Allergic cough

Introduction Allergic cough (AC) has not been recognized as an independent disease. The definition of it is still only in a descriptive stage, lacking a large number of systematic research observations. Mainly refers to some patients with clinical chronic cough, with some atopic factors, antihistamines and glucocorticoids are effective, but can not be diagnosed as asthma, allergic rhinitis or eosinophilic bronchitis (EB) It is not suitable for generalization to other diseases. The definition of such cough is AC, and its relationship and similarities with allergic pharyngitis, EB, cough after a cold, etc. need to be further explored to determine whether it is an independent disease entity.

Cause

The concept of allergic cough was first proposed by Japanese scholar Fujimurat in 1992. It mainly refers to patients with dry cough who have poor therapeutic effects on bronchodilators but are effective in antihistamines and glucocorticoids. With certain special effects, sputum eosinophils are normal. Often accompanied by symptoms of itchy itching. The cause of the disease is not very clear. It is currently believed that allergic cough is caused by prolonged unhealed virus infection and bacterial infection, and allergic factors are involved. The main manifestation of paroxysmal dry cough caused by itchy throat.

an examination

Related inspection

Bronchoscopy sputum bacterial smear examination

A multifaceted inspection is required:

(1) Inquire about the medical history in detail, and look for the cause of the past medical history and family history, especially allergic diseases.

(B) the main symptoms such as itchy throat, continuous sneezing and so on.

(C) bronchoscopy: visible bronchial mucosa pale edema, a large amount of water-like secretions, if due to persistent edema can occur nasal polyps or polypoid degeneration.

(D) sputum secretion smear examination: during the onset of allergic reactions, eosinophilic leukocytosis can be seen in the nasal secretions, and more eosinophils or mast cells can be found.

(5) Allergic challenge test: generally used skin test (scratch, intradermal and contact method, etc.), the principle is that there are a variety of hypothetical allergic substances, so that after contact with the body, depending on whether there is any reaction, can help diagnosis. This allergen can also be used for desensitization after the allergen diagnosis is clear.

Differential diagnosis

diagnosis:

1 Chronic cough.

2 lung function is normal, airway hyperresponsiveness test is negative.

3 has one of the following characteristics

(1) History of exposure to allergens.

(2) Allergen skin test is positive.

(3) Increase in serum total IgE or characteristic IgE.

(4) Increased cough sensitivity.

4 Exclude chronic cough caused by CAV, upper airway cough syndrome, EB and other causes.

5 glucocorticoids or anti-allergic amines are effective.

Differential diagnosis:

1, pharyngitis

Chronic pharyngitis is a common pharyngeal disease, and its prominent symptom is irritating dry cough. Because of the itching and discomfort in the pharynx, the patient often clears the dry cough of the pharynx, and the symptoms are more obvious when speaking. The symptoms can be alleviated after drinking water or after swallowing. Most of them are secondary to upper respiratory tract infections, or frequent smoking, alcoholics and some people who are exposed to certain harmful dust or gas. Pharyngeal congestion can be seen in the pharyngeal examination. There are many dilated capillaries and a small amount of lymphoid follicles on the surface of the posterior pharyngeal mucosa. The mucosa of the posterior pharynx and some exposure to harmful dust or gas are more common. Pharyngeal congestion can be seen in the pharyngeal examination. There are many dilated capillaries and a small amount of lymphoid follicles on the mucosal surface of the posterior pharyngeal wall. The mucosa and sacral arch of the posterior pharyngeal wall are slightly thickened, and the secretion is increased. Chronic simple pharyngitis generally mild symptoms, pharyngeal reaction is also easy, chronic proliferative pharyngitis clinical symptoms are more significant, pharyngeal reaction is heavier, visible pharyngeal congestion, vasodilation, soft palate congestion, county sputum congestion and edema, lymphatic filtration The proliferation of the vesicles is obvious, the nucleus is thicker, and the pharyngeal reflex is particularly sensitive. The pharyngeal dryness of chronic atrophic pharyngitis is the most prominent symptom of the patient. The pharyngeal examination shows that the pharyngeal mucosa is pale. Dry, thin, pharyngeal muscle atrophy and pharyngeal cavity is relatively wide.

2, laryngitis

The main symptoms are hoarseness, which often occurs intermittently in the early stage, and occurs every time when the pronunciation is high. If the condition is aggravated, the vocalization can be sustained, but none of them are rare. Because the patient has a dry cough to relieve symptoms. Indirect laryngeal mucosa examination, patients with chronic simple laryngitis often show larynx mucosal congestion, vocal cord tarnishing, there are dilated blood vessels distributed, mucus secretions increase; the disease progresses to aggravate the development of chronic proliferative laryngitis, mucosa Apparently thickened in dark red, the edges are thick and round, the pronunciation is often closed, the throat chamber is often thickened by compensatory activities; chronic atrophic laryngitis is rare, often cyanated after yellow-green Suede, burning or painful in the throat.

3, throat tuberculosis

Often in patients with open tuberculosis, early symptoms often have dry cough and mild hoarseness. As the condition worsens, the vocalization becomes more and more serious. Until the later stage, not only the vocal increase is aggravated, but the severe punishment is like whispering because of the lack of pronunciation. Indirect laryngoscopy in the early stage of patients with common sacral space and swelling of the posterior epiglottis, swollen mucosa was pale, vocal cord or throat room, ulcers appeared in the epiglottis, severe throat morphology may change, difficult to identify.

4, laryngeal cancer

Commonly, the coughing sound is hoarse, and as the condition worsens, the symptoms gradually become apparent, and the late stage may have aphasia and difficulty breathing. Direct laryngoscopy or fiber laryngoscopy, early cancer occurs in the anterior and middle segments of one side of the vocal cords, and is a nodular or cauliflower-like new organism. According to the location of the tumor, it is divided into glottic cancer, supraglottic cancer and sub-acoustic carcinoma. The location of subglottic carcinoma is difficult to detect early. All suspicious tissue of the throat should be taken for pathological diagnosis of living tissue.

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