Treatment of cough associated with allergies
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Antihistamines for Allergic Cough Treatment
Antihistamines, especially second-generation non-sedating H1-receptor antihistamines like cetirizine, bilastine, and levocetirizine, are widely used to treat cough associated with allergies. Studies show that cetirizine significantly reduces both the intensity and frequency of cough in children with pollen allergies, providing clear clinical improvement . Systematic reviews and clinical trials also support the use of non-sedating antihistamines for patients with chronic cough linked to allergic rhinitis or atopic cough, with notable improvements in cough scores, particularly in those with seasonal allergic rhinitis or atopic cough 68. Bilastine, in combination with other agents, has demonstrated efficacy in relieving cough without causing sedation, making it suitable for both adults and children 210.
Combination Therapies: Antihistamines, Antitussives, and Decongestants
Combining antihistamines with antitussives (such as dextromethorphan) and decongestants (like phenylephrine) is an effective approach for managing allergic cough, especially when the cough is dry and persistent. Fixed-dose combinations, such as bilastine/dextromethorphan/phenylephrine syrup, have been shown to be effective, safe, and non-sedating, providing significant relief from cough and associated symptoms in both adults and adolescents 2310. These combinations are particularly beneficial for patients who experience throat irritation and sleep disturbances due to cough, and are well-tolerated with minimal side effects 2310.
Intranasal Corticosteroids for Allergic Rhinitis-Associated Cough
Intranasal corticosteroids, such as mometasone furoate nasal spray, are effective in reducing cough severity in patients with seasonal allergic rhinitis. Clinical trials demonstrate significant improvement in both daytime and nighttime cough scores, as well as overall nasal symptoms, with good tolerability and minimal adverse effects 58. These medications are especially useful when cough is accompanied by other nasal symptoms like congestion and rhinorrhea.
Additional Management Strategies and Considerations
Avoiding known allergens is the first step in managing allergic cough, but when avoidance is not possible, pharmacological treatments are necessary. Decongestants and topical glucocorticoids are often prescribed alongside antihistamines to suppress allergic reactions and reduce mucus discharge . Mucolytic agents, such as ambroxol, may also be considered in cases where cough is associated with lower respiratory tract infections in patients with allergic rhinitis, offering additional anti-inflammatory and mucolytic benefits .
Limitations and Unmet Needs
Despite the availability of various treatments, surveys of allergy specialists indicate that no single therapy is rated as "very effective" for the majority of patients with chronic cough associated with allergies. Many patients continue to experience persistent symptoms, highlighting the need for further research and development of more effective therapies .
Conclusion
The treatment of cough associated with allergies typically involves second-generation non-sedating antihistamines, either alone or in combination with antitussives and decongestants, as well as intranasal corticosteroids for those with allergic rhinitis. These approaches are generally effective, safe, and well-tolerated, but there remains a need for improved therapies to fully resolve symptoms in all patients.
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Most relevant research papers on this topic
Cough in patient with concomitant allergic pathology
Cetlo® Plus effectively treats dry cough in patients with respiratory tract infections and concomitant allergic pathology, providing symptom relief and a simple regimen for adults and adolescents aged 12 and older.
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Relief of cough and nasal symptoms associated with allergic rhinitis by mometasone furoate nasal spray.
Mometasone furoate nasal spray effectively and well-tolerated relieves daytime cough and nasal symptoms associated with seasonal allergic rhinitis.
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The allergic cough
Antihistamines, decongestants, and topical glucocorticoids can effectively reduce allergic coughing when the allergen cannot be completely avoided.
Referrals, Etiology, Prevalence, Symptoms and Treatments of Chronic Cough: A Survey of Allergy Specialists.
Current treatments for chronic cough do not effectively resolve symptoms, and additional treatments are needed to improve quality of life for patients.
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