Thunderstorms and Asthma

Thunderstorms and AsthmaA very interesting article was published in the current issue of the Journal of Allergy and Clinical Immunology in the section “Paradigms and Perspectives.”

In Melbourne, Australia, on Monday, November 21, 2016, hospitals were swamped with emergency patients affected by severe asthma exacerbations.  There were more than 8,500 patients from Monday night to Tuesday and 9 of them died.  Firefighters and police were called in to help physicians and paramedics respond to thousands of calls after the outside conditions caused breathing problems for its many citizens.  It caused many individuals, including those with a history of hay fever (i.e., allergic rhinitis), without a prior history of asthma, to experience breathing difficulties.  Many had severe and/or near-fatal asthma exacerbations.  The epidemic in Melbourne was due to a very unusual weather occurrence.  There were thunderstorms with high wind velocities and torrential rain combined with a high pollen count sending a large amount of grass pollen allergens into the air across the city.

In normal circumstances, pollen grains penetrate into the upper airways of individuals but only reach these larger airways in the lungs due to their large size.   However, it is postulated that during thunderstorms, pollen grains can rupture due to osmotic shock and release their content into the atmosphere.  As a result, the very small granules released into the air are now able to reach the lower smaller airways which then in turn induces asthma symptoms.

During the first 20 to 30 minutes of a thunderstorm, a high concentration of allergenic material released by the pollen is dispersed into the atmosphere.  People who have been previously sensitized to the pollen can experience acute and severe flare-ups of coughing, wheezing, chest tightness, and/or shortness of breath after inhaling these allergens.  This situation described above constitutes a major concern nowadays because of the ‘‘highly likely’’ increase in the frequency of heavy precipitation events, including thunderstorms, projected by climate change scenarios for future decades.

Ironically, rainfall is usually known to remove pollens from the air.  During a thunderstorm, however, dry updrafts force whole pollens into the high humidity at the cloud level, where pollens can rupture and cold downdrafts can carry pollen fragments to the ground level.  The relationship between allergen exposure, airway inflammation, and clinical symptoms is complex.  Factors other than allergens such as cold air and perhaps electrical charges of the atmosphere may also be playing a role in triggering asthma.

It is important to realize that people who previously had only hay fever symptoms are also at a higher risk for asthma during a thunderstorm.  Patients affected by pollen allergies should be aware of the danger of being outdoors during a thunderstorm in the pollen seasons.  Staying indoors with the windows closed significantly reduces the risk of asthma exacerbations.  Using inhaled asthma medications (e.g., bronchodilators, corticosteroids) at the onset of symptoms can minimize the severity of the asthma “attacks.”  Allergy shots (i.e., allergy immunotherapy, allergy injections) can also minimize or prevent asthma exacerbations caused by pollens, as well as dust mites, molds, pets, and cockroaches.

The board certified allergists at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding your asthma and/or allergy symptoms.  We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  In addition, the Washington, DC and McLean, VA offices are accessible by Metro.  There is also a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will answer you within 24 hours by the next business day.  Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 50 years.

Pet Allergies – What are They and What Can Be Done to Help?

Pet Allergies Individuals who are allergic to their pets generally have the same symptoms as people who have allergic rhinitis and allergic conjunctivitis to other allergens such as dust mites, molds, pollens, and, cockroaches.  These symptoms may include some or all of the following:  sneezing, runny nose, nasal congestion, itchy nose, post-nasal drip, itchy ears, clogged ears, itchy throat, itchy eyes, red eyes, watery eyes, puffy eyes, sinus congestion, sinus headaches, snoring, hives, generalized itchiness, swelling episodes, fatigue, wheezing, chest tightness, coughing, and/or shortness of breath.

It is the proteins found in the pet’s dander, urine, and saliva that act as the allergens which cause pet allergic individuals to react when exposed to pets.  In cats, the major allergenic protein is called Fel d 1.  Fel d 1 is primarily produced in cat saliva as well as in the skin itself.  Male cats produce more Fel d 1 than female cats.  Other cat allergens include Fel d 2, Fel d 3, Fel d 4, Feld 5, and Fel d 6.  Fel d 4 seems to be the 2nd most potent cat allergen after the major cat allergen which is Fel d 1.  Can f 1 and Can f 2 are the two major dog protein allergens which are found on a dog’s dander.  They are produced by the dog’s tongue tissue as well as other salivary glands.

In addition to cats and dogs, there are numerous other animals that people have as pets, some of which include birds, rabbits, ferrets, hamsters, guinea pigs, gerbils, mice, rats, spiders, snakes, lizards, turtles, fish, and horses.  In general, fish, reptiles, and amphibians as pets do not cause significant allergies to most individuals.

If you or someone you know has allergy and/or asthma symptoms when exposed to pets or has allergy and/or asthma symptoms and they live with a pet, they should seek a board certified allergist’s care to determine if they are in fact allergic to that pet.  At Black & Kletz Allergy, our board certified allergy doctors have the expertise in determining if someone has a pet allergy.  It begins with a comprehensive history and physical examination to identify any signs or symptoms that appear to be attributable to a pet allergy.  The diagnosis can be confirmed with allergy testing which can be done via blood tests or allergy skin tests, with the latter being a more sensitive testing method.

Once the diagnosis is made, our allergists will make recommendations on how to best avoid the pets as well as reduce exposure to the pet allergens, since in almost every circumstance, the person does not want to part with their pet as it is a beloved member of their family.  Black & Kletz Allergy offers many tips to pet-allergic individuals that help reduce exposure to the pet allergen proteins that cause allergic symptoms.  Allergy medications are usually prescribed in order for the individual to be able to tolerate being around the pet.  These medications may include oral antihistamines, nasal sprays, eye drops, inhalers, and/or leukotriene antagonists.  Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) has been found to be extremely effective in the management of pet allergies.  In addition, allergy shots may also contain other allergens such as dust mites, molds, and/or pollen, depending upon the individual’s sensitivities and his or her allergy history.  Allergy shots are effective in the treatment of allergic rhinitis in about 80-85% of the patients that take them.  The average length of treatment on allergy shots usually ranges from 3-5 years.

Black & Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  If you suffer from pet allergies and/or asthma related to animals, as well as any other type of allergy, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been providing excellent allergy and asthma care in the Washington, DC metro area for more than 50 years and we look forward to helping you.

Grass Allergy and What Can Be Done to Help You

Grass Allergy

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, grass pollinates mostly from the end of April through the end of August.  The peak grass pollen levels tend to be from May through July, however.  Grass is a very common allergen as it affects millions of individuals.

There are thousands of types (i.e., species) of grasses and many cross-react with one another.  This means that if you are allergic to a particular type of grass, then you are likely to exhibit allergic symptoms if you are exposed to another type of grass if it is within the same grass subfamily.  Pooideae is the largest subfamily of the grass family Poaceae.  These grasses are common grasses known to cause allergic rhinitis (i.e., hay fever) in sensitized individuals.  They tend to occur in temperate climates in the U.S.  Some of the grasses in this subfamily include Timothy, Red top, Sweet vernal, Orchard, Meadow fescue, Kentucky blue, and June.  They also include the common cereal grasses (e.g., rye, wheat, barley, oat).  Panicoideae, also in the grass family Poaceae, is another common grass subfamily and its’ grasses are also a common cause of allergic rhinitis.  Common grasses in this subfamily include Johnson and Bahia.  In the grass family Poaceae, subfamily Chloridoideae, the most common grass to cause allergy symptoms is Bermuda.  Bermuda grass tends to occur mostly in the southern half of the U.S. where there are warmer temperatures.

The typical allergic rhinitis symptoms that most allergic individuals suffer from may include all or some of the following:  sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, clogged ears, itchy ears, itchy eyes, watery eyes, puffy eyes, hoarseness, snoring, sinus congestion, sinus headaches, wheezing, chest tightness, shortness of breath, and coughing.  In very allergic individuals, contact with grasses may cause itchy skin and hives.  Rarely, a very grass-allergic person may develop anaphylaxis if he or she scrapes their skin on grass and it gets into the bloodstream, as is not uncommon in certain sports such as football, baseball, and soccer.

In order to manage one’s grass allergies, the following tips are recommended:

  • Avoid mowing the lawn, but if you need to mow it, wear a mask.
  • Remove your clothes after coming inside from outdoors. Take a shower to wash the pollen off of you as well as wash your clothes.
  • Keep your lawn short, as grass pollinates when the grass is tall.
  • Keep an eye on the pollen count. You check it daily by clicking Today’s Pollen Count.
  • Wash your pets when they come indoors, as their fur will transport grass pollen into your home.
  • Avoid hanging wet clothes outdoors to dry, as pollen will gather on the clothes.
  • Keep your windows and sunroofs closed in your motor vehicles.
  • Keep your doors and windows closed in your house.
  • Use over the counter allergy medications such as oral antihistamines, nasal sprays, and/or eye drops, if approved by your physician.
  • See a board certified allergist, like the ones at Black & Kletz Allergy, if your symptoms are not alleviated by over the counter medications.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating grass allergies as well as other environmental allergies such as trees, weeds, dust mites, molds, cockroaches, pets, and other animals.  We diagnose and treat both children and adults.  In addition, we also see patients with a variety of other allergic/immunologic conditions such as asthma, eczema, sinus problems, hives, swelling episodes, generalized itching, food allergies, poison ivy, poison oak, poison sumac, contact dermatitis, insect sting allergies, medication allergies, eosinophilic esophagitis, hypogammaglobulinemia, and other immune disorders.

Black & Kletz Allergy has 3 convenient locations in the Washington, DC metropolitan area.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Each office has on-site parking and the Washington, DC and McLean offices are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office location that is most convenient for you or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy strive to provide our patients with the highest quality allergy and asthma care in the Washington, DC and Northern Virginia metropolitan area.

New Treatments for Eczema

Eczema Treatment

Atopic dermatitis is a common genetically determined chronic inflammatory disorder of the skin. Eczema is a term used to describe the appearance of the skin in atopic dermatitis, as well as in other skin diseases. Though atopic dermatitis generally tends to be more severe in childhood and improve in adulthood, most people with this condition continue to have remissions and exacerbations throughout their lifetimes.

Environmental factors such as weather changes and food allergies can exacerbate the eczema and itching.  Atopic dermatitis is usually more bothersome during the winter months due to excessive dryness.  Individuals with atopic dermatitis are more likely to have sensitivities to foods and exposure to these foods can worsen their eczema.  Individuals with eczema tend to be most sensitive to the following foods:  milk, wheat, soy, peanut, egg, and seafood.

Though there is no known cure for atopic dermatitis, many treatments are available to relieve the symptoms and improve one’s quality of life.

Traditionally, management of atopic dermatitis consists of:

  1. Identifying the triggering and aggravating factors (which can vary from patient to patient) for eczema and avoiding exposure as best as possible.
  2. Hydrating the skin with daily application of emollients (i.e., moisturizing creams and lotions) all over the body immediately after bathing or showering.
  3. Limiting the duration of bathing or showering to a few minutes, if possible.
  4. Oral antihistamines to relieve the troublesome itching. The goal is to break the itch-scratch cycle which can perpetuate eczema.
  5. Antibiotics to reduce the colonization of the inflamed skin with bacteria, especially when there are open sores in order to prevent secondary skin infections such as staph.
  6. Topical calcineurin inhibitors [e.g., Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment] are immunomodulators which can help in controlling inflammation of the skin. Note that this group of drugs carries an FDA “black box” warning that certain type of tumors (e.g., lymphomas) were observed in rodents receiving these medications.
  7. Corticosteroid creams and ointments are the mainstay of controlling the flare-ups of eczema due to their anti-inflammatory properties. More than a dozen varieties of topical steroids are available with varying degrees of potency.  Due to their potential side effects which can include thinning of the skin and whitish discoloration (i.e., hypopigmentation), among their use is generally restricted to 10 days to 2 weeks at a time.
  8. In severe cases of atopic dermatitis unresponsive to the usual treatments, systemic immuno-suppressants (e.g., cyclosporine, dapsone) are employed to control severe inflammation. However their use is limited by their toxicity to other organs such as the liver and kidneys.

Very recently, two new forms of treatments for atopic dermatitis were approved by FDA.

  1. Eucrisa (i.e., crisaborole) belongs to a class of drugs called phosphodiesterase-4 (PDE-4) inhibitors. It is available as a 2% ointment and indicated for treatment of mild to moderate atopic dermatitis in patients 2 years of age and older.  It should be applied in a thin layer to the affected area twice a day.  Since it is not a steroid, it can be applied even to the face.
  2. Dupixent (i.e., dupilumab) is a biologic injectable medication approved for treatment of moderate to severe atopic dermatitis not adequately controlled by topical therapies in patients 18 years of age and above. It is a monoclonal antibody which blocks the receptor of a common inflammatory mediator called IL-4 (i.e., interleukin-4).  The initial dose is two injections (given subcutaneously under the skin) of 300 mg. each at different sites, followed by 300 mg. every other week.  It can be used along with or without topical steroids preparations.

Black & Kletz Allergy has board certified allergy and immunology specialists as well as a trained staff experienced in both the diagnosis and treatment of atopic dermatitis of varying degrees of severity.  We treat both children and adults and have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and the Washington, DC and McLean offices are Metro accessible.  There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us if you, a family member, a friend, or a colleague suffers from eczema or atopic dermatitis and want to be evaluated and treated.  In addition to conventional therapy, we also have expertise in the newer treatment options for the treatment of eczematous dermatitis or any other allergic or immunologic disorder.  You may also click Request an Appointment and we will respond within 24 hours of the next business day.  The allergists at Black & Kletz Allergy strive to keep up with the newest allergy and asthma treatment modalities so that cutting edge medicine is always available to our greater Washington, DC community.

Shortage of Venom Extracts

Venom Extract ShortageMost insect bites cause “local reactions” resulting in redness and/or swelling at the site of the bite which usually subsides in a few days.  However, stings by 5 different types of insects (honey bee, yellow jacket, yellow-faced hornet, white-faced hornet, and wasp) belonging to the Hymenoptera species, can cause a life-threatening “systemic reaction” (i.e., anaphylaxis) in sensitized individuals.  Approximately 5% of the population has had systemic reactions to stinging insects.

The more common symptoms of anaphylaxis may include:

  • Swelling of the lips, face, throat, and/or tongue (i.e., angioedema)
  • Difficulty breathing, wheezing, chest tightness, and/or coughing
  • Dizziness or lightheadedness which could signify a drop in one’s blood pressure
  • Abdominal cramping and/or diarrhea
  • Nausea and/or vomiting
  • Generalized itchiness (i.e. pruritus) and/or hives (i.e., urticaria)

Avoidance of stings by insects is not always possible and the reactions tend to get progressively more severe with each sting.  In fact, many fatalities are reported in the U.Ss every year from insect stings.

A highly effective form of treatment called venom immunotherapy (i.e., allergy shots for venoms) significantly reduces the risk of severe reactions in sensitized people.  The process involves building up tolerance by injecting gradually increasing doses of commercially made “extracts” from the insect venoms at regular intervals.  Venom immunotherapy has been credited with saving a number of lives and helps people live without fear of a serious reaction from insect stings.  Venom immunotherapy is effective in preventing a systemic reaction to further insect stings in approximately 95% of individuals that go on such treatment.

In the U.S., there are only two companies (i.e., ALK and HollisterStier) which manufacture insect venom extracts which are utilized as antigens during venom immunotherapy.  Unfortunately, since October 2016, ALK Laboratories has notified that it is unable to fill orders for Hymenoptera venom extracts due to manufacturing difficulties.  It is not known how long it will take to restore normal production and distribution.

HollisterStier has indicated that it is doing everything possible to equitably distribute the available venom and to ramp up production of the venoms to help deal with the shortage. However, it is expected that increased production will take time to reach the market.

As the demand now exceeds supply, there is a need to judiciously manage the reduced availability of commercial extracts.  The American Academy of Allergy, Asthma, and Immunology came up with guidance for allergy/immunology practices all over the country regarding the measures that are needed to mitigate the venom shortage that likely will exist for some period of time.

There are 4 strategies to be considered until the shortage eases up:

  • Increasing the maintenance interval
  • Decreasing the maintenance dose
  • Suspending or restricting treatment in patients with the lowest risk of severe reaction to stings
  • Scrupulous avoidance of wastage of extracts in mixing and administration

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the board certified allergists at Black & Kletz Allergy are striving to increase the supply of venom extracts by following the recommendations of the American Academy of Allergy, Asthma, and Immunology in order to make available the extracts to our patients according to their risk profiles.  Black & Kletz Allergy treats both adults and children for venom sensitivities and we have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

We encourage all our patients to call us and discuss their concerns over the venom shortage situation and we would be happy to answer any questions that may arise.  If you would like to make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.

Allergies or the Common Cold?

Common ColdHow does one distinguish whether they have a common cold or if they are bothered by allergies?  This question plagues many individuals all the time.  It may not be easy to differentiate the two maladies since the two conditions have a lot of crossover signs and symptoms.  An allergist in Northern Virginia and Washington, DC which can be found at Black & Kletz Allergy can help you in the differentiation among these two conditions.  In the Washington, DC, Northern Virginia, and Maryland metropolitan area, as well as the rest of the country, the common symptoms of both conditions may include runny nose, nasal congestion, post-nasal drip, sore throat, sneezing, sinus headaches, fatigue, snoring, and/or coughing.  In addition, asthma is often exacerbated with both allergies as well as the common cold causing wheezing, chest tightness, and/or shortness of breath and is also treated in the metro DC area by an allergist in Northern VA and/or Washington, DC.

In allergic rhinitis (i.e., hay fever), additional symptoms may also include itchy nose, itchy eyes, watery eyes, puffy eyes, dark circles under the eyes, and/or itchy throat.  When a common cold occurs, additional symptoms may include fevers, chills, achiness, and/or sweating.  One of the most telling signs that the symptoms are more consistent with allergic rhinitis (i.e., hay fever) rather than the common cold is if the signs and/or symptoms persist more than 1 week in duration.  Generally, the common cold and/or viral upper respiratory tract infection (i.e., URI), usually last 1 week or less.  Allergic rhinitis is an allergic condition that individuals suffer from generally for at least several weeks or more.  If the allergic rhinitis is seasonal, it may only occur when the pollen count is high.  For example, in the Spring in the Washington, DC metro area, the tree pollen usually pollinates typically from the end of February through mid-May and tree-allergy sufferers usually experience symptoms during that time period.  However, if a person is only allergic to a specific type of tree (e.g., birch, maple, oak), they will only exhibit symptoms when that specific tree pollen is pollinating.  Still, however, the time period is much longer than 1 week.  From May through early August, the grass pollinates in the Washington, DC area and an allergist in Northern Virginia and DC can help patients that are bothered by grass pollen.  Lastly, regarding pollen, ragweed in the DC metro area usually begins in mid-August and generally finishes pollinating after the first frost which usually occurs at the end of October.  Like the other pollens, an allergist in Northern VA, such as the ones at Black & Kletz Allergy can perform allergy testing via skin testing or by blood testing in order to determine one’s allergies.

An allergist in Northern Virginia and Washington, DC can help you determine if you have allergies, and to which allergens.  In addition, an allergist in Northern VA and/or Washington, DC can also recommend ways to prevent or minimize one’s exposure to allergens, as well as prescribe medications to combat one’s allergies.  An allergist in Northern Virginia and Washington, DC, like the ones at Black & Kletz Allergy can also place an individual on allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization) which help allergy patients 80 -85% of the time.  They are very effective and have been given for more than 100 years.

An allergist in Northern Virginia and Washington, DC that is board certified can be found at Black & Kletz Allergy.  We diagnose and treat both adults and children.  We have 3 convenient offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  If you suffer from allergies, asthma, sinus problems, hives, the common cold and other infections, swelling episodes, and/or eczema, please call our office to schedule an appointment with an allergist in Northern VA and/or Washington, DC.  All 3 offices of Black & Kletz Allergy have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergists at Black & Kletz Allergy pride themselves in serving the greater Washington, DC area for providing high quality allergy and asthma care as we have been doing for more than 50 years.

New Guidelines for the Prevention of Peanut Allergy

Peanut AllergyMore and more children and adults are being diagnosed with peanut allergy in the U.S. in the past few decades.  Peanut allergy was estimated to affect about 0.4% of children and 0.7% of adults in 1999.  By 2010, the prevalence increased to about 2% of all children.  Peanut allergy is the leading cause of death related to food allergies in U.S.

Until a few years ago, it was thought that delaying the introduction of allergenic foods to at-risk children reduced the likelihood of the development of food allergies.  However, a recent landmark study published in 2015 called LEAP (Learning Early About Peanut Allergy) provided evidence to the contrary. Based on the new findings, the National Institute of Allergy and Infectious Diseases amended the previous recommendations and issued new guidelines favoring early introduction of peanut products in children at risk for the development of peanut allergy.

It is known that infants diagnosed with eczema and/or allergies to eggs are at higher risk of developing peanut allergies.  These children were the focus of the new guidelines.  Though it is possible that other groups of children with a family history of food allergies and/or history of allergic reactions to other foods such as milk, soy, wheat, etc. also are more likely to develop peanut allergy, these children were not included in the current recommendations due to lack of enough evidence at this time.

Guideline 1:

In infants with no eczema or any food allergy, peanut products should be introduced in their diet in accordance with family preferences.

Guideline 2:

In infants with mild to moderate eczema with no other food allergy, peanut-containing foods should be introduced at about 6 months of age.  Other solid foods should be introduced before peanut-containing foods to ensure that the infant is developmentally ready.  These infants may have dietary peanut introduced at home, though some caregivers and healthcare providers may desire an in-office supervised feeding, evaluation, or both.

Guideline 3:

Infants with:

1. Severe eczema (defined as those with persistent and recurrent flare-ups of eczema needing prescription-strength medications)

2. Egg allergy (defined as those with a history of a reaction to egg and a positive skin prick test or a positive oral egg food challenge)

3. Both 1 and 2 above need to be tested for possible peanut allergy as follows:

1. If the blood test shows no peanut specific IgE antibody, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.

2. If the blood test shows elevated peanut IgE antibody, the children need prick skin testing with peanut antigen by an allergist.

A. If the skin test shows a wheal of 0 to 2 mm. in diameter, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.

B. If the skin test reveals a wheal of 3 to 7 mm. in diameter, a supervised in-office feeding or a graded oral food challenge with peanut should be undertaken. In the case of no adverse reaction, peanut-containing foods should be introduced in their diet.  In the case of an adverse reaction, peanut products should be strictly avoided.

C. If the skin test’s wheal diameter is 8 mm. or larger, these infants should avoid peanut products and should continue to be evaluated and managed by an allergist.

Infants, who are candidates for the introduction of peanut-containing foods at 4 to 6 months of age, should receive about 2 grams of peanut protein in the first feeding.  Subsequently, they should also be regularly fed about 6 grams of peanut protein per week, divided in 3 or more feedings.

It is hoped that this strategy will help in development of tolerance to peanut products and will substantially reduce the likelihood of the development of peanut allergy which can be very serious and even fatal.

Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergists are trained and very familiar performing prick skin testing as well as oral food challenges in the appropriate individuals.  Black & Kletz Allergy diagnoses and treats both adults and children.  We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  If you are concerned that you or your child has a peanut allergy or any other type of food allergy, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been serving the needs of allergy and asthma sufferers in the Washington, DC metro area for more than 50 years.

Dust Mite Allergy

Dust Mite Allergies Washington DC
What are dust mites ?
Dust mites are microscopic bugs that are about 0.25 mm. in length. They are arachnids like spiders and scorpions and like the former, generally have 8 legs. They tend to live in pillows, mattresses, bedding, carpeting, plush toys, upholstered furniture, etc. and are responsible for allergy and asthma symptoms in many individuals. When someone speaks of a dust allergy, they are in fact referring to dust mite allergy. Dust mites can survive in a broad range of environmental conditions but prefer warmer temperatures and places with higher humidity. They tend not to like high altitudes, but still can survive at relatively high elevations. Dust mites survive by eating organic matter such as your flaky dead skin that sloughs off of you each night while you are asleep. They also eat your hair, fingernails, fungi, bacteria, and can eat animal fur. For these reasons, dust mites tend to be most problematic in one’s bedroom. In addition, people tend to spend a lot of time in their bedrooms. A disgusting fact is that there are millions of these tiny bugs living on the average mattress.

Why are people allergic to them and what are the symptoms of dust mite allergy?
People are actually allergic to the allergens in the dust mite’s fecal material. The two most common species of dust mites found in the United States are Dermatophagoides farinae and Dermatophagoides pteronyssinus. There are many dust mite allergens which are divided into groups. The allergens in Group 1 and Group 2 are generally the most bothersome to individuals. The allergens “Der f 1” and “Der p 1” are the most allergenic proteins that are produced by these two mites. When a sensitized individual inhales these proteins, as well as other dust mite proteins, allergic symptoms may occur which can cause all or some of the following symptoms: itchy eyes, watery eyes, red eyes, runny nose, nasal congestion, post-nasal drip, sneezing, sinus headaches, wheezing, cough, shortness of breath, and/or chest tightness. These symptoms can be the same symptoms as some people experience with pollen, mold, and/or pet allergies. In addition, dust mites may cause exacerbation of one’s eczema (atopic dermatitis).

What can be done to minimize one’s exposure to dust mites?
It is advantageous to cover one’s pillows, mattress, and box spring with allergy-proof encasings that zipper up over the pillows, mattress, and box spring. This allows one to have a “protective” barrier in place between the dust mites and the individual’s nose which is responsible for inhaling the highly allergenic proteins of the dust mites. It is also beneficial to avoid wall-to-wall carpeting, especially in the bedroom and to get rid of plush stuffed animals in children’s bedrooms. Anything that tends to gather dust such as curtains also should be avoided. In addition, it is also beneficial to wash bedding in water that is equal to or greater than 130°F. The hot water will kill the dust mites, although dust mites will continue to reproduce and always will be present. Using a HEPA air filter is another important tool to reduce allergen exposure. Make sure to keep the humidity in the house below 50% as it has already been mentioned above that dust mites thrive in high humidity, particularly over 70% humidity. It is preferable to avoid sleeping in basements, as they tend to be damper and concrete floors also should be avoided, since they tend to increase moisture.

How is dust mite allergy diagnosed and treated?
When an individual sees a board certified allergist, it is important for the allergist to take a detailed history from the patient so as to ascertain if his/her symptoms could possibly be due to dust mites. One common feature amongst people with dust mite allergies is that their symptoms can and usually are perennial in nature and not just seasonal as found often in patients with pollen allergies. It is also very common for patients with dust mite allergy to have a worsening of their symptoms in the Fall and Winter, which is usually the time that the heat gets turned on in most homes and businesses, particularly in the Washington DC, Northern Virginia, and Maryland metropolitan area. The next step in diagnosing dust mite allergy is a thorough physical examination to look for visual clues of hay fever (allergic rhinitis) and/or asthma. Allergy skin testing or allergy blood testing can be performed in order to confirm the diagnosis. Once a dust mite allergy is diagnosed, there are a few options for treatment which involve a combination of reducing one’s exposure to dust mites as mentioned in the previous paragraph, and medical treatment. Treatment can be given to patients by either using medications and/or receiving allergy immunotherapy (i.e., allergy shots, allergy desensitization). Allergy medications may include antihistamines, decongestants, nasal sprays, and/or eye drops, etc. Allergy desensitization has been around for over a century and has been proven to be very effective to treat dust mite allergies, as well as pollen, mold, pet, insect sting hypersensitivity, etc.

What should you do next?
The allergists at Black & Kletz Allergy are board certified in both adult and pediatric allergy, asthma, and immunology. We are proud to have served the Washington DC metropolitan area community for many decades and if you or someone you know appears to be suffering from “dust” allergies or allergies due to an “unknown” cause, please give us a call at one of our 3 convenient office locations in the area or click Request an Appointment and we will contact you within 24 hours on the next business day after your request, so that we can schedule an appointment for you.

It's an Early Spring – What Can You Do Now?

People in the Spring AllergyWashington, DC, Northern Virginia, and Maryland metropolitan area as well as in the Northeast are experiencing record warm temperatures this Winter.  This warm weather seems to have confused the trees into releasing their pollen much earlier this year than in previous normal years.  In February of this year, tree pollen counts hit “high” levels a few times, when normally they are at the most a “low” level by the end of February.  In addition to Washington, DC, the tree pollen counts has been much higher than normal this February in the following Northern Virginia cities:  Tysons Corner, VA, Vienna, VA, McLean, VA, Great Falls, VA, Arlington, VA, Fairfax, VA, Falls Church, VA, Alexandria, VA, Annandale, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Bristow, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Haymarket, VA, Gainesville, VA, Warrenton, VA, Springfield, VA, Ashburn, VA, Dumfries, VA, Culpeper, VA, Leesburg, VA, and Purcellville, VA.  In Maryland, the tree pollen counts have also been “high” this February in the following cities:  Potomac, MD, North Potomac, MD, Rockville, MD, Gaithersburg, MD, Germantown, MD, Olney, MD, Darnestown, MD, Bethesda, MD, North Bethesda, MD, Chevy Chase, MD, Great Falls, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Temple Hills, MD, Columbia, MD, Annapolis, MD, and Baltimore, MD.

Tree pollen usually begins to pollinate in late February and generally stops pollinating in May, however this year, tree pollen was seen in January.  Along with tree pollen comes misery for millions of allergic individuals who are sensitive to tree pollen.  The symptoms that allergic individuals typically experience may include sneezing, runny nose, nasal congestion, itchy nose, post-nasal drip, itchy throat, sinus congestion, sinus headaches, itchy eyes, puffy eyes, watery eyes, fatigue, snoring, and/or asthma (e.g., wheezing, shortness of breath, chest tightness, coughing).  Many people with hay fever (i.e., allergic rhinitis) are more prone to developing sinus infections (i.e., sinusitis) as well.

In order to try to ward off allergy and asthma symptoms at the beginning of the season, several things can be done by the allergy sufferer before the symptoms begin or certainly before the symptoms get bad.  Some of these things that can be done in order to help prevent allergy symptoms include:

  1. If doing yardwork or exercising outdoors, wash and change your clothes and take a shower after come inside.
  2. If you must do yardwork, wear a mask, preferably a respirator mask with a HEPA filter.
  3. Keep the windows and/or sunroof closed in your cars.
  4. Wash your pet if he/she has been outdoors for a prolonged period of time as the fur/hair collects pollen.
  5. If you need to do outdoor activities, try to do them in the late afternoon or after it rains, when the pollen levels are lower. Pollen counts are higher in the mornings.
  6. Watch the pollen count. You can check it daily on our website.  Click Today’s Pollen Count.
  7. If you need to go outdoors, try to avoid going out in hot, windy, dry days as the pollen counts tend to be higher on these days.
  8. Make sure you clean and/or change your filters in both your home and car.
  9. Make sure the setting on your car’s air conditioning system is set on recycle in order to avoid fresh air from the outside from entering your vehicle.
  10. Begin your allergy medications at the beginning of the season or even a few days before the season begins, only if suggested by your allergist.
  11. If you are on allergy shots (I.e., allergy immunotherapy, allergy injections, allergy desensitization), increase the frequency of the injections at the start of the season and continue that increased frequency throughout the season.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating allergic rhinitis and asthma in both adults and children for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have 3 office locations, all of which offer on-site parking.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  For an appointment, please call us at one of our locations or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have the expertise in order to take outstanding care of your allergy, asthma, sinus, skin-related disorders, and immunological needs.  Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless dedication and great pride as we have done for many years.

Allergies to Vaccines

About 220 million doses of vaccines are distributed in the United States each year.Allergies to Vaccines

Mild swelling and redness at the site of the injections and fever lasting for 1 to 2 days are very common reactions after vaccinations.  These adverse reactions do not preclude receiving future doses of the vaccines.  Rarely, however, sensitivity to a vaccine constituent may cause a lump at the injection site several hours after its administration, and this is also not a contraindication to subsequent vaccination.  In cases of severe adverse reactions, on the other hand, it is prudent to avoid further vaccination with that particular vaccine.  In these cases, a board certified allergist may measure the levels of IgG antibodies to the immunizing agent(s) to detect whether the individual has the sufficient amount of protective antibody levels.  Depending on the levels, the allergist can help determine whether further doses are needed.  If needed, the allergy doctor will discuss the risks of re-vaccination and may desensitize the individual to a particular vaccine, if the ability exists for that immunizing agent.

In cases of an anaphylactic reaction (a severe life-threating reaction involving multiple organ systems) to a vaccine, further evaluation should be undertaken by an allergist in an attempt to identify the culprit allergen.  These types of reactions are more often caused by additives (e.g., preservatives) or residual vaccine components, such as gelatin, rather than the microbial immunizing agent itself.

Patients who experience an apparent anaphylactic reaction should undergo immediate-type allergy skin testing to confirm that the reactions were mediated by an IgE antibody and to determine the responsible component of the vaccine.  If the skin tests are negative, the chance that the patient has IgE antibodies to any vaccine component are negligible, and the vaccine can usually be administered under physician supervision with epinephrine and other medications readily available.  If the skin tests are positive and suggestive of an IgE-mediated reaction, consideration may be given to administer all future doses in a graded fashion under close physician monitoring.

Pregnant women should not receive live vaccines.  They can however be given inactivated influenza (i.e., “the flu”), tetanus, and hepatitis B vaccines, if approved by their Obstetrician.  Live vaccines should also not be given to persons with immune system defects and/or function because of a risk of it resulting in a generalized infection with that immunizing agent or vaccine.

Certain vaccinations (e.g., MMR) and/or the preservatives used in some vaccines (e.g., thimerosal) have been purported to have long-term consequences such as autism.  Other vaccines (e.g., hepatitis B, influenza, tetanus) have been alleged to cause or aggravate multiple sclerosis.  Epidemiological studies have not supported such associations at this time, so it is probably safe to say that it is very unlikely that the MMR vaccine or thimerosal causes autism.  Likewise it is also fair to say that at this time in is very unlikely that the hepatitis B vaccine causes multiple sclerosis or that the hepatitis B, influenza, and/or tetanus vaccines worsen a patient’s multiple sclerosis.  It is however very important to discuss such apprehensions with your physician before receiving a vaccination, as you are your best advocate.

Individuals with a history of a suspected egg allergy should be evaluated by an allergist to determine the status of their egg allergy.  Most people, even with confirmed egg allergy, should receive influenza vaccinations because the risks of vaccinating are generally outweighed by the risks of not vaccinating.  Skin testing with the influenza vaccine is no longer recommended in people with a history of an allergic reaction to eggs.

Patients with egg allergy with a history of only hives after egg ingestion can receive the influenza vaccine in a primary care provider’s office provided the appropriate personnel and equipment are available, whereas those with a history of more severe reactions to egg ingestion should receive their vaccine in an allergist’s office.

In patients with a history of an allergic reaction to the influenza vaccine itself, additional evaluation is appropriate including skin testing with the vaccine and vaccine ingredients.  For patients with positive skin test results, the vaccine can either be administered in multiple divided doses (i.e., desensitization) or it can be withheld.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  We welcome any and all questions regarding vaccines including their possible benefits and the potential untoward reactions.  Black & Kletz Allergy diagnose and treat both adults and children and have had more than 50 years of experience dealing with the subject of vaccinations.  We test, administer, and desensitize patients to many kinds of vaccinations depending upon the type of vaccination and their need to receive the inoculation.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, each with on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call us to make an appointment for any of your allergy, asthma, and immunology needs or alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.  The allergy doctors at Black & Kletz Allergy are happy to assist you by providing high quality allergy care in a professional and friendly environment.