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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. Can mold on corn used to make chips like Doritos and Fritos cause severe allergic reaction?

A. Not much is known about gastrointestinal or systemic allergic reactions when inhalant allergens are ingested. There are rare case reports of adverse reactions attributed to dust mite in mite-infested flour.

Based on pure speculation, a fungal allergen on corn would likely be broken down by the heat in the processing and baking of the product made of the corn flour. Without knowing the specifics of the mold in question, it is not possible to look up the effect of heat and processing on a particular mold.

However, it may not be generally healthy to eat food made of flour that was subjected to the unhealthy conditions that made it become moldy. It is very likely that food made from moldy ingredients would not be very palatable either.

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.