The approach to pediatric cough.

OBJECTIVE: To provide an overview of pediatric cough, with specific emphasis on various causes, to aid in diagnosis and treatment. DATA SOURCES: Relevant articles and references published between January 1, 1961, and May 1, 2009, were found through a PubMed search using the following keywords: pediatric cough and cough in children. STUDY SELECTION: All key relevant articles and textbook sections were reviewed, and the most relevant were selected for inclusion in this review. RESULTS: Although asthma, gastroesophageal reflux disease, and postnasal drip can be causes of cough in children, it is important to think of other potential causes, such as bronchitis, postviral cough, and foreign-body inhalation. Testing and treatment for cough will vary, depending on the presentation and diagnosis. Just as in adults, in children, the cause of cough can be multifactorial. CONCLUSIONS: Pediatric cough is commonly encountered by primary care physicians and allergists. Physicians should be aware of the various potential causes of cough in children to properly determine the cause so that testing and treatment can proceed appropriately.

Habit cough.

OBJECTIVE: To review habit cough and its treatments to raise awareness of this condition as a potential cause of chronic cough. DATA SOURCES: Relevant articles and references published between January 1, 1962, and April 30, 2008, were found through a PubMed search using the following keywords: habit cough, psychogenic cough, chronic cough, and tic cough. STUDY SELECTION: All key relevant articles were reviewed, and the most relevant were selected for inclusion in this review. RESULTS: Habit cough is a diagnosis of exclusion and can occur in children and adults with chronic cough. Characteristic features of habit cough include a loud honking or barking cough, disruption of normal activities, and the frequent presence of a secondary gain (such as school absence). Successful treatment has been described in several case reports and involves mostly nonpharmacologic measures. CONCLUSIONS: It is important to consider habit cough in the differential diagnosis of chronic cough because early diagnosis can help to avoid unnecessary invasive procedures and potential iatrogenic complications.

Taming chronic cough.

OBJECTIVE: To review the available evidence on treating chronic cough to relay a thoughtful, evidence-based approach for the diagnosis and treatment of chronic cough. DATA SOURCES: MEDLINE, PubMed, EMBASE, and CINAHL were searched using the following keywords: cough, asthma, gastroesophageal reflux, sinusitis, rhinitis (allergic, seasonal), postnasal drip, vocal cord dysfunction, lung disease (interstitial), bronchiectasis, and bronchoscopy. STUDY SELECTION: Studies were selected based on their relevance to the diagnosis and treatment of chronic cough. Because of a lack of randomized prospective studies, nonrandomized and retrospective studies were considered, with their strengths and limitations noted. RESULTS: Few randomized controlled trials have addressed the diagnosis and treatment of chronic cough. There are several prospective noncontrolled trials for adults with chronic cough that found a high percentage of cough resolution when using an approach that focused on the diagnosis and treatment of the most common causes: asthma, gastroesophageal reflux disease, and upper airway cough syndrome. Preliminary studies in children support an approach that distinguishes between a wet and dry cough, as well as an in-depth investigation of any specific symptoms that point to an underlying chronic illness. CONCLUSION: Allergists, as experts in treating upper airway and lower airway disorders, are uniquely poised to diagnose and treat chronic cough.

Management of occupational allergy to natural rubber latex in a medical center: the importance of quantitative latex allergen measurement and objective follow-up.

When our employees began coming to the Occupational Health Service, Dermatology, and Allergy Clinics with symptoms of allergy to rubber gloves 12 years ago, the Mayo Clinic initiated 3 responses. (1) The Allergic Disease Research Laboratory adapted well-established technology to measure both the IgE antibody specific to natural rubber allergens, and by use of this IgE antibody, the allergens in rubber products and in the air of the workplace. (2) The Division of Allergic Diseases and Internal Medicine reviewed the prevalence and severity of the problem. (3) The Clinical Practice Committee appointed a multidisciplinary task force to implement measures to reduce exposure. The 3 sections of this article describe the Mayo Clinic's experience of successful control of this occupational health problem. Use of only gloves with low or undetectable allergen content greatly reduced the concentration of allergen in the work site, reduced the number of new cases of occupational allergy to rubber, and allowed individuals with latex allergy to work at their usual jobs.