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Q. What's the difference between allergies and asthma?

A. Allergies are an immune system response, or oversensitivity, to an environmental "trigger" (known as an allergen), such as pollen, dust, mold, pet dander or certain foods, to name a few. Signs of an allergic reaction include frequent or regularly recurring itchy eyes, nose, mouth or ears, sneezing, a runny nose, dry skin or hives, a productive cough, wheezing or tightness in your chest. Allergies can trigger an asthma attack; however, asthma is present in some people without allergies.

Asthma involves inflammation of the lungs that constricts the muscles around your airways, resulting in chest wheezing, coughing and shortness of breath. The bronchial tubes tighten and air flow is reduced as the lungs expand. While allergens provoke most asthma attacks, other triggers include smoke, cold or humid air, strong odors, and strenuous exercise.

Allergies and asthma are treatable and the first step is proper diagnosis to pinpoint the source of your symptoms. An allergist is a specialist in diagnosing and treating allergies and asthma.

Q. What's the best way to find out what I'm allergic to?

A. See an allergist, a physician with additional, specialized training to diagnose, manage and treat allergies and asthma. The doctor will review your health history, give you a physical exam and administer any necessary tests to identify the substances to which you are allergic. Skin tests, for example – a method sensitive to even subtle allergies and which involves exposing your skin to small amounts of allergy – causing substances and watching for reactions – can identify the cause of your suffering and put you on the road to relief.

Q. How do you tell the difference between a cold and allergies?

A. The biggest clue in deciding whether symptoms like sneezing or a runny nose are a cold or allergies is how long they last. A cold normally lasts about a week, but allergies can last for several weeks or longer—depending on what you are allergic to and how often you are exposed to it.

Other differences include some of the symptoms. While both can cause a runny or stuffy nose, sneezing and wheezing, you are more likely to have itchy, watery eyes with allergies and get a fever or body aches with a cold. Another clue is your runny nose. If it's clear, it's usually related to an allergy and not an infection.

Q. I’m getting ready for my first job. I have asthma, I’m very allergic to mold, and the job is in an old office building. What precautions should I take, and what do you recommend I discuss with my employer about my asthma?

A. Everyone with asthma and allergies should be able to live a normal life free of symptoms. And if they’re on the right medicines, they should be able to do anything they want to do, including working in any environment.

Consider first seeing an asthma specialist to make sure your asthma is well controlled and your lung function is normal – before you start the job.

When you're starting a new job and are worried about mold allergy, you may want to ask during the interview process to actually see where they will work. It’s not unreasonable to ask the prospective or new employer to look at the work site. If there’s a problem, ask if there’s an opportunity work in a place that is less moldy. For example, telecommuting may be a possibility.

If the workplace is in an old historic building, the employer may not be able to do very much about mold. It’s difficult to completely eliminate all mold, and it can be expensive to hire a professional contractor, especially for a small business. Mold could be inside air supply ducts, in wall cavities, across ceiling tiles or underneath damp carpets.

Certainly mold removal is something to discuss with your employer. But if little can be done, then you may want to think about working somewhere else.

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.

Q. I have a negative reaction to most public pools: I can’t stand the smell, and I get red eyes and a runny nose. I don’t have any trouble breathing, but the smell of the chlorine is intolerable to me. Some pools, especially outdoor pools, do not cause this reaction. My regular physician says this is a sensitivity issue. Is there a test I can have done to confirm whether this is an allergy or not?

A. Public swimming pools that use chlorine or bromine as disinfectants may be associated with upper and lower respiratory symptoms, as well as skin irritation.

A recent study of swimmers who practiced in indoor chlorinated swimming pools showed that these athletes developed early inflammatory changes in their lower airways consistent with mild asthma. Regular swimming in indoor pools increases the risk of developing asthma among adults.  

It is likely that higher concentrations of chlorine are generated in indoor pools, compared with outdoor pools, due to inadequate ventilation of chlorine vapors.  For pool caretakers, improving ventilation and using disinfectants other than chlorine and related chemicals may prevent these health effects.

For swimmers experiencing a chlorine sensitivity, your allergist can conduct testing to help determine the underlying cause and recommend 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. 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.