Chronic Dry Cough in Allergic Respiratory Diseases: Diagnostic and Management Approach.

Cough is considered as a single most common complaint for which patients globally seek medical attention. A multitude of allergic etiologies contribute to the development of chronic cough in adults, which makes the diagnosis and treatment quite challenging. Allergic cough is a distinct entity where there is no respiratory obstruction and there is presence of a family history, past history and/or concomitant allergic conditions. Sensitivity to allergens is readily demonstrable by skin testing. It is also characterized by a therapeutic response to epinephrine and a periodic nature. The intention of this article is to highlight the common causes of chronic dry cough associated with allergic diseases, to differentiate allergic cough from various other causes of chronic cough associated with asthma syndromes (which include related airway disorders like ‘classic’ asthma [cough-variant asthma], nonasthmatic eosinophilic bronchitis and atopic cough) and to discuss its management strategies.

An unusual case of invasive aspergillus ulcerative tracheobronchitis without involvement of lung parenchyma in a post-renal transplant patient.

We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.