Month: February 2017

Allergies to Vaccines

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

5 Unusual Allergies that are Not Uncommon

Most people are aware of many of the typical allergies that a lot of individuals suffer from, but did you know that there are many unusual allergies that are kind of common?  Some of the classic allergies or allergic conditions that most people have heard about include hay fever (i.e., allergic rhinitis), food allergies, medication allergies, insect sting allergies, asthmahives (i.e., urticaria), and eczema.  There are however some unfamiliar allergies that exist that one may want to be aware of, as they are not uncommon.

Allergy to Vibration

The medical term for this allergy is vibratory urticaria.  Individuals with this condition develop hives on the skin where they have been exposed to vibration or repetitive stimulation.  Individuals who work with jackhammers may develop hives on their hands.  People who mow the lawn may get hives on their hands or if they use a riding lawn mower, they may also develop hives on any part of their body that vibrates.  Hand clapping and drying oneself with a towel are also common causes.  The hives may be accompanied by itching, swelling, and/or local redness.  They generally occur within 10 minutes after stimulation of the skin and typically last less than 2 hours, although more severe reactions are known to occur.  Treatment is based on prevention, antihistamines, and other medications.

Allergy to Kissing

This actually is usually due to the person being allergic to a medication, cosmetic, and/or specific food such as peanuts, tree nuts, fish, and shellfish, although any food can cause this condition.  There are reported cases of allergic individuals that have kissed another person who had recently eaten a food that the allergic individual was allergic to resulting in an allergic reaction in the allergic individual.  The allergic reaction can be mild (e.g., itchy lips, itchy mouth, rash on lips, rash in mouth), moderate, or severe (e.g., hives, wheezing, shortness of breath, throat swelling, anaphylaxis), which can be life-threatening.  In fact, there have been fatalities documented.  Understanding what allergies you have is the first step to preventing this type of unwanted allergic reaction.

Allergy to the Sun

Often referred to as solar urticaria, this condition and is characterized by itching, burning, and hives in sun-exposed areas of the body.  In some individuals, they can occur on parts of the body that are covered by thin light clothing.  The symptoms usually occur within a half-hour of sun exposure and usually lasts for a few hours after there is no more sun exposure.  The disorder can occur from natural sunlight or artificial lighting.  Treatment generally involves avoiding sunlight, antihistamines, Xolair (i.e., omalizumab) injections, and/or UV light treatments.

Allergy to Money

This may sound made up, but it is not uncommon for some individuals to develop rashes on their hands which usually begins about 24-48 hours after handling coins.  The rashes can consist of blisters, redness, and/or dry skin and be accompanied by itching.  The nickel in the coins is usually the culprit and nickel allergy is a fairly common cause of this contact dermatitis.  People who handle money often such as cashiers and bank tellers, as well as jewelers (i.e., jewelry often contains traces of nickel) are more prone to this condition.  People with this condition may also be bothered when they eat foods that are high in nickel (i.e., cocoa, soybeans, kidney beans, cashews, spinach).  In addition to avoiding nickel, the treatment may include antihistamines, moisturizing creams, corticosteroid creams, and oral corticosteroids.

Allergy to Exercise

If you don’t feel like exercising, you may have a legitimate reason why.  Exercise may cause many symptoms that are found in other allergic conditions.  Exercise in some individuals may be a trigger and cause that individual to wheeze, become short of breath, develop chest tightness, and/or cough.  This is often referred to exercise-induced asthma.  In others, exercise may trigger generalized itching (i.e., pruritus), hives, swelling (i.e., angioedema), and/or anaphylaxis.  These symptoms generally occur within minutes of completion of an exercise routine, but can occur during exercise itself.  The symptoms generally subside within 3 hours.  In a more unusual and rare condition, there is a condition where an individual will develop any of the above symptoms if they eat a certain food within 2 hours of exercising.  These individuals can exercise without problems and they can eat that certain food without problems, but if they consume that food and exercise within 2 hours, the allergy or asthma symptoms occur.  The foods most commonly associated with this condition include celery, shellfish, wheat, nuts, legumes, and seeds, although any food can trigger this condition referred to as “food-dependent exercise-induced” asthma, pruritus, urticarial, angioedema, and/or anaphylaxis.

The board certified allergists at Black & Kletz Allergy have treated numerous patients with all of the above conditions in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  We treat both adults and children and we have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  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 our McLean, VA office and the Spring Hill metro station on the silver line.  If you would like to be seen for hay fever, asthma, hives, swelling episodes, generalized itching, eczema, insect sting allergies, food allergies, medication allergies, or any other allergy or immunologic condition, please call us to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours of the next business day.  Black & Kletz Allergy is proud to continue to provide high quality allergy and asthma care to the Washington, DC metropolitan area.