Month: March 2017

New Guidelines for the Prevention of Peanut Allergy

More 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

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 asthmasymptoms 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 pollenmold, 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 pollenmoldpetinsect 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 Appointmentand 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 Washington, 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.