Month: February 2015

Vaccinations and Food Allergies – What Should You Know?

With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.

Some vaccines like the MMR (measles, mumps, and rubella), influenza, yellow fever, and certain rabies vaccines are grown in chicken embryo cultures and may contain small amounts of egg protein in them, raising concerns about potential adverse reactions in children and adults with egg allergies.

Other vaccines contain small amounts of gelatin which can cause adverse reactions in patients allergic to gelatin.  Some of these vaccines include MMR, influenza, varicella, DTaP (diphtheria, tetanus, and acellular pertussis), yellow fever, rabies, shingles (herpes zoster), and Japanese encephalitis.

Below are the most current recommendations as of February 2015:

  1. MMR vaccine:
    • Can be safely given in a single dose without prior testing in all children and adults with a history of egg allergy.
  2. Influenza vaccine:
    • People with a history of egg allergy who have experienced hives (urticaria) after exposure to should not receive the live influenza vaccine (FluMist).  They can, however, receive a recombinant (egg-free) influenza vaccine (Flublok) if they are 18 years of age or older, or they can receive an inactivated vaccine. Either the recombinant or the inactivated influenza vaccine must be administered by a health care provider familiar with the potential manifestations of egg allergy. The patient must also be observed by the provider for at least 30 minutes for signs of a reaction after administration of each vaccine dose.  Note that neither the recombinant (Flublok) nor the inactivated influenza vaccines contain any live influenza virus, unlike the live attenuated (weakened) influenza vaccine (FluMist) which does contain live influenza virus.  FluMist is given intranasally (in the nose) rather than the inactivated influenza vaccine which can be given either as an intramuscular or an intradermal injection.  The recombinant influenza vaccine is given as an intramuscular injection.  Also note that FluMist is only given to individuals from ages 2 through 49.  FluMist should not be given to pregnant women or in patients with an immunodeficiency (weakened immune system) without consulting their physician.  FluMist should not be given to children and adolescents through age 17 years of age who are receiving aspirin therapy or aspirin-containing therapy because of the association of Reye’s Syndrome with aspirin and wild-type influenza infection.
    • People who have had more severe reactions to egg such as dizziness and/or lightheadedness, angioedema (swelling), vomiting, breathing difficulties (i.e., wheezing, shortness of breath), and/or who have been treated with epinephrine in the past for an egg allergy can also receive the recombinant influenza vaccine (egg-free) if they are 18 years of age or older or an inactivated influenza vaccine.  This must only be given by a physician, such as an allergist, with experience in the recognition and management of severe allergic conditions like anaphylaxis.  These individuals must also be observed for at least 30 minutes after vaccination.
  3. People who have had anaphylactic reactions to the previous doses of any vaccine due to sensitivity to any of its components (i.e., gelatin, thimerosal, antibiotics) of the vaccine, should not receive any further doses of that particular vaccine.  Note that thimerosal-free influenza vaccines can be obtained for those who are either allergic to thimerosal or do not want thimerosal.
  4. Individuals who have had Guillan-Barré Syndrome (a severe paralyzing illness) should not get any vaccine without consulting their physician.
  5. People with egg allergies should also not get the vaccinations for yellow fever and certain rabies vaccines since they also may contain small amounts of egg protein.  The rabies vaccine Imovax can however be given to people with egg allergies, as Imovax is not cultured in chicken embryos and therefore does not contain egg proteins.  Desensitization to the yellow fever vaccine can be performed by an allergist in a medical setting.  If either the yellow fever or rabies vaccine is necessary, please consult with your physician.

The board certified allergists of Black & Kletz Allergy have over 50 years of experience in addressing the vaccination needs of people with food allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area based on the latest evidence-based clinical guidelines.  If you need to consult us on vaccinations, please make a appointment at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA.

Dr. Michael R. Kletz has done clinical research on the topic of the administration of egg-derived vaccines in patients with a history of egg sensitivity.  Please click his research article that was published in the Annals of Allergy in the following link: http://www.ncbi.nlm.nih.gov/pubmed/2346238

Respiratory Tract Infections

In the winter, everyone seems to either have had a “cold” or knows someone who has a “cold.”  When people refer to a “cold,” they are actually referring to some sort of respiratory tract infection.  To understand a respiratory tract infection, one must first know the parts of the body that make up the respiratory tract.  The respiratory tract can be broken down into two parts:  the upper respiratory tract and the lower respiratory tract.

The upper respiratory tract is located outside of the chest and is made up of the following:

  1. Nasal cavity – The space inside the nose
  2. Sinuses – The air-filled cavities in the skull
  3. Pharynx – The space inside the mouth where the passages of the nose connect to the mouth and throat
  4. Epiglottis – The flap that covers the trachea (windpipe) during swallowing, so that food does not enter the trachea and thus the lungs. It is on top of the larynx (voice box)
  5. Larynx – The voice box (part of the throat that contains the vocal cords which is just above the trachea or windpipe)

The lower respiratory tract is located in the chest and is made up of the following:

  1. Trachea – The windpipe or breathing tube
  2. Bronchi – The trachea splits into 2 different smaller tubes.  One tube goes into the right lung and the other goes into the left lung.
  3. Lungs – Consists of bronchioles (very small divisions of the bronchi within the lungs) and alveoli (very small air sacs within the lungs where air exchange of oxygen and carbon dioxide occurs)

Infections of each site above can occur and each has a corresponding name associated with the location.  Infections of such areas are usually named by putting the suffix “itis” (which means “inflammation of”) at the end of the anatomical location. The names of the infections of each location are listed below:

  1. Nasal cavity – Rhinitis
  2. Sinuses –  Sinusitis
  3. Pharynx – Pharyngitis (i.e., Strep. throat, tonsillitis)
  4. Epiglottis – Epiglottitis
  5. Larynx – Laryngitis
  6. Trachea – Tracheitis
  7. Bronchi – Bronchitis
  8. Lungs – Pneumonia (Note that one can also have bronchiolitis and/or alveolitis)

The cause of most respiratory tract infections is viruses.  There are over 200 known viruses that cause these infections.  In addition to viruses, a bacteria, fungus, or parasite can also be the cause of a respiratory tract infection. Most of the viruses that cause respiratory tract infections are the following:  rhinovirus, adenovirus, influenza virus (the “flu”), parainfluenza virus, enterovirus, coronavirus, and respiratory syncytial virus (RSV).

The symptoms of a respiratory infection range in type and severity depending upon the duration, and the virulence of the virus, bacteria, fungus, or parasite.  It also depends if the individual has any pre-existing risk factors or medical illnesses such as diabetes, immunodeficiency, elderly, underlying lung disease (asthma, COPD or chronic obstructive pulmonary disease, cystic fibrosis, etc.), smoking, allergies, congestive heart failure, crowded living conditions (i.e., dormitories, nursing homes, hospitals), exposure to others with a “cold” or flu, and/or lack of vaccination [i.e., influenza (flu), Pneumovax 23 and/or Prevnar 13 (pneumonia shots)].  Common symptoms include:

  1. Malaise
  2. Runny nose
  3. Stuffy nose
  4. Sore throat
  5. Headache
  6. Post-nasal drip
  7. Cough (with or without sputum)
  8. Fever and/or chills
  9. Body aches
  10. Wheezing
  11. Shortness of breath
  12. Chest pain

The diagnosis involves taking a detailed history followed by a careful physical examination.  Laboratory studies may include blood work, throat culture, chest X-ray, and CT scan of the sinuses.

Prevention of respiratory tract infections can never be 100%, but there are some common sense things that should be done in order to minimize contracting and passing on the infection.  One should avoid contact with other sick individuals, wash one’s hands frequently, stay home from school and/or work if one develops symptoms, get vaccinations for influenza ( flu) annually, if appropriate for that individual, get the Pneumovax 23 and/or Prevnar 13 vaccination (pneumonia shots) if elderly or immunocompromised, consult your physician within 48 hours for known exposure to the flu so that an antiviral medication such as Tamiflu can be prescribed within 48 hours of the beginning of flu symptoms.  Note that there are rapid diagnostic tests which entail a quick painless nasal swab to diagnose the flu. The result of the test is back within 15 minutes. It can be done in order to determine if you have the flu.  Keep in mind that the tests are between 50-70% accurate, but can help the physician in the diagnosis.

Treatment may range anywhere from supportive care such as drinking plenty of fluids, rest, gargling with salt water, and over the counter medications, to treatment with antibiotics, antiviral medication, corticosteroids, bronchodilator medications, intravenous therapy, oxygen administration, and very rarely a surgical procedure may be necessary. The vast majority of upper respiratory infections will resolve on their own, since most of them are of viral origin.

The board certified allergists of Black & Kletz Allergy have been treating respiratory tract infections in the Washington, DC Northern Virginia, and Maryland metropolitan area for over 5 decades.  If you are experiencing any of the above symptoms, please contact us for an appointment at any one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA.  You can also click Request an Appointment and we will answer you within 24 hours of the next business day to schedule you an appointment. We strive to provide excellent care to our patients in a friendly, comfortable, and professional setting.