My 3 year old son has rhinitis allergies and cough variant asthma. He currently takes singulair, allegra 2x daily, pulmicort 2 x daily, and xopenex as needed. With all this being said he still continues to get sick every 2 weeks. he wakes up with a fever and then has a persistant phlegmy cough that lasts a week. Can anyone help me with some ideas on how to control the cough? The specialists he sees are running out of answers.

Dr. Greene’s Answer:

Even stubborn, chronic allergies and asthma can often be brought under control. Marie, it sounds like you and your son have both been through quite a lot. He’s on a powerful arsenal of medications and already under the care of specialists.

With allergies and asthma causing this much trouble, I’m a big fan of allergy testing to identify the specific offending allergen(s), to be able to be smart about reducing exposure to the triggers, and perhaps to treat those allergies specifically. One of the biggest risk factors for asthma is being sensitive to indoor allergens, such as dust, mites and increased exposure in homes1.

Whether or not something specific is identified, when the symptoms are in the nose, lungs, and the rest of the respiratory system, the problem is usually something in the air. A powerful study published in the New England Journal of Medicine2 looking at 1000 kids with asthma serious enough to hospitalize them or send them to the ER on more than one occasion. They found that taking control of the air in the home was as powerful as steroid medications. Those kids had 34 fewer days with symptoms than their peers.

A mold problem in the home is something to consider.

Treatment alternatives for the Symptoms

For nasal allergies, I like Ortho Molecular D-Hist Jr, which uses quercetin, stinging nettle N-acetyl cysteine, and bromelain to reduce the allergic response and reduce phlegm.

For cough variant asthma I like traditional Chinese medicine herbs, such as Kan Herbals Deep Breath. The NIH Center for complementary and alternative medicines has published a statement on these herbs3 that the preliminary evidence for using these herbs is promising, with all the studies showing positive results.

At Stanford, my colleague who was across the hall from me for years, pulmonologist John Marks, MD, has had success with mind-body relaxation techniques in kids, such as massage or guided imagery — sometimes being able to reduce the over-active immune response enough to get kids with asthma off of controller medicines.

Both honey and dark chocolate can be powerful at reducing coughs. The dark chocolate contains a compound similar to theophylline, an asthma drug we quite using, in part, because we had to keep drawing blood tests to be sure the dose didn’t get too high. You don’t have that problem with food.

Speaking of food, how kids eat can have a major impact on asthma symptoms. If they’ll eat that way, a Mediterranean diet such as this has been much-studied and can be a great choice.

With your son’s complex medicine regimen, Marie, you’ll want to discuss any new supplements or remedies with his specialists, though clean air and healthy food are good for any child with allergies and asthma.

Finally, for my own family, I like to brew a cup of Traditional Medicinals Organic Chamomile tea to relax, loosen the phlegm and help calm the cough. It’s a simple, comforting choice you can share.


  1. Peat JK, Tovey E, Toelle BG et al. House dust mite allergens. A major risk factor for childhood asthma in Australia. Am J Respir Crit Care Med (1996) 153(1):141.
  2. Morgan WJ, Crain EF, Gruchalla RS et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med (2004) 351(11):1068-80.
  3. Li X-M, Brown LV. Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and allergy. Journal of Allergy and Clinical Immunology (2009) 123(2):297-306.

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