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Ask The Expert

May 5, 2014

Constant Itchy Throat with Cough

Question

I have a case to present. A woman who is 62 years old complained of constant itchy throat for many years. She tried many kinds of antihistamine drugs without good effect. I can't find any environmental factors influencing her disease. She has been to Australia without a change in symptoms. The SPT showed negative results. I prescribed 1st generation and 2nd generation antihistamines for her without good effect. I can't explain it. She does not have asthma nor allergic rhinitis, etc. She coughs sometimes because of the itching.

Answer

By Prof Giovanni Passalacqua

The causes of itchy throat with cough (especially if long-lasting) are multiple. I suppose that asthma has been properly excluded by means of spirometry, nonspecific bronchial challenge (methacholine) or bronchodilation, and angiotensin converting inhibitors are not taken.

The next diagnostic steps should include a fiberoptic rhinoscopy or paranasal sinus CT (chronic rhinosinusitis) and the assessments for gastroesophageal reflux (oesophageal pH measurement and trendelemburg baritate contrast X-raY or fiberoptic gastroscopy). It is essential that, in the case of chronic cough, a standard chest X-ray is performed, to immediately exclude gross pulmonary alterations (1). A further step is the execution of a neck CT, to exclude anatomical alterations (e.g. goitre, abnormal vascularization, malignancies), but this is improbable, also because dysphonia is not reported.

Goldsobel AB, Kelkar PS. The adult with chronic cough. J Allergy Clin Immunol. 2012 Sep; 130(3):825-825

Natt RS, Earis JE, Swift AC. Chronic cough: a multidisciplinary approach. J Laryngol Otol. 2012 May; 126(5):441-4

Giovanni Passalacqua, MD
Allergy & Respiratory Diseases, Dept of Internal Medicine
Genova, Italy


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