Chronic Cough from more than 8 months for a 4yr old

Hi,

We went to my son physician again for the same problem. He also suggested to continue 'Zyrtec' for few more months. He also mentioned not to worry about using 'Zyrtec' for long time as it will not reach brain.

We were keep asking the reasons for the cough and he mentioned it could be due to high levels of 'histamine' in his body. It is hard to identify exact reason for 'histamine' but it can go over the period is what he mentioned. 'Zyrtec' can stop or disable the impact of 'histamine' in body. He also mentioned that 'Zyrtec' cannot control other issues like if any problem in lungs or so if that is the reason for the cough. As cough is getting controlled by 'Zyrtec' only, he said 'histamine' could be the problem.

Need your help in understanding more about 'histamine'.

@windwalker @pfists @jenblalock @g3smith60 @kaystrand @irene5 @bassman

Some very common allergens that make our little ones release histamine are: pillows that are not covered by an allergy proof, zippered covering, mattress, box springs, same thing. All collect dust. Curtains, bedspreads, rugs, carpet. All collect dust mites.

Peanuts and peanut butter, eggs, strawberries, wheat products, fish. You could try keeping a food diary for your little one. To give a daily account of the foods he eats. Sometimes this helps your Pediatrician figure out what allergies to test for.

I myself am not only allergic to common foods, but trees, grasses, plants....the list goes on and on. At some point He or She will want to test your little love for allergies

Good luck! Take good care and let me (and us) know how you are doing.

Mamacita

@krishnareddy84 - Wow, that's surprising that his allergy skin test was negative for everything. I believe (although I'm not an expert by any means) that that might indicate his issue may be more infectious or immunological. Here's some things to consider:

1. Home remedies to at least help relieve symptoms: Two thumbs up to @mamacita's suggestion of investing in an allergy-specific mattress cover and pillow protectors (look specifically for a mattress/pillow encasements for the most complete protection; I looked at this one -- https://amzn.to/2NINiT7 -- because it includes a zip-off top to allow you to wash it often and easily, also important for allergy control, and it would be a good fit for you as it's also supposed to be waterproof for any bed-wetting incidents). You may wish to try a humidifier, especially being in Houston's dry air (just be sure to clean it fairly frequently/weekly to prevent any sort of mold/bacterial growth) and/or air purifier (HEPA filters are often recommended for those with allergies/asthma, both in an air purifier and in your vaccuum). Check with your apartment complex to verify when your air filter was last replaced (unless the system is in your apartment that you can check it yourself), and consider asking if you could replace replace the generic cheap one that's likely in there with a HEPA/allergy emphasis model.

2. I second the note about testing his eosinophils/basophils; if he hasn't already he should have a CBC (complete blood count) and CMP (complete metabolic panel) done. I would also suggest asking about having his tryptase levels tested as a possible early manifestation of some type of mast cell activation disorder, which is where your body overreacts to a variety of triggers, and not always the same ones (read more about tryptase at https://labtestsonline.org/tests/tryptase); a 24-hour urine histamine test can also give an idea of his levels over a longer period of time (note, you'll want to check about how Zyrtec might affect the results of these tests). You might also ask about a trial of Singulair instead of and/or in addition to the Zyrtec; it treats for allergies/asthma in a different way.

3. I also recommend requesting a referral to an immunologist to explore some type of immune deficiency/issue (note this is different than a rheumatologist/autoimmune issues); you'll want to ask about testing his immunoglobulins, particularly IgE and IgA if he hasn't been already (learn more at https://labtestsonline.org/tests/total-ige and https://labtestsonline.org/tests/quantitative-immunoglobulins). Ask also about a pneumococcal serotope blood test, which can help identify either a recent/current pneumonia infection, a general immunodeficiency disorder or a selective antibody deficiency (learn more at https://www.merckmanuals.com/home/immune-disorders/immunodeficiency-disorders/selective-antibody-deficiency-with-normal-immunoglobulins).

4. Check and find out if he's current on his vaccinations to make sure he's not at risk for something like pertussis (the immunologist will also want/need to know this for the tests above), and/or whether he's had any vaccinations recently that he may be slightly reacting to (very rare).

5. A referral to an ENT (ear, nose and throat doctor) may provide insight, especially if there's some kind of structural issue at fault. He/she may order a CT of the face and sinus and examine your son's tonsils.

6. If none of the above provide any answers/relief, next up would be a check with an infectious disease specialist to rule out something like some sort of fungal infection like blastomycosis or, on the more unlikely end of the spectrum, TB. He or she may want to do a sputum test as mentioned by someone else, and/or a chest x-ray or CT scan.

That's all I can think of at the moment, but feel free to keep us posted on any results that might prompt new possibilities. Your son is very lucky to have you as his advocate; I wish you both the best of luck and happier health soon.