351. doi:10.21037/jtd.2018.09.153
  4. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009; 64: 476–83.
  5. Singh S, Sharma BB, Salvi S, et al. Allergic rhinitis, rhinoconjunctivitis, andeczema: prevalence and associated factors in children. Clin Respir J 2018;12: 547–56.
  6. Prasad R, Kumar R. Allergy situation in India: whatis being done? Indian J chest dis allied Sci. 2013;55:7-8.
  7. Varshney J, Varshney. Allergic rhinitis: an overview. Indian J otolayngol Head Neck Surg. 2015;67(2):143-9.
  8. Salvi S., Apte K., Madas S. Symptoms and medical conditions in 204 912 patients visiting primary health-care practitioners in India: a 1-day point prevalence study (the POSEIDON study) Lancet Glob Health. 2015;3(12):e776–e784. doi: 10.1016/S2214-109X(15)00152-7. PubMed PMID: 26566749.
  9. Salvi S., Anil Kumar G., Dhaliwal R.S. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018;6(12):e1363–e1374. doi: 10.1016/S2214-109X(18)30409-1. PubMed PMID: 30219316; PubMed Central PMCID: PMCPMC6227385.
  10. Kumar P., Ram U. Patterns, factors associated and morbidity burden of asthma in India. PloS One. 2017;12(10) doi: 10.1371/journal.pone.0185938. PubMed PMID: 29073132; PubMed Central PMCID: PMCPMC5657621.
  11. Galli SJ, Tsai M, Piliponsky AM. The development of allergic inflammation. Nature. 2008;454(7203):445-454. doi:10.1038/nature07204
  12. https://www.medicalnewstoday.com/articles/allergy-cough#triggers
  13. Kanemitsu Y, Matsumoto H, Osman N, Oguma T, Nagasaki T, Izuhara Y, et al. “Cold air” and/or “talking” as cough triggers, a sign for the diagnosis of cough variant asthma. Respir Investig. 2016;54:413–418.
  14. https://www.healthline.com/health/home-remedies-for-allergies#home-remedies
  15. Quirt J, Hildebrand KJ, Mazza J, Noya F, Kim H. Asthma. Allergy Asthma Clin Immunol. 2018;14(Suppl 2):50. Published 2018 Sep 12. doi:10.1186/s13223-018-0279-0
  16. Yukselen A, Kendirli SG. Role of immunotherapy in the treatment of allergic asthma. World J Clin Cases. 2014;2(12):859-865. doi:10.12998/wjcc.v2.i12.859

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