Managing Persistent Cough and Throat Phlegm from Allergic Rhinitis

Nasal allergies

Hello Doctor: I have a history of nasal allergies, and recently I've been coughing non-stop, both in the morning and at night.
I feel like there's phlegm in my throat, but when I cough it up, it's white.
Occasionally, I also taste nasal mucus.
I've visited the clinic four times, and the doctors have all said I have post-nasal drip and prescribed medication for my nasal allergies, but there has been no improvement.
I've been coughing for almost three months now.
I would like to know what I can do to alleviate my cough and the symptoms of throat irritation caused by phlegm.

Xuan, 20~29 year old female. Ask Date: 2022/02/10

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the situation you described may be chronic pharyngitis.
It is recommended to seek medical attention for a laryngoscopy to rule out any masses and to consider medication treatment.
In addition to medication, daily lifestyle precautions include: avoiding lying down for two hours after eating, and avoiding coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Regarding allergic rhinitis, there are several important concepts: the individual's constitution and environmental allergens and irritants are the main triggering factors.
If one parent has allergic rhinitis, the likelihood of the child developing allergic rhinitis is four times higher.
Common allergens include dust mites, followed by animals, insects, mold, and pollen.
Recently recognized fine particulate matter (PM2.5) is also an important irritant.
The treatment approach typically starts with oral medications and nasal sprays, and surgery may be considered if necessary.
The main medications include oral antihistamines and topical low-dose corticosteroid nasal sprays, with additional options such as topical antihistamines/vasoconstrictors or oral leukotriene receptor antagonists as needed.
If symptoms do not improve with medication and there is significant structural obstruction, such as a deviated septum, enlarged inferior turbinates, or nasal valve narrowing, appropriate surgical intervention can be performed.
Recently, minimally invasive surgical techniques have been developed, which require shorter operation times and do not necessitate hospitalization, making them widely applicable.
To avoid allergens and reduce irritants, it is important to wear masks, maintain a good home environment, regularly clean bedding, avoid extreme temperature/humidity changes, and reduce outdoor activities during severe PM2.5 air pollution.
Although allergic rhinitis can be bothersome, with appropriate medication or combined surgery, and by avoiding allergens and irritants, it can be well-controlled, significantly improving quality of life and making academic and work tasks easier to manage.
Wishing you peace and health.

Reply Date: 2022/02/10

More Info

Managing persistent cough and throat phlegm, especially when associated with allergic rhinitis, can be quite challenging. The symptoms you describe—persistent coughing, throat phlegm, and postnasal drip—are common in individuals with allergies. Here’s a comprehensive approach to managing your symptoms based on your situation.

Understanding Your Symptoms
1. Postnasal Drip: This occurs when excess mucus accumulates in the back of your throat, often leading to coughing and throat irritation. Allergic rhinitis can cause inflammation in the nasal passages, leading to increased mucus production.

2. Coughing: A persistent cough can be a reflex to clear the throat of mucus. If the mucus is clear or white, it typically indicates that the underlying cause is not a bacterial infection but rather an allergic or viral response.

3. Throat Phlegm: The sensation of phlegm in the throat can be uncomfortable and may lead to frequent throat clearing, which can further irritate the throat.

Management Strategies
1. Medications:
- Antihistamines: These can help reduce the allergic response and decrease mucus production. Non-drowsy options like loratadine (Claritin) or cetirizine (Zyrtec) may be beneficial.

- Nasal Corticosteroids: Sprays like fluticasone (Flonase) or mometasone (Nasonex) can significantly reduce inflammation in the nasal passages, helping to alleviate postnasal drip.

- Expectorants: Medications like guaifenesin (Mucinex) can help thin mucus, making it easier to expel.

- Saline Nasal Irrigation: Using a saline solution to rinse your nasal passages can help clear mucus and allergens, providing relief from congestion and postnasal drip.

2. Lifestyle Modifications:
- Hydration: Drink plenty of fluids to help thin mucus. Warm fluids, like herbal teas or broths, can be soothing.

- Humidifiers: Using a humidifier in your home can add moisture to the air, which may help soothe irritated airways and reduce coughing.

- Avoid Irritants: Stay away from smoke, strong odors, and allergens that may trigger your symptoms. This includes dust, pollen, and pet dander.

3. Dietary Considerations:
- Anti-inflammatory Foods: Incorporate foods rich in omega-3 fatty acids (like fish and flaxseeds), fruits, and vegetables to help reduce inflammation.

- Avoid Dairy: Some people find that dairy products can thicken mucus, so it may be worth reducing or eliminating them from your diet to see if it helps.

4. Consultation with Specialists:
- If your symptoms persist despite these interventions, consider seeing an allergist or an ear, nose, and throat (ENT) specialist. They can perform tests to identify specific allergens and may recommend additional treatments, such as allergy shots (immunotherapy).

5. Follow-Up:
- Keep a symptom diary to track your cough and any associated factors (like exposure to allergens or changes in medication). This information can be helpful for your healthcare provider in tailoring your treatment plan.

Conclusion
Persistent cough and throat phlegm due to allergic rhinitis can be frustrating, but with the right combination of medications, lifestyle changes, and possibly specialist consultations, you can find relief. It’s essential to communicate openly with your healthcare providers about your symptoms and any treatments you’ve tried, as this will help them assist you more effectively. If your symptoms do not improve or worsen, seeking further evaluation is crucial to rule out other underlying conditions.

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