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Q. At present we are having work done in our house. The dust is causing my partner to have breathing troubles, but he insists he is fine and will not seek advice or support from our general practitioner. He wheezes badly, but says that Vicks and lozenges will help him. It has been going on for months and I am concerned for his health. What is your advice to him?

A. Depending upon the age of the house, renovation could stir up many allergens and toxins that have been settled for many years. These may include mold, dust mites, and asbestos, among others.

If your partner does not have a history of asthma and/or environmental allergies, reactive airway disease could be responsible for the symptoms he is experiencing. Common symptoms of asthma include breathlessness, wheezing, cough, and chest tightness.

If your partner has not experienced similar symptoms in the past, and the timing of his symptoms relates with the work being done on his home, a first step would be to minimize his exposures within the home. This can be accomplished by either not being in the home while work is being done or wearing a respirator or N95 face mask while in the building.

It is also possible that your partner has asthma and his symptoms coincidentally appeared at the time of the renovation, without a direct cause and effect relationship. His allergist may want to conduct a pulmonary function test. If your partner has asthma, his treatment will be based on the severity and frequency of his symptoms.

Treatment for severe, irregular episodes typically involves use of a short-acting inhaled beta agonist. If symptoms persist and/or worsen, his allergist will likely recommend ongoing tailoring of his medications.

Your partner should discuss his symptoms and potential strategies for diagnosing and managing his symptoms with his allergist.

Q. I have hives, and have been to an allergist, but haven't been able to determine a cause. I have Hepatitis B - could my hives be related to that?

A. Unfortunately, many patients who struggle with urticaria (or hives) are unable to discover a cause.

Urticaria has been reported in association with a wide variety of viral illnesses.  It is certainly possible that your urticaria could be related to Hepatitis B infection. It is also possible that your urticaria is not related to Hepatitis B infection.

Acute urticaria has been observed in the early stages of Hepatitis A, B, and C infection.  There is a 2012 case report published in the medical literature of a patient with chronic urticaria following an acute infection with Hepatitis A.  

Your allergist can help with personalized recommendations and strategies for your evaluation and treatment.

Q. have mold allergies. Which nonprescription drugs are good to relieve headaches?

A. Many headaches can be relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Acetaminophen also is a good choice. Avoid using opioids to relieve headaches.

A more important question is, what causing the headache? There are several potential causes of for headaches. I recommend you see your physician for evaluation.

Common causes of headaches are migraine, tension and sinus headaches. Migraines are neurologic headaches. They often have an aura, such as a sense of nausea, shimmering lights, dizziness or other sensations that provide a warning that the headache is coming on. This early set of symptoms is call a prodrome.

Tension headaches are caused by stress. There is some controversy over whether tension headaches actually exist, since many are actually migraine headaches. Tension headaches are frequently treated with NSAIDs as listed above.

Allergies are a rare cause of headaches, though certain foods containing tyramine or phenylethylamine, such as chocolate or fermented cheeses, can induce headaches.

Sinus headaches don’t really occur in the head. A sinus headache is usually manifested as pain over the face, particularly the cheeks and forehead. Pain in the teeth is also common with sinus headaches. If you have these symptoms, particularly if you also have yellow-green nasal drainage, congestion and postnasal drip, you should see your doctor as soon as possible.

Q. Can mold on corn used to make chips like Doritos and Fritos cause severe allergic reaction?

A. Not much is known about gastrointestinal or systemic allergic reactions when inhalant allergens are ingested. There are rare case reports of adverse reactions attributed to dust mite in mite-infested flour.

Based on pure speculation, a fungal allergen on corn would likely be broken down by the heat in the processing and baking of the product made of the corn flour. Without knowing the specifics of the mold in question, it is not possible to look up the effect of heat and processing on a particular mold.

However, it may not be generally healthy to eat food made of flour that was subjected to the unhealthy conditions that made it become moldy. It is very likely that food made from moldy ingredients would not be very palatable either.

Q. Just like there are different levels of eye doctors -- optometrist, ophthalmologist, eye surgeon, etc. -- what are the different kinds of allergy doctors, and which one would be considered the most knowledgeable?

A. Members of the specialty of Allergy/Immunology are physicians who are specifically trained to diagnose and treat patients who have asthma, allergic and immunologic diseases. Within the profession, there are certainly physicians with interest and expertise in specific areas of the field. If your allergist is certified by the American Board of Allergy and Immunology, you can be certain that he or she has completed a three-year residency program in internal medicine or pediatrics and an additional two or three years of study specifically in the field of allergy and immunology.

Q. Who should have vitamin D blood tests?

A. Presently, it is not recommended that all individuals have annual vitamin blood tests. However, it is appropriate for certain subsets of the population to have routine assessment of vitamin D levels. It is appropriate to determine vitamin D levels in the following individuals:Q: How often should vitamin D levels be checked? A: An annual baseline vitamin D level is considered to be appropriate for the above individuals. If the vitamin D level is low, then a vitamin D supplement should be started and the vitamin D level should be re-checked in 6 to 8 weeks. If the vitamin D blood level has risen to normal, then the vitamin D supplementation should be continued with annual or semi-annual assessment of vitamin D levels.Q: What is considered to be an optimal vitamin D level?A: The current parameters defining normal vitamin D levels are based on maintaining normal calcium-bone-phosphate homeostasis. There is no universal agreement on what vitamin D levels are ideal in all individuals in all age brackets. The most commonly accepted vitamin D level parameters used by most reference laboratories in the United States are those developed by the Endocrine Society. Whether these cut points represent vitamin D levels for optimal immunomodulatory, antimicrobial, and paracrine function is unknown at this time and is an area being intensively researched. The Endocrine Society has defined the following serum vitamin D-25-hydroxy parameters:References: