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Month: March 2015

Peanut Allergy – New Developments

The vexing question about what to do about the alarming increase in peanut and other food allergies may have been finally answered.  The prevalence of peanut allergy tripled in the U.S. in the past decade while also rising in Africa and Asia.  It affects more than 1% of the U.S. population and is the leading cause of anaphylaxis and death from food allergy.  The American Academy of Pediatrics recommended in the year 2000, that parents refrain from feeding peanuts to children until 3 years of age hoping to reverse the trend.  However in 2008, after reviewing the published literature, the American Academy of Pediatrics retracted its recommendation, stating that there was insufficient evidence to call for early food avoidance.  Last month, (February of 2015), at the annual conference of the American Academy of Allergy, Asthma, and Immunology, the results of a landmark prospective, randomized controlled study addressing this issue were revealed and simultaneously published in the New England Journal of Medicine online.  The data strongly suggested that feeding peanut products regularly to infants with eczema, egg allergy, and a family history of food allergies from 6 months of age dramatically reduces the risk of peanut allergy, compared to children who avoided exposure to peanuts.  The differences in the two controlled groups were so stark that the guidelines are likely to be revised soon to promote early introduction of peanut products into the diets of at-risk children.

Prick skin testing with peanut extract and a blood test to measure antibodies to peanut protein are routinely employed in detecting allergic sensitivity to peanuts.  The recent availability of tests to measure antibodies to specific components of peanut proteins increased the predictability of adverse reactions on exposure to peanuts in sensitized children and adults.  These tests are also helping physicians to identify the appropriate patients and the clinical situations for in-office oral challenges with peanut products, which is the gold standard in the accurate diagnosis of peanut allergy.

In the past decade, a number of small, largely uncontrolled clinical trials have suggested that oral immunotherapy (giving children with peanut allergies increasing doses of peanut flour or peanut extract by mouth over time) can effectively desensitize many children with peanut allergy.  Although peanut oral immunotherapy shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice.  Until more data is available, strict peanut avoidance is the current standard of care.

The board certified allergists/immunologists at Black & Kletz Allergy are can answer your questions and address your concerns regarding peanut allergies or any other type of allergy.  We have been serving the Washington, DC, Northern Virginia, Maryland metropolitan area for over 50 years and offer 3 convenient locations with parking.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our Washington, DC and McLean, VA are accessible by the Metro.  Please call us at one of our locations to schedule an appointment or you can Request an Appointment online on our website and we will respond within 24 hours by the next business day.

Tree Pollen Allergies in the Washington, DC Metropolitan Area

Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from hay fever (allergic rhinitis).   In the early Spring, tree pollen is mainly responsible for the symptoms that cause hay fever.

There are of course molds in the air simultaneously, but they are always present in Washington.  In the DC area, trees usually begin to pollinate at the end of February, peak in mid- to late-April and continue to pollinate through late May and occasionally through early June.  Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar.  Later in the season, the predominant tree that causes problems for individuals with tree pollen allergies is the oak tree.  Other tress that pollinate in this later time frame include hickory, walnut, and pine.

It is interesting to note that, in general, people are not allergic to flowering trees (i.e., cherry tree, dogwood tree).  Many people think they are allergic to flowering trees because they develop allergy symptoms when these trees are in bloom, however, it is usually not due to these trees, but due to other non-flowering trees that happen to pollinate at the same time.  Nature is behind this sleight of hand trickery.  Flowering trees have pollen that is fairly heavy in weight.  Since the pollen is heavy, it is not easily wind-disbursed and as a result, individuals do not breathe in the pollen and thus do not become sensitized to these pollens.  The flowers are present in order to attract insects such as bees.  When the bee lands on the flower, the pollen sticks to the abdomen of the bee.  The bee will then fly to another flower of another tree and the pollen will intermingle with that flower.  It is by this method that cross-pollination is achieved, made possible by the aid of the bees.  Non-flowering trees such as cedar, maple, elm, alder, birch, poplar, oak, hickory, walnut, etc. have very light weight pollen.  These pollens are easily wind-disbursed.  It is these wind-disbursed tree pollens that individuals breathe in and become sensitized to, that are the cause of hay fever symptoms in sensitized people.  It just so happens that people develop their hay fever symptoms at the same time when the flowering trees bloom.  People then associate these flowering trees with their symptoms and blame their symptoms on the wrong trees.

The symptoms of tree pollen allergies are the classic symptoms of hay fever.  They can include any or all of the following:  runny nose, stuffy nose, post-nasal drip (which can lead to a sore throat, hoarseness, and/or cough), sneezing, itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, itchy throat, sinus pressure and/or pain, wheezing, chest tightness, cough, and/or shortness of breath.

The following are some measures that can be taken to reduce one’s exposure to the tree pollen in the Spring besides living in a “plastic bubble:” It is advisable to keep one’s windows and sunroof closed.  It is advisable to turn on the air conditioner and change air filters regularly (about once a month).  Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside.  Choose an automobile that has a filter in its air conditioning unit, if possible.  Avoid yard work and mowing lawns.  If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen.  If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure.  Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry tree pollen on their coats.  Monitor pollen counts daily.  Click Today’s Pollen Count to view the daily pollen count.  Stay indoors wherever possible when the pollen count is high (generally on dry warmer days).  Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days.  Avoid drying clothes outdoors when the pollen count is elevated.  Avoid contact lenses which may trap pollen in one’s eyes.  Since pollen is released in the early mornings, try to avoid exercising during this time.

The diagnosis and treatment of tree pollen allergies begins with a thorough history and physical examination by a board certified allergist.  Our board certified allergists in both adult and pediatric allergy at Black & Kletz Allergy have had more than 50 years of experience diagnosing and treating tree pollen allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  After the history and physical examination, allergy testing is usually done by skin testing, or in some cases, by blood tests to confirm if the patient is in fact allergic to trees.  Once confirmed, there are a multitude of treatment options to alleviate the annoying symptoms of tree pollen allergies.  In addition to pollen avoidance measures in the above paragraph, the treatment of tree pollen allergies includes medications which can include oral medications (tablets, capsules, syrups, granules, etc.), nasal sprays, eye drops, and/or lung inhalers.  If there are additional environmental allergens that are found in a particular person which correlate with his/her symptoms during a different time of the year (Fall, Winter, etc.), then allergy shots (also referred to as “allergy immunotherapy” or “allergy desensitization”) may be a great way to treat the pollen allergy.  They are extremely effective and have been available for over 100 years.

If you would like a consultation for your hay fever symptoms, please do not hesitate to call Black & Kletz Allergy to make an appointment.  Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day.  We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is parking at each location and the Washington, DC and McLean, VA locations are accessible by using the Metro.  Whether your hay fever symptoms are seasonal or perennial, we would be happy to help you.