Throat Irritation and Coughing: Allergies or GERD?

The throat is constantly itchy and there is a dry cough, sometimes leading to choking?

Hello Doctor: Recently, I often wake up with nasal congestion, and my nose feels uncomfortable, as if mucus is draining down, making me want to swallow frequently.
My throat often feels itchy, and I have a persistent dry cough.
A few days ago, I experienced dizziness and headaches along with a runny nose.
Sometimes, I feel cold air or saliva passing through my throat, which causes me to choke.
I have seen a doctor, and most of them said my throat is slightly swollen and overly sensitive.
Two weeks ago, I had an endoscopy, which showed some gastroesophageal reflux, but there were no abnormalities in my throat or esophagus.
I would like to ask...
do I have allergic rhinitis or sinusitis? Or is it chronic pharyngitis? I am particularly concerned about my tendency to choke...
Given my situation, along with gastroesophageal reflux, am I more prone to choking? How should I take care of myself?

Ailen, 30~39 year old female. Ask Date: 2013/07/02

Dr. Zheng Jueyi reply Otolaryngology

Hi Allen,
I recommend that you seek medical evaluation to determine if you have allergic rhinitis, which could explain your frequent symptoms of nasal congestion, post-nasal drip, nasal itching, or sneezing.
If you also experience gastroesophageal reflux, it can indeed lead to chronic pharyngitis, causing throat discomfort and a sensation of a foreign body.
I suggest reducing your intake of coffee, tea, or overly sweet foods, and avoiding late-night snacks.
Additionally, if allergies are significantly impacting your daily life, medication treatment is advisable.
Wishing you peace and health,
Dr.
Jue-Yi Cheng
Director, Department of Otolaryngology
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2013/07/02

More Info

Based on your symptoms and the medical history you've provided, it seems that you are experiencing a combination of issues that could be related to allergic rhinitis, gastroesophageal reflux disease (GERD), and possibly chronic pharyngitis. Let's break down your symptoms and explore the potential causes and management strategies.

Symptoms Overview
1. Nasal Congestion and Discomfort: This is often associated with allergic rhinitis, where allergens trigger an inflammatory response in the nasal passages, leading to swelling and mucus production.

2. Postnasal Drip: The sensation of mucus running down the back of your throat can cause throat irritation and a persistent cough. This is common in both allergic rhinitis and sinusitis.

3. Throat Irritation and Dry Cough: This can be a result of postnasal drip irritating the throat or could be exacerbated by GERD, where stomach acid irritates the esophagus and throat.

4. Headaches and Dizziness: These symptoms can occur due to sinus pressure from nasal congestion or could be related to dehydration or other factors.

5. Gastroesophageal Reflux Disease (GERD): The presence of GERD can indeed make you more susceptible to throat irritation and coughing, especially if acid reflux is causing inflammation in the throat.

Potential Diagnoses
1. Allergic Rhinitis: This is characterized by nasal congestion, sneezing, and postnasal drip. It can be triggered by environmental allergens such as pollen, dust mites, or pet dander.

2. Chronic Sinusitis: If your nasal symptoms persist for more than 12 weeks, it might indicate chronic sinusitis, which can also cause postnasal drip and throat irritation.

3. Chronic Pharyngitis: This condition involves inflammation of the throat that can be caused by irritants, allergies, or infections.

4. GERD: As you mentioned, the presence of GERD can lead to throat irritation and coughing, especially when lying down or after meals.

Management Strategies
1. Allergy Management: If allergies are suspected, consider using antihistamines (like loratadine or cetirizine) to help alleviate nasal symptoms. Nasal corticosteroids (like fluticasone) can also be effective in reducing inflammation in the nasal passages.

2. GERD Management: To manage GERD, lifestyle modifications are crucial. This includes avoiding trigger foods (spicy, fatty, or acidic foods), eating smaller meals, and not lying down immediately after eating. Over-the-counter medications like proton pump inhibitors (PPIs) or H2 blockers can also help reduce stomach acid.

3. Hydration and Humidification: Staying well-hydrated can help thin mucus and reduce throat irritation. Using a humidifier at night can also help keep your throat moist and alleviate coughing.

4. Avoiding Irritants: Stay away from smoke, strong odors, and other environmental irritants that can exacerbate your symptoms.

5. Throat Care: Gargling with warm salt water can soothe throat irritation. Additionally, lozenges or throat sprays may provide temporary relief from throat discomfort.

Conclusion
Given your symptoms and the fact that you have GERD, it is indeed possible that your throat irritation and cough are exacerbated by both allergies and acid reflux. It would be beneficial to follow up with an ENT specialist or a gastroenterologist for a comprehensive evaluation and tailored treatment plan. They may recommend allergy testing or further investigations to rule out other conditions. In the meantime, implementing the management strategies mentioned above can help alleviate your symptoms and improve your quality of life.

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