Ask Dr. Paul Library
"Tickle in the throat"- may be a sign of allergies
DEAR DR.PAUL: My 5 year daughter has a tickle in her throat that starts about the end of September and then turns into a cough or a constant clearing hack and her nose is constantly plugged. I think she has is the mucus from her sinus passage but the doctors say no. What can this be?
PEDIATRICIAN DR.PAUL ANSWERS: This is one of the most common problems I see in children less than eight years of age. The key here is the specific description of your daughter's symptoms and their timing. First of all, the fact that this occurs each year at the same time prompts me to suspect a seasonal allergy. September is usually ragweed season, which could explain the symptoms. Typically, the symptoms correlate with the ragweed pollen season which, usually ends with the coming of the cold weather in October, (depending, of course, where you live in North America).
Having said that, let's focus on the symptoms. They provide important clues. When you mention a tickle in the throat, it usually means a "post nasal drip". In other words, there are secretions (mucus) that drip into the throat area from the back of the nose. This tickle can cause frequent throat clearing, or it can often cause a chronic cough. Because the cough is due to mucus in this area, the cough is often described as a moist or wet cough. Also, although this type of cough can occur at any time of the day, it typically occurs when a child lies down or gets up from bed. Not surprisingly then, parents often report the cough to be worse at bedtime and in the morning. The reason? Well, when we lie down, the secretions tend to trickle down into the throat more, resulting in a cough. I frequently see such children whose parent's fear that their child has asthma. One way to differentiate between a post nasal drip cough and asthma induced cough is timing. Usually an asthmatic cough occurs in the middle of the night as compared to the distinct typical timing of the post nasal drip cough which we've just described.
What about treatment? As always, the treatment depends on the cause. In the case of an allergic-based postnasal drip, there may also be nasal congestion or a constantly runny nose. The presence of nasal symptoms even more confirms a diagnosis of an upper airway (meaning the nose and area behind it) allergy. Assuming that we have proven a ragweed allergy, we focus on trying to limit exposure to the ragweed pollen, and possibly using medications, depending on the individual situation. The medications can range from antihistamine pills or syrups taken by mouth, to nasal sprays containing small amounts of steroids. One of the questions that many parents ask me regarding mucus accumulation in the nose and throat area is does milk consumption cause or increase mucus production? To my knowledge, there are no studies that have confirmed this notion.