A 42-Year-Old Woman Comes to the Office Due to Several

A 42-year-old woman comes to the office due to several months of episodic shortness of breath and cough.  The patient has a history of migraines and occasionally takes acetaminophen.  She is a school teacher and does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.1 C (97 F) , blood pressure is 110/80 mm Hg, and pulse is 84/min.  Pulse oximetry shows 96% on room air.  Lung examination and chest x-ray are normal.  Spirometry shows that FEV1 is 71% of the predicted value.  Sputum analysis shows predominant eosinophils.  Exposure to which of the following is most closely associated with this patient's symptoms?

A) Acetaminophen
B) Gliadin-containing grains
C) Histoplasma microconidia
D) House dust mites
E) Shellfish and other seafood
F) Thermophilic actinomycetes

Correct Answer:

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