Allergic coughing

By Tedler D. Depaynos, MD

The patient together with his relatives grew up in a mining community. He inherited his mining claims from his father and digging and processing the precious metals they dug out has always been his job. Despite the exposure to the chemicals used he never had any problem until now that he is about to be a senior citizen. Actually his adjacent relatives who grew up with him are having the same problem. They have always chronic coughing which they noticed to be dry and from time to time they could feel themselves wheezing with difficulty of breathing. Initially they thought this was mainly due to their smoking habits which they replaced by chewing beetle nut but their coughing problem was worsening. They have been consulting the MDs near their jeepney station which dispensed their medicines but their relief was just temporary. Perhaps because of the numerous patients, the consulted MD did not have time to explain to them that their coughing was due to their chemical exposure.
Another patient who was a super store accountant takes the jeepney plying their barangay practically daily which was very convenient. Despite the daily exposure to the fumes emitted by the running vehicles she never felt anything except some irritation in the eyes as well as in the throat from time to time. Because she enjoys cooking, she does her major marketing every weekend personally and again despite the heavy load of vegetables, fish, etc. and unavoidable exposure to the vehicle fumes, she never had any major health problems. Actually, she retired from her super store job after more than two decades of work without any significant medical problems.
Recently while over the street over pass carrying her marketed goods, she suddenly complained of difficulty of breathing with wheezing respiration. It was her first time to feel the dreadful attack and she nearly collapsed with transient dimming of her vision. Although the occurrence was just few seconds she was so afraid because it was her first time to experience such. It made her mummer prayers while she was trembling continuously even when she got inside the taxi she took going home.
On retrospect, she recalled that the event occurred when she was suddenly exposed to the fumes of a heavy diesel truck which was apparently speeding to beat the traffic lights. Since then, she noticed herself to be sensitive to the vehicular exhaust fumes which apparently was becoming worse resulting in episodes of chronic dry coughing sometimes lasting for many weeks. In a way, she was happy that she already retired or else she would be irritating her co-employees. She was also wondering openly when the young traffic enforcers who sometimes appeared like they were somebody and were exposed daily to the same exhaust pollution while doing their job would experience the same. She could not imagine their lungs to be soon as dark as the walls of the cemented mid barrier in the streets planted with flowers.
Actually it seems that this is now the common observation. The things you were never allergic to when you were much younger are the cause of your allergic problems now that you have aged. In short, you might have been getting more sensitive as you reached your retirement years. The problem now is how to avoid them.
A coffee mate low profile lawyer was once relating his sudden experience while driving his new top of the line SUV. The cold air from his air con which was directed to his arms while driving was always refreshing. In one of his long drives, he suddenly experienced itchiness in his arms which he tried not to entertain. When the irritation became worse he noticed his arms to be reddish and apparently swollen. He said that he could now even write his name on his more swollen left arm using his right forefinger. This incident became a routine whenever he goes on long drives with his air con open. He said he was never allergic to cold and to think that he was born and practically grew up here in Baguio. He was diagnosed to have skin asthma when he was forced to consult doctors at St. Lukes Hosp. where his condo unit is located. Jokingly we asked if we could borrow his SUV to see if we would also experience the same.
Despite the prescribed medicines which he took from time to time, his sensitivity to colds worsened. He later easily manifested running nose and dry coughing which became irritating not only to him but to his coffee mates. Relief with his prescribed meds always took time especially during the cold months.
Some younger medical practitioners claim to have encountered various patients suddenly allergic to their favorite foods especially chicken and crabs. One could imagine the host of these patients feeling snubbed and frustrated if they failed to touch those mouth watering delicacies served during special occasions.
With this common trend, experienced doctors always include allergy as a cause of continuous colds or dry chronic coughing which may even last for weeks or even months and frequently recurring. In general, cough due to viruses last only for 3 to 5 days with or without supportive care depending on the resistance of the patient. It may last longer with super imposed bacterial infection. The cough would then become productive with yellow, green or blackish sputum and sometimes foul smelling. Treating the bacterial infection with proper antibiotics will usually relieve the patient.
Allergic coughing is described as irritating, non-productive and sometimes accompanied by wheezing respiration. Bacterial infection may also be superimposed but its successful treatment will not relieve the patient unless the allergic reaction will also be treated.
Hence, aside from treating the infection, treatment of the allergy is a must. Depending on the severity of the condition, antihistamines, steroids, bronchodilators and nebulizations are basically prescribed. For patients who have difficulty getting relieved with the basic medicines, better consult a pulmonologist. You may have a more serious pulmonary condition.
To avoid the allergic attacks, one must know and avoid the factors causing the allergy which may sometimes be impossible. One could perhaps migrate to a warmer place, give up processing precious metals or avoid riding jeepneys with uncontrolled exhausts by buying a new car. In young patients, the cause may be obvious but in elderly ones who just developed their allergy, it maybe not. They become hard headed and may even insist that they have no known allergy!
Taking anti-histaminics may prevent and control simple allergic manifestations like itchiness and patchy skin swelling. In one medical forum, a young lady graduate of our medical school who later specialized in allergy lectured to us that the newer forms of anti-histaminics can and should be taken continuously for not less than 3 weeks for more lasting treatment. Hence, consult your doctor. **