Cough is a common complaint that can be caused by upper respiratory cough syndrome, allergic and vasomotor rhinitis syndrome, chronic rhinitis, asthma, and gastroesophageal reflux disease. Other causes include chronic smoking or exposure to smoke, aspiration, bronchiectasis, infections such as pertussis and tuberculosis, non-asthmatic eosinophilic bronchitis, cystic fibrosis, sleep apnea, restrictive lung disease, and bronchogenic or laryngeal neoplasm, among others (Sharma, Hashmi, & Alhajjaj, 2019). In Florida, an important number of non-smoker cough cases are related to allergic rhinitis.
Choose one differential diagnosis for cough and discuss the presenting symptoms, diagnostic testing, and treatment.
Allergic rhinitis results from a IgE mediated inflammation of the mucosa in the nares after exposure to an allergen (Sharma, Hashmi, & Alhajjaj, 2019). The response to this exposure includes sneezing, congestion rhinorrhea, and mucosa hyperactivity (Sharma, Hashmi, & Alhajjaj, 2019). Allergic rhinitis can be seasonal, which is normally related to outdoor allergens, or perineal, which is normally related to indoor allergens (Sharma, Hashmi, & Alhajjaj, 2019). Risk factors include family history, tobacco smoke exposure, history of asthma, pets in the house, and houses infested with roaches (Sharma, Hashmi, & Alhajjaj, 2019). History and physical exam are crucial to diagnose allergic rhinitis, identifying nature, onset time, and duration of symptoms (Sharma, Hashmi, & Alhajjaj, 2019). Other information that will be significant to allergic rhinitis includes whether the patient has a history of atopic dermatitis or food allergies, or both (Sharma, Hashmi, & Alhajjaj, 2019). History of nasal congestion, itchy nose, watery itching eyes, itching ears, or sneezing is also significant in the diagnosis of the condition.
Findings during physical exam include dark circles under the eyes, rubbing of the nose, rhinorrhea, clear nasal discharge, blue-gray, pale nasal mucosa, post-nasal discharge, and oropharyngeal lymphoid tissue hypertrophy (Wheatley & Togias, 2015). Differential diagnosis includes infection rhinitis, medication-induced cough, rebound effect after continuous use of decongestants, vasomotor rhinitis, adenoidal hypertrophy, and septal abnormalities (Wheatley & Togias, 2015). The first line of treatment is second-generation antihistamines such as cetirizine and loratadine. The second line of treatment includes nasal antihistamine and first-generation antihistamines.
References
Sharma S, Hashmi MF, Alhajjaj MS. Cough. [Updated 2019 Sep 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493221/
Wheatley, L. M., & Togias, A. (2015). Clinical practice. Allergic rhinitis. The New England journal of medicine, 372(5), 456–463. doi:10.1056/NEJMcp1412282.
