Salbutamol, budesonide, and mometasone nasal spray was prescribed. These findings were suggestive of allergic rhinitis and asthma in the workplace. The chest radiograph was normal, and skin-prick allergy testing with common inhalant allergens showed positivity only to grasses. Following salbutamol inhalation, we observed a 10% increase in FEV 1 (to 2.92 L) and a modest change in the FEV 1/FVC ratio (to 74%). Lung function tests indicated a forced expiratory volume in 1 second (FEV 1) of 2.64 L, and the ratio of FEV 1 to forced vital capacity (FVC) was 68%. The physical examination was unremarkable apart from swollen turbinates. The patient keeps no pets at home, and although there is no personal history of atopy, her father has hay fever. The patient later noted shortness of breath and skin rash when feeding the fish. On a recent holiday, her symptoms completely resolved, but they recurred within a week of her returning to work. Her symptoms seemed to worsen at her workplace, a research laboratory that studies fish biology. A 37-year-old woman who was a nonsmoker presented to the allergy and asthma clinic with episodes of cough, shortness of breath, wheezing, and nasal congestion.
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