D1.58 - “Evaluation of Chronic Cough in Patients with Allergic Disease, GERD, and Chronic Rhinosinusitis”

Chronic cough is a common and challenging clinical problem with a significant impact on quality of life. The primary causes in non-smokers are often attributed to upper airway conditions, asthma, and gastroesophageal reflux disease (GERD). This study aimed to evaluate the prevalence of these conditions in a cohort of patients presenting with chronic cough.

A total of 120 patients presenting with chronic cough were prospectively evaluated. Inclusion criteria were age between 15 and 55 years for both genders. Patients with a known diagnosis of Chronic Obstructive Pulmonary Disease (COPD) were excluded. The diagnostic protocol involved measuring total serum IgE and specific IgE for common aeroallergens (tree/grass pollens, dust mites, molds). All patients were also clinically assessed for allergic rhinitis, chronic rhinosinusitis (CRS), bronchial asthma, and GERD.

An allergic etiology was identified in 79.2% (95/120) of patients, who all showed elevated total IgE levels. Within this allergic cohort (n=95): Allergic rhinitis was diagnosed in 100% (95/95) of patients. Chronic rhinosinusitis was a comorbidity in 86.3% (82/95). This combination of rhinitis and sinusitis represents a form of Upper Airway Cough Syndrome (UACS), a leading cause of chronic cough. Bronchial asthma was present in 25.3% (24/95).

Of the remaining non-allergic patients (n=25), GERD was identified as the cause in 60% (15/25), and non-allergic CRS was diagnosed in the other 40% (10/25). Overall, chronic rhinosinusitis (allergic and non-allergic) was the most frequent single diagnosis, affecting 76.7% (92/120) of the entire cohort. 

Using statistical analisis several associations were detected: 

Association Between Elevated IgE and Allergic Rhinitis-(χ² = 120.0; p < 0.0001); 

Association Between Allergic Rhinitis and Chronic Sinusitis-(χ² = 50.1; p < 0.0001)

Association Between Elevated IgE and Bronchial Asthma-(χ² = 7.89; p = 0.005)

Association Between Normal IgE and GERD-(χ² = 57.1 p < 0.0001)

Allergic disease is a dominant factor in this cohort, with upper airway conditions—specifically the combination of allergic rhinitis and chronic rhinosinusitis known as Upper Airway Cough Syndrome (UACS)—being the primary driver of chronic cough. Chronic rhinosinusitis, in both its allergic and non-allergic forms, was the most common underlying pathology overall. GERD represents the other major etiology, particularly in non-allergic individuals. These findings highlight that a systematic evaluation of patients with chronic cough must include allergy testing and a thorough assessment of the upper airways and esophagus to identify the underlying cause and guide appropriate therapy