Al­lergy to dust mites trig­gers cough

The News-Times - - ADVICE / GAMES - Keith Roach, M.D. Read­ers may email ques­tions to: ToYourGood­[email protected] .cor­nell.edu or mail ques­tions to 628 Vir­ginia Dr., Or­lando, FL 32803.

Dear Dr. Roach: For months, I have had a per­sis­tent cough that I have been un­able to get help with. I saw an al­ler­gist about three years ago and was told I am al­ler­gic to dust mites. I was first re­ferred to a lung doctor where X-rays showed that my cheek si­nus drains were com­pletely blocked, and then to an ear, nose and throat doctor, who also con­firmed this diagnosis.

This ENT doctor rec­om­mended I have surgery to un­block the drains and clear out the si­nus area. I un­der­stand that si­nus drainage can cause cough­ing and won­der if this would still make me cough. I some­times cough un­til I can cough up some­thing, and this seems to stop my cough for a while. I was us­ing a nasal rinse for a while un­til about two weeks ago when it caused my nose to bleed. The ENT doctor pre­scribed an­tibi­otics and oral steroids that did not make any dif­fer­ence. It doesn’t seem to make any dif­fer­ence whether I’m home or sit­ting in the doctor’s of­fice, I’m still cough­ing. What is the best way to deal with dust mite al­lergy?

J.S.

An­swer: There are many causes of chronic cough, but post­nasal drip is at the top of the list. Dust mites are in­deed a com­mon al­ler­gen, and symptoms may in­clude runny nose, wa­tery eyes, sneez­ing and cough from post­nasal drip. Spe­cific treat­ment for dust mites should in­clude phys­i­cal barriers, such as cov­ers for pil­lows and mat­tresses, and some­times for other soft sur­faces, like furniture cush­ions, but this is only part of an ef­fec­tive strat­egy. Re­mov­ing as many fab­rics as pos­si­ble where dust mites can live is es­sen­tial. Reg­u­lar clean­ing is nec­es­sary, and high ef­fi­ciency par­tic­u­late air (HEPA) fil­ters for vac­u­um­ing have been shown to re­duce dust mites. A low-hu­mid­ity en­vi­ron­ment can be very ef­fec­tive in dis­cour­ag­ing dust mites, and cooler air can re­duce ir­ri­ta­tion of nasal pas­sages caused by dry air. Many in­ter­ven­tions for a pro­longed pe­riod are nec­es­sary to re­duce dust mite in­fes­ta­tion and the symptoms as­so­ci­ated with them.

The is­sue of the si­nuses is prob­a­bly sec­ondary to on­go­ing al­ler­gic ex­po­sure. Fix­ing your si­nuses will not fix your on­go­ing symptoms. With­out con­trol of the al­ler­gens, you will con­tinue to have symptoms and may even de­velop si­nus block­ages again, no mat­ter how good a job the sur­geon does on your si­nuses.

Dear Dr. Roach: I am an 87-year-old man in good health. Re­cently my physi­cian dis­cov­ered that I was hav­ing atrial fib­ril­la­tion. I had no symptoms. My pulse was 80. He placed me on Eliquis twice daily, which I am tak­ing. I feel fine, but I dis­like tak­ing an­ti­co­ag­u­lants and pre­fer other treat­ment for my con­di­tion. Is there other treat­ment you rec­om­mend?

H.A.S.

An­swer: Atrial fib­ril­la­tion is a com­mon rhythm dis­tur­bance. Treat­ment is de­signed to re­duce symptoms, pre­vent heart dam­age from too fast a heart rate, and pre­vent a stroke from a blood clot. Since you have had no symptoms and your heart rate is nor­mal, you need no ther­apy to con­trol your heart rate. How­ever, you are at in­creased risk for stroke just be­cause you are over 75 years old, and oral an­ti­co­ag­u­la­tion from apix­a­ban (Eliquis) or an­other agent is strongly rec­om­mended. With­out treat­ment, you have about a 4% risk of stroke per year. With treat­ment, your risk is only about 1%. It’s much riskier NOT to take the medicine.

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