Month: April 2017

Shortage of Venom Extracts

Most insect bites cause “local reactions” resulting in redness and/or swelling at the site of the bite which usually subsides in a few days.  However, stings by 5 different types of insects (honey bee, yellow jacket, yellow-faced hornet, white-faced hornet, and wasp) belonging to the Hymenoptera species, can cause a life-threatening “systemic reaction” (i.e., anaphylaxis) in sensitized individuals.  Approximately 5% of the population has had systemic reactions to stinging insects.

The more common symptoms of anaphylaxis may include:

  • Swelling of the lips, face, throat, and/or tongue (i.e., angioedema)
  • Difficulty breathing, wheezing, chest tightness, and/or coughing
  • Dizziness or lightheadedness which could signify a drop in one’s blood pressure
  • Abdominal cramping and/or diarrhea
  • Nausea and/or vomiting
  • Generalized itchiness (i.e. pruritus) and/or hives (i.e., urticaria)

Avoidance of stings by insects is not always possible and the reactions tend to get progressively more severe with each sting.  In fact, many fatalities are reported in the U.Ss every year from insect stings.

A highly effective form of treatment called venom immunotherapy (i.e., allergy shots for venoms) significantly reduces the risk of severe reactions in sensitized people.  The process involves building up tolerance by injecting gradually increasing doses of commercially made “extracts” from the insect venoms at regular intervals.  Venom immunotherapy has been credited with saving a number of lives and helps people live without fear of a serious reaction from insect stings.  Venom immunotherapy is effective in preventing a systemic reaction to further insect stings in approximately 95% of individuals that go on such treatment.

In the U.S., there are only two companies (i.e., ALK and HollisterStier) which manufacture insect venom extracts which are utilized as antigens during venom immunotherapy.  Unfortunately, since October 2016, ALK Laboratories has notified that it is unable to fill orders for Hymenoptera venom extracts due to manufacturing difficulties.  It is not known how long it will take to restore normal production and distribution.

HollisterStier has indicated that it is doing everything possible to equitably distribute the available venom and to ramp up production of the venoms to help deal with the shortage. However, it is expected that increased production will take time to reach the market.

As the demand now exceeds supply, there is a need to judiciously manage the reduced availability of commercial extracts.  The American Academy of Allergy, Asthma, and Immunology came up with guidance for allergy/immunology practices all over the country regarding the measures that are needed to mitigate the venom shortage that likely will exist for some period of time.

There are 4 strategies to be considered until the shortage eases up:

  • Increasing the maintenance interval
  • Decreasing the maintenance dose
  • Suspending or restricting treatment in patients with the lowest risk of severe reaction to stings
  • Scrupulous avoidance of wastage of extracts in mixing and administration

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the board certified allergists at Black & Kletz Allergy are striving to increase the supply of venom extracts by following the recommendations of the American Academy of Allergy, Asthma, and Immunology in order to make available the extracts to our patients according to their risk profiles.  Black & Kletz Allergy treats both adults and children for venom sensitivities and we have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA 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.

We encourage all our patients to call us and discuss their concerns over the venom shortage situation and we would be happy to answer any questions that may arise.  If you would like to make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.

Allergies or the Common Cold?

How does one distinguish whether they have a common cold or if they are bothered by allergies?  This question plagues many individuals all the time.  It may not be easy to differentiate the two maladies since the two conditions have a lot of crossover signs and symptoms.  An allergist in Northern Virginia and Washington, DC which can be found at Black & Kletz Allergy can help you in the differentiation among these two conditions.  In the Washington, DC, Northern Virginia, and Maryland metropolitan area, as well as the rest of the country, the common symptoms of both conditions may include runny nose, nasal congestion, post-nasal drip, sore throat, sneezing, sinus headaches, fatigue, snoring, and/or coughing.  In addition, asthma is often exacerbated with both allergies as well as the common cold causing wheezing, chest tightness, and/or shortness of breath and is also treated in the metro DC area by an allergist in Northern VA and/or Washington, DC.

In allergic rhinitis (i.e., hay fever), additional symptoms may also include itchy nose, itchy eyes, watery eyes, puffy eyes, dark circles under the eyes, and/or itchy throat.  When a common cold occurs, additional symptoms may include fevers, chills, achiness, and/or sweating.  One of the most telling signs that the symptoms are more consistent with allergic rhinitis (i.e., hay fever) rather than the common cold is if the signs and/or symptoms persist more than 1 week in duration.  Generally, the common cold and/or viral upper respiratory tract infection (i.e., URI), usually last 1 week or less.  Allergic rhinitis is an allergic condition that individuals suffer from generally for at least several weeks or more.  If the allergic rhinitis is seasonal, it may only occur when the pollen count is high.  For example, in the Spring in the Washington, DC metro area, the tree pollen usually pollinates typically from the end of February through mid-May and tree-allergy sufferers usually experience symptoms during that time period.  However, if a person is only allergic to a specific type of tree (e.g., birch, maple, oak), they will only exhibit symptoms when that specific tree pollen is pollinating.  Still, however, the time period is much longer than 1 week.  From May through early August, the grass pollinates in the Washington, DC area and an allergist in Northern Virginia and DC can help patients that are bothered by grass pollen.  Lastly, regarding pollen, ragweed in the DC metro area usually begins in mid-August and generally finishes pollinating after the first frost which usually occurs at the end of October.  Like the other pollens, an allergist in Northern VA, such as the ones at Black & Kletz Allergy can perform allergy testing via skin testing or by blood testing in order to determine one’s allergies.

An allergist in Northern Virginia and Washington, DC can help you determine if you have allergies, and to which allergens.  In addition, an allergist in Northern VA and/or Washington, DC can also recommend ways to prevent or minimize one’s exposure to allergens, as well as prescribe medications to combat one’s allergies.  An allergist in Northern Virginia and Washington, DC, like the ones at Black & Kletz Allergy can also place an individual on allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization) which help allergy patients 80 -85% of the time.  They are very effective and have been given for more than 100 years.

An allergist in Northern Virginia and Washington, DC that is board certified can be found at Black & Kletz Allergy.  We diagnose and treat both adultsand children.  We have 3 convenient offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  If you suffer from allergies, asthma, sinus problems, hives, the common cold and other infections, swelling episodes, and/or eczema, please call our office to schedule an appointment with an allergist in Northern VA and/or Washington, DC.  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 the McLean, VA office and the Spring Hill metro station on the silver line.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergists at Black & Kletz Allergy pride themselves in serving the greater Washington, DC area for providing high quality allergy and asthma care as we have been doing for more than 50 years.