CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement

Raymond J Mullins, Constance H Katelaris and Janet Rimmer
Med J Aust 2010; 192 (11): . || doi: 10.5694/j.1326-5377.2010.tb03681.x
Published online: 7 June 2010

To the Editor: We read the article by Gibson and colleagues on the assessment and management of cough1 with some concern, specifically regarding the authors’ classification of levels of evidence for current therapies for allergic rhinitis. We would agree that a trial of antihistamines, intranasal corticosteroids and allergen immunotherapy is unlikely to help non-specific cough in the absence of allergic rhinitis. This consensus should be distinguished from the beneficial impact of these modalities on symptoms of allergic rhinitis, for which the authors misquote their main source of information2 and suggest that evidence of benefit from these is “weak”. Although evidence of benefit from allergen avoidance to help manage allergic respiratory disease is controversial,3 a large number of double-blind placebo-controlled trials of all other modalities show Level I evidence of benefit and category A strength of recommendation specifically for treatment of allergic rhinitis, as recently reviewed2,4-6 — evidence consistent with “strong” recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.7 We do our patients and colleagues a disservice to suggest otherwise.

  • 1 Health Sciences, University of Canberra, Canberra, ACT.
  • 2 Medical School, University of Western Sydney, Sydney, NSW.
  • 3 St Vincent’s Hospital, Sydney, NSW.

Competing interests:

Janet Rimmer has been on drug advisory boards for Novartis and GlaxoSmithKline and has received reimbursement for travel/accommodation expenses from Schering Plough. She has also received institutional support from Novatech, Novartis, GlaxoSmithKline and Schering Plough for clinical trials work. Constance Katelaris has been on drug advisory boards for GlaxoSmithKline and Nycomed and received reimbursement for travel/accommodation expenses.

  • 1. Gibson PG, Chang AB, Glasgow NJ, et al. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement. Med J Aust 2010; 192: 265-271. <MJA full text>
  • 2. Wallace DV, Dykewicz MS, Bernstein DI, et al; Joint Task Force on Practice; American Academy of Allergy; Asthma & Immunology; American College of Allergy; Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol 2008; 122 (2 Suppl): S1-S84. Erratum in J Allergy Clin Immunol 2008; 122: 1237.
  • 3. Platts-Mills TA. Allergen avoidance in the treatment of asthma: problems with the meta-analyses. J Allergy Clin Immunol 2008; 122: 694-696.
  • 4. Scadding GK, Durham SR, Mirakian R, et al. British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38: 19-42.
  • 5. Calderon MA, Alves B, Jacobson M, et al. Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev 2007; (1): CD001936.
  • 6. Canonica GW, Bousquet J, Casale T, et al. Sub-lingual immunotherapy. World Allergy Organization position paper 2009. World Allergy Organiz J 2009; 2: 233-281.
  • 7. Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations. BMJ 2008; 336: 1049-1051.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.