Month: May 2016

Asthma and Aspirin

Providers of Asthma Treatment Gainesville VA Patients Trust: Dr. Kletz & Dr. Gondi
Any provider of asthma treatment in Gainesville can tell you that about 10% of all adults with asthma may have a condition called Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad, or Aspirin-Sensitive Asthma.

The 3 components of the disease are:

  1. Persistent asthma
  2. Chronic inflammation in the nose and sinuses with polyp formation
  3. Allergic sensitivity to aspirin and other non-steroidal anti-inflammatory drugs NSAID’s

The asthma associated with AERD tends to be more severe and poorly responsive to the usual treatments.  When providing the treatment for allergies and asthma Gainesville VA residents need, we see that most patients also suffer from recurrent sinus infections and often experience a reduced sense of smell and/or taste.

The adverse reactions on exposure to aspirin and/or NSAID’s can include:

  1. Flushing, rash, and/or itching
  2. Increased nasal congestion
  3. Facial pain and headache over the forehead region
  4. Coughing, wheezing, and/or heaviness in the chest
  5. Abdominal cramps and/or nausea
  6. Dizziness

What causes it?

AERD is not a genetic or inherited condition.  The exact cause of the disorder is not known at this time, although a lot of research is being done in order to try to find a cause.  The patients have higher than normal levels of eosinophils (i.e., a type of white blood cell that tends to be high in allergic individuals) in their blood and in the sinuses, and these cells usually play a role in causing chronic allergic inflammation.  They also have high levels of substances called leukotrienes which also cause inflammation.  Ingestion of aspirin and/or NSAID’s leads to a further increase in these leukotrienes resulting in a flare-up of asthma symptoms.

How is it treated?

  1. Patients who are diagnosed with AERD and who have not been desensitized to aspirin should always avoid taking aspirin and other NSAID’s like ibuprofen (e.g., Motrin, Advil) naproxen (e.g., Naprosyn, Aleve), diclofenac (e.g., Voltaren, Arthrotec), indomethacin (e.g., Indocin), meloxicam (e.g., Mobic), piroxicam (e.g., Feldene), nabumatone (e.g., Relafen), sulindac (e.g., Clinoril), ketorolac (e.g., Toradol), oxaprozin (e.g., Daypro), etc.  Acetaminophen (e.g., Tylenol) is a suitable alternative medication for relief of pain. Certain related non-steroidal anti-inflammatory drugs called COX-2 inhibitors like celecoxib (Celebrex) may be safer alternatives to aspirin in some individuals.
  2. In spite of avoiding these drugs, many patients will continue to experience frequent asthma symptoms, repeated sinus problems, and growth of nasal polyps.  They may need daily inhaled corticosteroid medications into their lungs to control asthma and daily corticosteroid nasal sprays and saline irrigations into their nostrils to control nasal congestion and polyps.
  3. Medications that inhibit leukotrienes like zileuton (Zyflo), which reduce the production of leukotrienes, or montelukast (Singulair) and zafirlukast (Accolate), which block the effects of leukotrienes on tissues can be helpful in certain patients to reduce the exacerbation of symptoms.
  4. Many patients also need sinus surgery and removal of nasal polyps, often more than once, as polyps tend to regrow after the surgery.  Regular use of intranasal corticosteroids and oral leukotriene modifiers after the surgery can help some patients in slowing the progression of their disease.
  5. Aspirin desensitization (i.e., the administration of gradually increasing doses of aspirin under close monitoring in a hospital or clinic, followed by daily intake of a standard maintenance dose of aspirin by mouth) has been shown to reduce the need for medications and the number of surgeries in some patients with AERD who were unresponsive to other standard treatments.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults andchildren with asthma, AERD, sinus disease, nasal polyps, other allergic and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also 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 or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to administer high quality allergy and asthma care in a caring professional environment.

Allergist Gainesville VA: Can Allergies Cause Dental Problems?

Dr. Kletz & Dr. Gondi, Trusted Gainesville Allergists, Discuss Dental Problems and Allergies
As allergists that Gainesville, VA calls upon, we know that when one thinks about allergies and allergy symptoms, dental problems usually do not come to mind.  In fact, most people tend to separate dental and medical problems into two distinct categories.  Medical diseases can and do influence your dental health.  Most people know that certain heart defects and murmurs may require premedication with antibiotics in order to prevent subacute bacterial endocarditis.  Patients with GERD (gastroesophageal reflux disease), Sjögren’s syndrome, anorexia, and bulimia are more prone to cavities of the teeth.  There are many more medical conditions which can have profound implications on the health of one’s teeth which will not be discussed.

What about allergies?  Can they cause dental problems?  The simple answer to this question is:  Yes

Many children with hay fever (allergic rhinitis) have nasal congestion as a major feature of their disease.  The nasal congestion frequently causes these children to become “mouth breathers,” since they are unable to breathe through their noses.  As the children grow, they develop a narrow high upper arched palate in their mouths which results in malocclusion (i.e., poor bite) of their teeth.  The teeth grow in crooked usually resulting in the need for costly braces by an Orthodontist.  Seeing a board certified allergist like the ones at Black & Kletz Allergy in the Gainesville, VA, Falls Church, VA , and Tysons Corner, VA areas can prevent this type of dental problem in children if addressed early on.  The allergists at Black & Kletz Allergy would perform a comprehensive history and physical examination and likely do allergy testing to find out if and what the child is allergic to in the environment.  Allergies to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, and cockroaches are very common allergens that can cause chronic nasal congestion.  There are other nasal conditions, such as nasal polyps, which are usually due to an underlying allergy that can also cause chronic nasal congestion.  After fully evaluating the child, a treatment plan would be discussed with the parent(s) which may include measures to avoid the offending allergen, use medications in the forms of syrups, powders, tablets, capsules, nasal sprays, eye drops, and/or begin a course of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization).  Allergy immunotherapy or allergy shots are very effective as they work in 80-85% of the individuals taking them.  They are given to people ranging in age from young children through the elderly.  They have been given in the U.S. for over 100 years.  Treating the hay fever early in its course is very effective in preventing the dental malocclusion that occurs too often in untreated individuals with this condition.

Another problem that people face when it comes to allergies and dentistry is the common “I am allergic to Novocain” response that dentists hear over and over again from patients.  We, as allergists near Gainesville, VA, also hear this common complaint.  Dentists frequently have to use a “numbing medicine” before they can do certain dental procedures such as root canals, pulling teeth, dental implants, putting in crowns, etc. in order to prevent pain from occurring in their patients.  Many times the “allergy” symptoms described are really a side effect of the Epinephrine (adrenaline) that is frequently mixed in with the “numbing medicine” rather than a true allergy to the “numbing medicine” itself.  Epinephrine is usually mixed in with the “numbing medicine” as a way to constrict the small blood vessels in the mouth which helps prevent excessive bleeding.  The most common “numbing medicines” or local anesthetics used are categorized as “Caine drugs.”  (See “Medication Allergies”).  Some examples of “Caine drugs” include Novacain (procaine), Xylocaine (lidocaine), Carbocaine (mepivacaine), Marcaine (bupivacaine), and Pontocaine (tetracaine).  Some individuals are truly allergic to the local anesthetic and some are even allergic to the preservatives found in the local anesthetic.  It turns out, however, that most individuals who think they are allergic to a “Caine drug” usually are not when skin tested by an allergist.  It is important, however, to see a board certified allergist and have skin testing performed to rule out a “Caine drug” allergy, as such an allergy can be very serious and potentially life-threatening.  The allergy doctors in the Gainesville, VA, Falls Church, VA, and Tysons Corner, VA areas at Black & Kletz Allergy routinely see patients with this potential allergy and skin test them to a specific local anesthetic in the “Caine drug” class at one of our 3 office locations in theWashington, DC, Northern Virginia, and Maryland metropolitan area.  If the skin testing to a specific “Caine drug” is negative, then the allergist will let your dentist know that is fine to use that particular medication.  Note that it is possible to be allergic to one specific “Caine drug” but not another specific “Caine drug.” (Example: One can be allergic to Novacain but not Xylocaine).

The board certified allergists at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning local anesthetic allergy testing as well as other medication allergy testing such as penicillin testing.  Black & Kletz Allergy has locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at each location and the Washington, DC and McLean offices are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergist, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been providing quality allergy care to the DC metro area for more than a half century.