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Allergies

Coughing and post-nasal drip from Sept to Jun

06/27/2008

Question:

For over 15 years I have started a dry cough in Sept and continued to cough untill June. During this time I have post nasal drip into my throat and a tingling sensation in my throat. I cough almost every time I talk and mostly when I am not lying down. Sometimes I cough so much I vomit or till my neck and sides hurt.

Over the past 15 years I have been to my family doctor, a pulminory specialist, an eye, ear, nose and throat specialist, and this year to an allergist. None of them have stopped my coughting. I have been given a bevy antihistimines, anti-biotics, cough syrups, z packs, nasal sprays, Singular, Advair, inhailers, and over the counter cough and cold medicines to no avail. I have been treated for sinus, bronchitis, and asthma, and acid reflux.

I have lived in the same house for 22 years and eat pretty much the same foods year round. I have been taking allergy shots for dust mites and rag weed for 1 year now and I just stopped coughing as per usual at the beginning of June. Got any ideas what could cause this. I live in Mobile, Alabama and spend most of my time each day inside in air conditioned spaces. The allergist I am seeing has given up already. Got any suggestions? If you need me to provide you with any other information email me back. Thank you

Answer:

Chronic cough is one of the more difficult aspects of respiratory medicine and it is good to see that you have touched all the right bases in your work up.

You have seen a pulmonary specialist and presumably had pulmonary function testing which helps to identify whether there is an obstructive component to your problem. You probably had a chest x-ray to rule out structural problems in the lungs. You may even have had a methacholine challenge test which reveals bronchial hyperreactivity and asthma as a cause of the cough. You have been on asthma medications - Singulair, Advair and inhalers - which indicate that your pulmonologist or allergist thought that bronchial hyperreactivity plays a role in your symptoms. You have seen an allergist and have been found to have dust mite and ragweed allergies, so we know your have that component. Inflammatory post nasal drip from allergies can cause chronic cough (called upper airway cough syndrome), and can be a risk factor for sinus infection as well. You have seen an otolarygologist who would be able to diagnose sinusitis, which is a common cause of cough.

One hint of another cause of cough that your doctors could examine is vocal cord dysfunction caused by gastroesophageal reflux. Upper airway obstruction and congestion can make this worse. It typically presents with irritation of the vocal cords such that talking will start the cough, as you mentioned. Laying down makes this condition worse as the reflux can then reach the upper airway, what I call the "flood plain" phenomenon. This condition can be documented by a videolaryngoscopy where a scope is put down into the larynx to observe the vocal cords. This is a particularly difficult condition to treat. It is made worse by allergies. Dust mite allergy is worse when the house is closed up and generally improves when the air in the house is dried out by the use of air-conditioning.

Since this has been going on for 15 years it is not likely a more troubling cause of cough such as bronchogenic carcinoma. And the fact that it is relieved seasonally indicates that environmental factors such as allergy play a role and that a chronic lung-altering, year round condition, such as bronchiectiasis, is less likely. It may well be that your condition is not the result of one single factor, but due to a combination of factors that result in persistent symptoms. That makes it especially hard to easily pin down one or even two treatments that will work.

Your allergist or pulmonologist may be able to help you explore more environmental factors that are typically found in your area Sept through June.

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Response by:

Charity C Fox, MD Charity C Fox, MD
Clinical Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University