Triggers of allergic cough are factors that induce acute attacks of allergic cough and aggravate the symptoms of allergic cough in patients who are already suffering from allergic cough disease.
I. Psychosocial factors
Psychosocial factors are also clinically important in relation to allergic cough, and most guidelines for the management of allergic cough or manuals for the management of allergic cough give greater attention to psychosocial factors. Studies have established that lower patient education, poor compliance, and inadequate health care conditions are associated with mortality and prevalence of allergic cough. Most authors now believe that psychosocial factors are closely related to the onset of allergic cough, and Lehrer et al. suggested that psychiatric, psychological, emotional, and personality factors should be taken into account in the study of allergic cough. Yang Jibing, Department of Respiratory Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine
Certain studies have confirmed that wheezing episodes can be induced in most patients with allergic cough by changes in certain psychosomatic stresses and emotional factors, which are more evident in adult patients, such as anxiety, anger, mental tension, panic, depression, anger and worry can be one of the triggers of allergic cough attacks. In addition, the patient’s poor socioeconomic status (e.g., inability to afford inhaled glucocorticoids and other medications), inadequate social and health care (e.g., lack of appropriate anti-inflammatory medications or nebulization devices, inability to master certain allergic cough self-management techniques, and lack of guidance from an allergic cough or allergist) can seriously affect the stability of allergic cough.
Social and family factors such as excessive work stress, career setbacks, financial constraints, poor social and health care conditions and other diseases, as well as worries and frustrations caused by family break-ups, failed marriages or love affairs, can all be triggering factors for allergic cough.
Second, climate factors
Cold air, changes in air humidity, and high or low air pressure can trigger an allergic cough attack. The incidence of allergic cough is significantly higher in areas with large temperature changes, high humidity or low air pressure. When patients with allergic cough in these areas go to areas with dry climate and high air pressure, the allergic cough can often be relieved. The mechanism of cold air-induced allergic cough is that cold air can lead to heat loss in the airways, resulting in the release of mediators from mast cells, which directly or indirectly induces airway inflammation and causes allergic coughing episodes. Too high or too low temperatures are both unfavorable factors for allergic cough.
Based on the fact that patients with allergic cough often feel that their symptoms worsen during thunderstorms, Robert et al. conducted a six-year study on the occurrence of thunderstorms and emergency admissions of children with allergic cough, which confirmed the existence of “thunderstorm allergic cough”. It was found that children were 15% more likely to be hospitalized for allergic cough during thunderstorms. It has been suggested that increased airborne pollen concentrations are the cause of “thunderstorm allergic cough”, but Robert’s study confirmed that the occurrence of “thunderstorm allergic cough” is associated with increased concentrations of fungal spores in the air during thunderstorms, and not with changes in airborne pollen concentrations. The study confirmed that the occurrence of “thunderstorm allergic cough” is associated with increased concentrations of fungal spores in the air during thunderstorms, but not with changes in airborne pollen. During thunderstorms, the concentration of fungal spores in the air nearly doubles.
Excessive exercise and hyperventilation
Examples of exercise-induced allergic cough are common in clinical practice. For most patients with allergic cough, exercise is only the precipitating factor, whereas for patients with exercise-induced allergic cough, exercise may be the causative factor. Practically all patients with allergic cough and some patients with allergic rhinitis can develop wheezing symptoms after a certain amount of exercise. The mechanism is related to hyperventilation caused by excessive exercise, which leads to excessive heat loss from the airways and cooling of the airway environment, thus inducing the release of inflammatory mediators from mast cells and leading to airway inflammation. Hyperventilation due to laughing and crying in children with allergic cough also often induces wheezing symptoms.
The treatment of allergic cough is the same as that of asthma, with the principles of removing the cause, controlling the attack and preventing recurrence. Because cough attacks only occur at night or early in the morning, they are more constant for the same child. During the day, there are usually no symptoms or very little cough, so some parents think that the cough is caused by the cold at night and cover the child more warmly, or do not pay attention to it. Doctors often diagnose the cough as an “upper respiratory tract infection” or “bronchitis” and use antibiotics and cough suppressants, but they often have no effect or little success. In fact, this is an allergic cough, mostly seen in children with allergic constitution. The bronchial mucosa is highly sensitive and has low tolerance to any external stimuli. Because of the unstable function of the plant nerves, children are particularly prone to attacks at night when the vagus nerve becomes more excited, which is atypical of asthma.
Etiology and pathology
The causes of allergic cough and allergic asthma are similar. The causes of allergy are numerous and complex, but there are two main aspects, namely the patient’s constitution and environmental factors. The patient’s constitution includes subjective conditions such as “genetic quality”, immune status, psychosomatic state, endocrine and health status, which are important factors in the patient’s susceptibility to allergic cough. Environmental factors, including allergens, irritant gases, viral infections, area of residence, living conditions, occupational factors, climate, medications, exercise (hyperventilation), food and food additives, dietary habits, social factors and even economic conditions may be more important factors in the development of allergic cough. The increasing trend in the incidence of allergic cough is also related to the susceptibility of patients due to their allergic constitution and to environmental factors.
Modern medicine considers the formation of allergic inflammation of the airways in patients with allergic cough as the result of a combination of many factors, and clinicians should distinguish between primary and secondary factors in order to target their prevention and treatment efforts. It should also be realized that the age of the patient’s first exposure to the above-mentioned adverse environmental factors, the harshness of the adverse environment, the frequency of exposure and the duration of exposure are also important factors in determining whether a patient changes from an allergic cough state to allergic asthma, and also key factors in determining the prognosis and regression of patients with allergic cough.
Some environmental factors that trigger allergic cough in daily life, such as dust mites, fungi, pollen and other allergens, viruses and climate change, are often persistent and difficult to avoid, and with the improvement of modern living standards, new allergens are frequently introduced into people’s lives. Allergic cough is often more difficult to prevent and treat. The inconsistency of monozygotic twins in the development of allergic cough suggests that environmental factors may have an important role in the development of allergic cough. Exposure to environmental allergens is often necessary for the expression of allergic cough genes in patients, and the concentration of environmental allergens can often determine the level of allergic cough gene expression.
Most authors believe that the many factors that cause allergic cough should be divided into two categories: Trigger, which is the trigger for the first episode of allergic cough, and Contributor, which plays an important role in both the onset and the development of allergic cough; and Trigger, which is the cause of allergic cough in patients who already have it. Triggering factors are factors that induce the reactivation of latent allergic cough or acute attacks of allergic cough on the basis of allergic cough.
Among the two main groups of factors mentioned above, some factors such as allergens, irritating and noxious gases, occupational factors, viruses, food and drugs have a dual role, both in the development of allergic cough and in the development of allergic cough. However, it should be clear that all environmental factors are not the only ones that determine whether an allergic cough occurs or not, but the atopic qualities of the patient with allergic cough itself are also very important and the Comet Allergic Cough Kit is recommended for the treatment of overactive cough.
Clinical manifestations
Persistent or recurrent episodes usually last for more than 1 month. Some patients only present with a cough at night, especially in the second half of the night, or an early morning cough or cough after exercise, with no clinical signs of infection and no obvious positive signs on examination. If the patient also has frequent “cold” symptoms without fever, such as sneezing, runny nose, itchy nose, itchy eyes, etc., it is especially important to pay attention to the presence of allergic cough if there is a history of personal allergies, such as eczema, during infancy and childhood. As with any allergic disease, one of the most important features of allergic cough is that it can recur with changes in climate, environment and lifestyle, and can be difficult to treat.
Complications
1. Respiratory tract and lung infections
Most cases of atopic asthma are caused by respiratory tract infections. Therefore, the immune function of the respiratory system is hindered, which makes it very easy to cause respiratory and pulmonary viral infections. Once the symptoms of infection appear, appropriate antibiotics can be selected according to the germs and drug sensitivity for reasonable treatment.
2.Sudden death
Sudden death is the most serious acute complication of cough variant asthma, which often occurs without obvious prior signs and is often too late to save the patient.
3.Pneumothorax and mediastinal emphysema
Experts from the Department of Pediatrics of Shenzhen Far Eastern Women’s and Children’s Hospital point out that because the gas will be retained in the alveoli during an acute attack of cough variant asthma, so that the alveoli contain a large amount of gas and the alveolar pressure rises, the emphysema caused by variant asthma will lead to alveolar rupture and the formation of spontaneous pneumothorax. Alveolar rupture can cause gas to enter the subcutaneous tissue and thus cause mediastinal emphysema, which can be life-threatening.
4. Water-electrolyte and acid-base imbalance
The acute attack of cough variant asthma is often complicated by water-electrolyte and acid-base imbalance due to lack of oxygen, insufficient food intake and dehydration, which affects heart, liver, kidney and respiratory functions. These are important factors that affect the treatment and recurrent attacks.
5. Multi-organ insufficiency and multi-organ failure
Acute attacks of cough variant asthma are due to severe hypoxia, infection, acid-base imbalance, respiratory bleeding and toxic side effects of drugs, which complicate multi-organ insufficiency and even functional failure.
6. Respiratory failure
Acute exacerbation of allergic asthma is a common trigger for complicating respiratory failure due to poor breathing, infection, improper treatment and medication, complications of pneumothorax, pulmonary distension and pulmonary edema. Respiratory failure, due to hypoxia, carbon dioxide retention and acidosis, makes the treatment of cough-variant asthma even more difficult.
Disease diagnosis
1. Regular antibiotic therapy is ineffective and antispasmodic and asthma medication is effective;
2.The airway is hyperreactive and the allergic skin test is positive;
3. The main symptom is a persistent dry cough, often accompanied by chest tightness, which intensifies at night, in the morning or after exercise, without dyspnea and wheezing;
4. Frequent attacks in spring and autumn, often triggered by cold air inhalation, overexertion, excessive mental stress or strenuous exercise;
Frequent coughing should be examined at a regular hospital as early as possible if treatment for coughing is not effective, so as not to miss the period of disease treatment and cause serious consequences.
Allergic cough, also known as cough variant asthma, is a specific manifestation of asthma, mainly due to persistent or recurrent coughing attacks for more than a month, some often accompanied by nocturnal or early morning episodes of coughing with little sputum, aggravated by exercise, without clinical manifestations of infection, or after a longer period of ineffective antibiotic treatment, treatment with bronchodilators can make the coughing attacks ease, often with personal or family allergies. The treatment of allergic cough is the same as that of asthma, with the principles of removing the cause, controlling attacks and preventing recurrences. Because cough attacks only occur at night or early in the morning, they are more regular for the same child. During the day, there are usually no symptoms or very little cough, so some parents think that the cough is caused by the cold at night and cover the child more warmly, or do not pay attention to it. Doctors often diagnose the cough as an “upper respiratory tract infection” or “bronchitis” and use antibiotics and cough suppressants, but they often have no effect or little success. In fact, this is an allergic cough, mostly seen in children with allergic constitution. The bronchial mucosa is highly sensitive and has low tolerance to any external stimuli. Because of the instability of the child’s vegetative nerves, the cough is particularly prone to attacks at night when the vagus nerve becomes more excited.
Treatment
In pediatric allergic cough, treatment with antimicrobials and cough suppressants has no significant effect, while the administration of wheezing medications and anti-allergic drugs can stop the cough. Ketotifol and salbutamol (albuterol) should be chosen for treatment. After medication, the cough usually disappears within 2 to 5 days, and in some cases the cough disappears completely two weeks to a month or longer after the medication is given. Long-term coughing damages the mucous membrane of the respiratory tract and the repair of the damaged mucous membrane tissues takes a process. It takes a longer time for the medication to work after the child has taken bronchospasm-relieving drugs and anti-allergic drugs.
In addition, according to the global standardized asthma treatment program developed by the World Health Organization, a stepwise, graded treatment according to the severity of symptoms should be used. Combination therapy with inhaled hormones, bronchodilation, and the administration of anti-inflammatory and desensitizing drugs is also advocated. Specific practices include.
1. When the seasons change and the temperature changes suddenly, parents should try to keep their children warm and avoid catching cold and flu.
2. Avoid foods that can cause allergy symptoms, such as seafood, cold drinks, carbonated beverages, etc.
3. Don’t keep pets and flowers at home, and don’t lay carpets to avoid children’s exposure to pollen, dust mites, oil fumes and paints.
4, do not let children hold long stuffed toys to sleep.
5.In the bathroom or basement, you should use a dehumidifier and air filter, and replace the filter regularly.
6.Bedding should be dried often.
Allergic cough herbal remedies
Children with allergic cough tend to have paroxysmal, irritating dry coughs at night, with no obvious signs of upper respiratory tract infection or fever beforehand. Chinese medicine considers this to be a deficiency of lung qi, and the treatment advocates “treating the symptoms urgently and fixing the root cause slowly”.
Prescription for treating the symptoms: 5 grams each of ephedra, tangerine, licorice and suzi, 6 grams each of almonds, mulberry, poria, dong quai and aster, and 4 grams each of dried eucommia.
How to use: Decoction with water, 2 posts a day, to the extent that the condition is relieved.
Prescription: Astragalus, Radix Codonopsis, Radix Rehmanniae, Rhizoma Atractylodis, Poria, 6g each, Radix et Rhizoma Macrocephala, Fructus Schisandrae, Rhizoma Polygonati, Aster, 5g each, Radix et Rhizoma Glycyrrhiza, 3g.
How to use: Decoction with water, 1 post daily for 4 weeks
Desensitization therapy is most suitable for allergic rhinitis or allergic cough caused by inhaled allergens, because inhaled allergens are dispersed everywhere and are difficult to avoid, so using desensitization therapy is an important measure to prevent the recurrence of asthma. There are three types of desensitization therapy: desensitization injection, sublingual administration and desensitization patch.
1.Sublingual desensitization therapy
Sublingual desensitization, sublingual desensitization therapy is the use of extracts of allergens dropped under the tongue to make the respiratory mucosa tolerant, so as to reduce or control allergy symptoms and reach the purpose of desensitization therapy. Its clinical features are.
The world’s fastest growing method of desensitization (i.e. specific immunotherapy or immunotherapy) for allergic cough, in line with the World Health Organization’s recommended symptomatic + cause-specific rationalized treatment protocol.
It overcomes the limitations of traditional hormonal chemical drugs, which only treat the symptoms of the disease at the onset and treat the symptoms but not the root cause, and with the prolongation of taking them, there are different degrees of adverse reactions that may produce a certain degree of drug resistance.
High safety: Globally, no serious side effects have occurred after 30 years of use, which maximizes the long-term medication safety of desensitization therapy; avoids the serious systemic adverse reactions (including anaphylaxis and even death) that may be caused by injectable desensitization therapy, thus reducing the psychological burden of health care workers and patients.
After 3 to 9 months of sublingual dust mite immunotherapy in patients with dust mite induced allergic asthma, the number and duration of asthma attacks can be reduced, the inhaled dose of glucocorticoids can be reduced, airway reactivity can be reduced and lung function indices can be improved. There are also changes in immunological indices in vivo before and after treatment, including increased serum IgG4 levels and improved Th2/Th1 cell ratios. Since the drug is administered sublingually, it usually does not produce serious adverse reactions such as anaphylaxis. Very few patients occasionally have mild rash or mild diarrhea, which can be recovered by stopping the treatment or reducing the dosage. The mechanism of sublingual desensitization therapy is because there are many Langerhans cells in the sublingual mucosa, which can prevent the occurrence of allergic reactions by absorbing minute amounts of dust mite allergens and transforming them into mite peptide information, which can be presented to Th0 cells to convert Th0 cells to Th1 cells.
2.Desensitization patch
The hospital uses “injection desensitization”, which is a method of making allergens into a certain concentration of leaching solution and repeatedly injecting patients with artificially prepared specific antigens in gradually increasing doses and concentrations, so as to gradually induce patients to tolerate the antigens without producing allergic reactions.
”Nano desensitization therapy” is based on the principle of “injection desensitization”, but the route of administration is changed to enter the body through percutaneous infiltration. The Tio2 (titanium dioxide) nanocrystals can effectively decompose the organic matter in the dry allergen powder and produce free small molecule antigen under the catalyst of light and far infrared rays; at the same time, the Tio2 (titanium dioxide) nanocrystals can decompose the skin keratin layer protein under the catalyst of light and make the epithelial tissue At the same time, Tio2 (titanium dioxide) nanocrystals can break down the skin keratin layer proteins under photocatalysis, so that the epithelial tissue gap increases, which is conducive to promoting the continuous and maximum penetration of small molecule antigens into the body. The body gradually develops immune tolerance under the long-term continuous stimulation of these antigens, and does not react to re-exposure to allergens to achieve the purpose of complete desensitization of the body.
Use cough medicine with caution for pediatric allergic cough
Physiologically, coughing in children is a protective reflex that cleans the respiratory tract and allows it to flow smoothly. Cough medication can stop coughing because it acts on the cough reflex. However, because the respiratory system of children is not yet mature, they have poor reflexes to cough, and because of the narrow lumen of the bronchial tubes, rich blood vessels and poor cilia movement, sputum is not easily expelled. Excessive use of cough medicines such as cough booster, cough mephentermine and wu wei zi can easily cause a large amount of phlegm to be retained in the respiratory tract, resulting in airway obstruction, chest tightness, breathing difficulties, rapid pulse rate, and even secondary bacterial infections.
Treatment of allergic cough in children
Allergic cough is a relatively serious type of allergic disease in children and is easily combined with bronchitis and pneumonia. 80% of children develop the disease before the age of 5 and treatment is best carried out at the age of 5 to 7. With the correct desensitization treatment, most children’s condition can be controlled and their allergies improved to achieve the goal of eradication.
Treatment of pediatric allergic cough should avoid the abuse of antibiotics and hormones. Allergens can be identified by searching for allergens and desensitization can be performed. Anti-allergic drugs such as paracetamol, omike and ketotifol should be used, as well as bronchodilators such as salbutamol and aminophylline. Parents should be fully aware of pediatric allergic cough and avoid excessive abuse of cold medications for their babies that may cause other adverse reactions.
Traditional Chinese Medicine (TCM) treatment
TCM treatment is not only herbal treatment, but also includes other TCM treatment techniques such as acupuncture, cupping, fumigation, etc. This is exactly what is done with magnetic medicine superimposed on immune regulation therapy, which combines these TCM treatments and uses the knowledge of TCM acupuncture points to treat allergic cough disease under the TCM theory of internal burial and external sparing.