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Allergies

Chronic cough and nasal drip

07/10/2008

Question:

I have been coughing for over a year. Have tried every over the counter remedies. Have a sinus drainage every day.Took allergy shots over 20 years.Am allergic to dust mites.allergist thinks it may be acid reflux. Cannot believe acid can cause a serious cough with drainage. Any suggestions will be appreciated. Thanks

Answer:

Chronic cough can have many causes. Inflammatory conditions that have been demonstrated to cause longstanding cough include chronic sinusitis, asthma, chronic bronchitis, and vocal cord dysfunction, which is often exacerbated by acid reflux.

Your allergist is correct in saying that gastroesophageal reflux disease can be a cause of chronic cough. Acid reflux, which ordinarily does not reach as far up as the larynx when sitting upright, can run into the larynx when laying down at night. This can irritate the tissues of the larynx, including the vocal cords, causing inflammation that stimulates the cough reflex. Chronic sinusitis or chronic nasal allergies can also contribute because of the post-nasal drip that can fall into the larynx during sleep, triggering the cough reflex. Infected sinuses often produce purulent mucous whereas allergic drainage is usually clear. Swallowed secretions from chronic sinus infection or chronic nasal allergies can also cause stomach upset, making acid reflux symptoms worse.

Sinus infection can be ruled out with CT scans of the sinuses. Pulmonary function testing can evaluate lung function for asthma. A videolaryngoscopy done by an otolaryngologist can evaluate vocal cord edema and function. And of course, a chest x-ray could be done in cases of chronic cough. The evaluation of chronic cough is often an involved process, though many practitioners start with eliminating acid reflux I would discuss your concerns with your allergist and work together to relieve your symptoms.

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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