What is the treatment for allergic bronchitis?

Treatment of Allergic Bronchitis

The most effective treatment for allergic bronchitis includes avoidance of respiratory irritants, inhaled corticosteroids, and targeted therapy for allergic components with antihistamines and leukotriene modifiers. 1, 2

First-Line Treatment Approach

• Avoidance of triggers is the most effective way to reduce or eliminate cough in patients with allergic bronchitis, including personal tobacco use, passive smoke exposure, and workplace hazards 1
• Inhaled corticosteroids are the cornerstone of treatment for allergic bronchitis with eosinophilic inflammation, significantly reducing eosinophil counts and improving symptoms 2
• Short-acting inhaled β-agonists provide immediate symptom relief and can improve cough in patients with allergic bronchitis 1
• Inhaled ipratropium bromide may improve cough symptoms in allergic bronchitis patients 1

Addressing the Allergic Component

• Second-generation antihistamines (cetirizine, desloratadine, levocetirizine) are effective for treating the allergic component and have been shown to relieve both upper and lower respiratory tract symptoms 1, 3
• Leukotriene modifiers such as montelukast are indicated for both asthma and allergic rhinitis, making them particularly useful for allergic bronchitis with both upper and lower airway involvement 4
• Intranasal corticosteroids may help manage the upper airway component of allergic bronchitis and have been shown in some studies to moderately improve asthma symptoms 1

For Acute Exacerbations

• Oral corticosteroids are effective for short-term management of acute exacerbations but should be limited due to side effects 1
• Antibiotics are only indicated if there is evidence of bacterial infection, as allergic bronchitis is primarily an inflammatory condition 5
• Central cough suppressants such as codeine and dextromethorphan are recommended only for short-term symptomatic relief of coughing 1

Additional Therapeutic Considerations

• Allergen immunotherapy should be considered for patients with persistent symptoms when there is clear evidence of a relationship between symptoms and exposure to specific allergens 1
• Combination therapy with inhaled long-acting β-agonist and an inhaled corticosteroid may improve cough in patients with more severe or persistent allergic bronchitis 1
• Nasal irrigation can be helpful as an adjunctive therapy, especially when upper airway symptoms are present 6

Treatment Based on Severity

For Mild Intermittent Symptoms:

• As-needed short-acting β-agonists and second-generation antihistamines 1, 3

For Persistent Symptoms:

• Daily inhaled corticosteroids as the foundation of treatment 2
• Add leukotriene modifier (montelukast) for patients with both upper and lower airway symptoms 4

For Severe or Refractory Symptoms:

• Consider combination therapy with inhaled corticosteroids and long-acting bronchodilators 1
• Consider allergen immunotherapy if specific allergens are identified 1
• Short courses of oral corticosteroids may be needed for acute exacerbations 1

Important Considerations and Pitfalls

• Avoid using expectorants, postural drainage, or chest physiotherapy as there is no proven benefit for allergic bronchitis 1
• Prophylactic antibiotics are not recommended for allergic bronchitis 1
• Patient education about the chronicity of the condition and realistic treatment outcomes is essential for adherence and optimal results 1
• Monitor for comorbid conditions such as allergic rhinitis, sinusitis, and gastroesophageal reflux that may exacerbate symptoms and require specific treatment 1