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Month: October 2017

Influenza (Flu)

“Flu” season is almost here and it is time to get prepared for its onslaught.

Influenza is a highly contagious viral infection which is the cause of the “flu.”  It impacts people of all ages.  Though it can occur any time of the year, most cases are reported from October through March, with peaks between December and February of each year.  It affects between 5 to 20% of the U.S. population annually.  It accounts for thousands of lost school and work days.  It can be especially serious in the very young and the elderly.  Each year, more than 200,000 individuals are hospitalized and several thousand people die from the complications of influenza.


Influenza usually presents initially as “cold-like” symptoms with runny nose, nasal congestion, itchy and/ or burning eyes, sore throat, and a dry cough.  Fever (usually 100°F – 102 degrees° F) is usually present and can be associated with chills.  Muscle aches (e.g., body aches) and fatigue are extremely common.  Joint pains, joint stiffness, gastrointestinal manifestations (e.g., diarrhea, nausea, vomiting) may also occur, but are not as common.

The symptoms usually lasts for approximately 7 to 10 days, but the malaise can continue for several weeks. Pneumonia is not an uncommon complication of the influenza virus and can substantially prolong the duration of illness.  Like other viral infections, influenza can also trigger acute flare-ups of asthma and chronic obstructive pulmonary disease (COPD) in susceptible individuals.

The influenza virus spreads from human to human via aerosols created by coughs and/or sneezes of infected individuals.  The incubation period ranges from 18 – 72 hours.  Shedding of the virus continues for 5 – 10 days in most individuals, however the duration of the shedding is longer in young children and immunocompromised persons.


There are rapid diagnostic tests that can directly detect influenza A or B virus-associated antigens or enzymes within 30 minutes by testing material obtained from throat swabs or nasal swabs.  Due to the cost, availability, and sensitivity of these tests, however, most physicians diagnose influenza based on clinical criteria alone.


Most patients with influenza benefit from rest and increased fluid intake and generally recover in a few days, though the fatigue may persist for weeks.  Antiviral medications can reduce the duration and severity of illness.  To be effective, these drugs must be started within 40 hours of the onset of symptoms.  There are two common antiviral medications used in the treatment and prevention of influenza A and B.  The first medication is oseltamivir (i.e., Tamiflu) which is taken orally 75 mg. twice a day for 5 days for individuals over the age of 12.  If using oseltamivir for prophylaxis for individuals 5 years of age and over, the dose is 10 mg. once a day for 10 days, but can be used in adults and adolescents (13 years of age and older) for up to 6 weeks for a community outbreak.  Smaller doses are given to children between the ages of 1 and 12.  The second medication is called zanamivir (Relenza) and is taken by inhalation using a Diskhaler (i.e., a device similar to an asthma inhaler) 10 mg. twice a day for 5 days for individuals 7 years of age and over.  If using zanamivir for prophylaxis for individuals 5 years of age and over, the dose is 10 mg. once a day for 10 days, but can be used in adults and adolescents for up to 28 days for a community outbreak.  Zanamivir should not be used by anyone who has respiratory problems such as asthma or other lung diseases.


Avoiding exposure to infected individuals and maximizing personal hygiene (e.g., frequent hand-washing with soap and water, not touching one’s nose and eyes) are the first line of defense in preventing the spread of the influenza virus.

Each year in U.S., vaccines that contain antigens from the strains most likely to cause infection during the winter flu season are produced.  These vaccines become effective 10 – 14 days after administration. It is recommended that all persons 6 months of age and above receive a routine annual influenza vaccination.

Only injectable vaccines are recommended for use during the 2017 – 2018 season.  The live nasal spray vaccine (e.g., FluMist) is not recommended due to concerns about its effectiveness against the H1N1 strains of the viruses.  A number of inactivated as well as recombinant vaccines are available for this season. Trivalent vaccines are designed to protect against three different influenza viruses (2 influenza A viruses and 1 influenza B virus). Quadrivalent vaccines protect against the same three viruses as the trivalent vaccine plus an additional influenza B virus.

In 2016, only about 50% if children ages 6 months to 17 years of age received the vaccine.  In adults 65 years of age and above, approximately 66% received the vaccine.  In individuals from ages 18 through 64, the percentage of people vaccinated for influenza was less than the two cohorts mentioned above.  Needless to say, there is great room for improvement in vaccinating the population against such a potentially virulent illness.

Special Populations:

Pregnant women can receive any licensed inactivated or recombinant trivalent or quadrivalent vaccine.  It is always advisable to check with your Obstetrician/Gynecologist physician and get his or her approval before receiving a flu vaccination.

Children between 6 months and 8 years of age who have never been vaccinated will require two doses of influenza vaccine administered at least 4 weeks apart.  If a child received two or more doses before July 1, 2017, only one dose of 2017 – 2018 flu vaccine is recommended.

As per the Centers of Disease Control and Prevention (CDC), children and adults with a history of severe allergic reaction to egg (i.e., any symptom other than hives) should receive the influenza vaccine in a medical setting under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions.  A previous severe allergic reaction to the flu vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

The board certified allergy doctors at Black and Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We diagnose and treat both adult and pediatric patients.  The allergists at Black & Kletz Allergy are extremely knowledgeable about vaccinations as we specialize in immunological conditions. In addition, we also specialize in allergies (environmental, foods, insect stings, medications), asthma, sinus problems, eczemageneralized itching (pruritus)hives (urticaria)swelling episodes (angioedema), and eosinophilic disorders (e.g., eosinophilic esophagitis).  Each one of our offices offers on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle service that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

If you would like to make an appointment to see one of our board certified allergists, please call us today.  Alternatively, you may click Request an Appointment and we will respond to your inquiry within 24 hours by the next business day.  Black & Kletz Allergy has been serving the Washington, DC and Northern Virginia metro area for more than 50 years and we look forward to helping you with you allergy, asthma, and immunologic needs.

Allergies and Halloween

Halloween is just around the corner and most individuals do not think of allergies when thinking of Halloween.  They more aptly think of costumes, trick-or-treating, candy, bobbing for apples, skeletons and skulls, and Halloween parties.  It is a festive time of the year and both adults and children enjoy the holiday.  Even though adults enjoy the event, it is the children that really become excited!

You may have never pondered about the connection between Halloween and allergies and you would not be alone.  Unfortunately, approximately 8% of all children in the U.S. have some type of food allergy.  These kids and their families are generally the only ones who connect this cheerful holiday with food allergies.  There is a good reason for this as food allergies can be very serious and in some cases fatal.  Almost 40% of children with food allergies have had a severe reaction to a food.  About 30% of children with food allergies have multiple food allergies.  According to Centers for Disease Control and Prevention (CDC), food allergies in children have increased by 50% between the years 1997 and 2011.  Peanut is the most common food allergy in children followed by milk.  The other 6 foods that are in the top 8 most allergic foods, (in addition to peanut and milk mentioned above) include shellfish, tree nuts, soy, wheat, eggs, and fish.  These 8 foods account for 90% of all food allergy reactions.  It is not surprising that Halloween candy often contains 6 of the 8 most common food allergens.  You guessed it, fish and shellfish are generally not a problem in Halloween candy, however, peanuts, tree nuts, milk products, soy, eggs, and/or wheat are found in a multitude of Halloween candy.  It is important to note that in some cases, miniaturized candies often given out during Halloween may contain different ingredients than their full-sized versions.  In addition, many miniaturized candies do not have labels which make it nearly impossible for the parents to deem the candy safe for their child.

What can be done to insure that a “food allergic” child can participate in Halloween and have as much fun as the next child?  Nothing is guaranteed, however, there is a program run by the Food Allergy Research and Education (FARE) organization called the “Teal Pumpkin Project”.  This FARE-sponsored international program has been around since 2014.   It began in Tennessee, however, as a local crusade in 2012 by the mother of a severely food allergic child.  She also created a food allergy support group called the Food Allergy Community of East Tennessee (FACET).

The Teal Pumpkin Project’s aim is to raise awareness of the severity of food allergies and show support to families who have a food allergic child.  This is accomplished by painting a pumpkin teal and placing it on one’s front porch to signify that non-food treats are available at that location on Halloween night.  The color teal was used because it represents food allergy awareness.  Typically, non-food treats may include toys, stickers, crayons, glow sticks, hair accessories, rings, bracelets, necklaces, coins, bookmarks, spider rings, vampire fangs, whistles, balls, finger puppets, etc.

Another important point is to clarify that the Teal Pumpkin Project is not exclusionary and it still promotes the option of giving out normal trick-or-treat candy to children without food allergies.  It recommends that the non-food items be kept in a different bowl than the traditional candy bowl.  FARE provides a “Teal Pumpkin Project Participation Map” on its website so that participating houses can be easily assessed by the parents of food allergic children.

The board certified allergists at Black & Kletz Allergy support the efforts of FARE’s Teal Pumpkin Project and hope that our patients will continue to expand this endeavor.  We have always had a link, on the upper portion of our website under the blue “Resources” tab, to the Food Allergy Research Education (FARE) organization.   If you or your child suffer from food allergies, food intolerances, or eosinophilic esophagitis, please call us to make 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 offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas with on-site parking all 3 locations.  Our Washington, DC and McLean, VA locations are Metro accessible and we offer a free shuttle between our McLean, VA office and the Spring Hill metro station on the silver line.  We look forward to helping you with all your allergy, asthma, and immunology needs as we have been doing in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half century.