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 (draperies, carpets, stuffed children’s toys) 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 — especially at night — 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. This is critical, because 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 90 years old. My husband and I donated blood as often as needed, over 100 times, but last week my doctor said I tested positive for syphilis. I about fell off my chair. I haven’t slept for four nights. Have you ever heard of this? — E.
ANSWER: The screening test for syphilis, called the VDRL or RPR test, is not particularly accurate. About 1-2% of people will have a false positive result. Meaning, the test is positive but they do not have syphilis.
There are many possible causes, such as infection and autoimmune disease, like lupus, but some people, particularly older people, will have a positive test for no identifiable reason. In your case, I am sure it is a false positive, but your doctor may do a more specific test, such as an FTAABS, to be 100% sure. You shouldn’t let it keep you awake at night.