American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication is the first-line therapy for treating upper airway cough syndrome due to allergic rhinitis?

1. Antihistamines

2. Intranasal glucocorticoids

3. Oral steroids

4. Otological drops

The correct answer is: Intranasal glucocorticoids

Intranasal glucocorticoids are recognized as the first-line therapy for treating upper airway cough syndrome that arises due to allergic rhinitis. This choice is based on the underlying pathophysiology of allergic rhinitis, which involves inflammation of the nasal mucosa in response to allergens. Intranasal glucocorticoids effectively reduce this inflammation, leading to improved nasal airflow and decreased post-nasal drip that often contributes to coughing. These medications work by reducing the release of inflammatory mediators, thus alleviating symptoms such as nasal congestion, sneezing, and rhinorrhea, which are all associated with allergic rhinitis. Clinical guidelines frequently recommend intranasal glucocorticoids due to their efficacy in controlling both nasal and associated respiratory symptoms. Antihistamines, while useful for managing symptoms of allergic rhinitis, primarily target histamine-related effects and may not address the underlying inflammation as effectively as glucocorticoids. Oral steroids could potentially be effective in severe cases, but their long-term use is associated with significant side effects, making them less desirable as a first-line option. Otological drops are not indicated for cough symptoms arising from upper airway conditions. Therefore, intranasal glucocorticoids represent the best choice