Identifying cough in children
Generally speaking, if a cough is accompanied by fever and nasal congestion due to wind and cold, it is a wind-cold cough. If the sputum is yellow and sticky, it suggests a respiratory infection, while nowadays more and more children have a chronic cough with no obvious cause, not accompanied by fever, nasal congestion, etc. Some have an itchy throat and sneezing symptoms. These coughs are frequent and, if not controlled in time, may lead to cough variant asthma, which should be given due attention.
The clinical manifestations of allergic cough in children are mainly: sneezing and coughing for no reason in the morning and violent coughing at night before going to bed. Sputum can be heard in the throat, and children can hear coarse breathing sounds and snoring in their sleep. They are prone to coughing bursts at night without a cause, and some of them are accompanied by itchy throat and nose.
Causes
The causes of allergic cough and allergic asthma are similar. The causes of allergy are numerous and intricate, but mainly include two aspects, the allergic constitution of the allergic cough patient and environmental factors.
Climate triggers
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 high temperature changes, high humidity or low air pressure. When patients with allergic cough in these areas go to areas with dry climate and higher air pressure, the allergic cough condition 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 exercising 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 frequently induces wheezing.
Immunopathology
In allergic children, the TH2 type of immunity at birth is reinforced by the intestinal flora, leading to recurrent allergic cough, rhinitis, bronchial asthma, atopic dermatitis (eczema) urticaria, food allergy and frequent use of antibiotics in treatment leading to immune disorders and nutritional deficiencies in children with recurrent allergies long-term medication in children has seriously jeopardized their physique.
Allergic cough is a polygenic autosomal dominant disorder whose pathogenesis is based on atopic qualities also known as allergic children. It has been found that the predominant response to allergens during fetal life is a Th2 response, which plays an important role in avoiding immune rejection between mother and child.
The type of immune response to allergens after birth determines the development of allergic diseases: healthy children show tolerance to allergens and thus avoid Th2 responses, while children with recurrent allergic symptoms such as allergic cough, asthma, rhinitis, eczema, atopic dermatitis, urticaria, food allergy and drug allergy can be sensitized to allergens and induce an over-activated Th2 response in the organism.
Secondly, the tendency to produce high levels of sensitizing antibodies to IgE in the body after exposure to allergens, as in the case of a predominantly Th2 immune response, is the most important susceptibility factor for allergic cough and is the root cause of recurrent allergic cough.
Some parents may say that their child was never allergic as a child, but only since starting kindergarten has he or she been prone to coughing and has been identified as having an allergic cough. In fact, it usually takes a period of sensitization for this Th2-dominant immune atopy to manifest itself, so most allergic coughs do not become apparent until one year after birth or in school-aged children, and some do not develop until adulthood.
The close relationship between airway hyperresponsiveness and high IgE levels in the development of allergic cough asthma
The vast majority of patients with allergic cough (especially in children) have a typical allergic constitution, and the increased serum total IgE levels and airway hyperresponsiveness caused by this allergic susceptibility are associated with genetic factors.
Inhalant allergens cause airway allergic inflammation in two stages: sensitization and inflammation. Sensitization can occur unknowingly when atopic patients are exposed to and inhale an environmental allergen for a long period of time.
During the sensitization phase: the main change in the body is the production of specific IgE in the airways corresponding to the allergen, which has a high affinity for mast cells in the airways and a certain affinity for eosinophils and macrophages in the airways. The binding of these specific IgE to these cells in the airway creates a sensitized state of the airway and the organism.
Inflammatory phase: When the same allergens are inhaled again, they bind to specific IgE and cause the activation of mast cells and eosinophils and the release of inflammatory mediators such as histamine and leukotrienes, causing allergic inflammation in the airways and leading to episodes of allergic coughing, which can last for months or even a year. Blood tests in children with this type of cough do not show high white blood cells, but abnormally high eosinophils or C-reactive protein, which would also point to recurrent coughing as allergic cough.
Disease characteristics
1. Pediatric cough often occurs during the alternation of hot and cold or the seasons, or in spring when there is a lot of pollen;
2. Children have a tendency to rub their eyes, nose or scalp;
3.Children are particularly sweaty when they sleep, and they do not like to sleep flat, but like to sleep curled up;
4. Repeated episodes of violent coughing with paroxysms;
5. The child’s cough lasts for a long time, usually more than 3 months;
6. Although the child coughs, he does not have a fever, and the sputum he coughs up is thin and white and foamy;
7.When coughing up, breathing is more rapid;
8.Baby’s cough is usually worse at night after going to bed than during the day, which can also occur with non-pediatric allergic cough.
Identifying allergic cough
I. Children with known allergic rhinitis, such as asthma induced by a cold or upper respiratory tract infection, improve after anti-inflammatory and nebulizing treatment, but then have a constant paroxysmal cough, with morning and nighttime as the main coughing times, and no longer accompanied by other infectious manifestations;
II. Children with a history of allergies, such as eczema in infancy or a history of food allergy and drug allergy, can be identified as atopic.
III. A paroxysmal cough lasting more than four weeks;
IV. Children with cough that has been ineffectively treated with anti-inflammatory and cough suppressant therapy or who have repeated coughs;
V. Laboratory results showing low white blood cells but high eosinophils (in cases of upper respiratory tract infection combined with allergic cough, the white blood cell value may be increased);
VI. High C-reactive protein values;
VII. Increased IgE values in serum tests.
Treatment
Allergic cough is a relatively serious type of allergic disease in children and can easily lead to allergic asthma. The onset of allergic cough is often combined with bronchitis, pneumonia and other diseases, and children with this atopic physique often show airway hyperreactivity, which can easily cause repeated wheezing bronchitis and pneumonia. The second is anti-allergic medication, such as loratadine, cetirizine hydrochloride, cisplatin, ketotifen and other anti-allergic drugs to relieve cough symptoms.
Although cough variant asthma is usually not life-threatening, it should be diagnosed early and treated aggressively because it can develop into typical allergic asthma and can seriously affect children’s sleep, rest and learning.
Once cough variant asthma is diagnosed, the application of antibiotics or antiviral drugs should be stopped and care should be taken to avoid allergen exposure. In particular, primary prevention of asthma should be implemented for pediatric cough variant asthma. Probiotics promote and strengthen the cellular response of Th1, which helps to regulate the immune metamorphosis to restore the correct immune response of the body.
Removing the main cause of the disease – human lungs often encounter “viruses”, “germs”, “smoke poison”, ” phlegm toxin”, “exhaust gas toxin”, “inflammatory toxin” and other six toxins, so that the respiratory system of patients with cough and other lung diseases produces a large number of “alienated acid sugar “Once formed, it causes long-term and continuous harm to the human respiratory system, leading to more serious cough and wheezing lung diseases and a vicious cycle.
Activating the immune system and erecting a barrier – When the immune cells of the respiratory system are rampant with “alienated sugars”, a small part of them are assimilated and mutated, and most of them are in a dormant state with low function. This is an important factor in the recurrence of cough and lung disease.
Treatment-based, repairing damage – The long-term attack of xenobiotics causes serious lesions and damage to the trachea, bronchi, alveoli, alveolar sacs and other physiological tissues, especially causing repeated damage to the airway mucosa and collapse of the alveoli, which seriously affects the function of gas exchange, resulting in a decline in lung respiratory function and weak dynamics, leading to many diseases.
Combination of prevention and treatment to enhance body function – To treat cough and asthma and other respiratory stubbornness, it is critical to treat the lesions, but the combination of treatment and nourishment is more important to make the respiratory system function stronger and not recur.