Nasal Allergies in Children can Cause Cough

DEAR DR.PAUL: My 6 year old son keeps coughing in the morning and when he lies down.
He did not get better with asthma puffers and his doctor says this might be allergies. Is this
possible?

DR.PAUL ANSWERS: : Cough is a very common symptom in children, and it has more
than one cause. Obviously you are referring to a cough that is chronic, in other words either
lasts for long periods of time or keeps on coming back. This pattern distinguishes it from a
cough due to the common cold or flu. The other possibility that you mention is asthma.
Asthma is defined as a condition with repetitive episodes of cough and/or wheeze and/or
shortness of breath. Among asthmatic children, 5% will have cough as their only symptom.

It is clear that we are not dealing with asthma as the main cause of your child's symptoms.
Your doctor, I think, correctly talked about allergies. Nasal allergies known as "Allergic
Rhinitis" in children can present in a variety of ways. The obvious symptoms of a nasal
allergy include nasal congestion, a runny nose and post nasal drip. However, many are
surprised to learn that in children, a persistent or recurring cough can be the main or only
symptom of a nasal allergy. I am not suggesting that all children with nasal allergies cough
nor am I suggesting that nasal allergies are the only cause of a cough in kids. However in
this situation we have to think of nasal allergies causing your child's cough. Here are some
helpful distinguishing features of a "Nasal Allergy Cough":

 A " Nasal Allergy Cough" usually worsens when there is a body change position. For
example upon lying down or getting up in the morning. Once the child is asleep, the cough
usually stops. An asthmatic cough usually occurs in the middle of the night after a child has
fallen asleep.

 A "Nasal Allergy Cough" can occur with exercise. The nasal cough tends to occur at the
beginning of the activity whereas an asthmatic cough tends to occur towards the end or
after physical activity.

 A "Nasal Allergy Cough" does not improve with asthma puffers, but may get better with
antibiotics. In some case there nasal secretions become infected resulting in a sinus
infection, making the cough worse. Antibiotics in this circumstance will make the cough go
away or improve but have no effect on asthma.

How do we diagnose a nasal allergy in children? First, we need to be aware that children can
suffer from nasal allergies too. Specifically, by looking for the features mentioned above and
examining a child's nose, we can usually confirm the presence of a nasal allergy. A positive
family history of allergies also helps make the diagnosis.

What is the treatment of nasal allergies? This depends on the child's age and specific
situation, but is based on identifying what the child is allergic to and getting rid of it. The
most common causes are dust mites, pet dander, mold, pollens and cigarette smoke. In
terms of medications, this ranges from antihistamines taken by mouth to the very effective
cortisone based nasal sprays.