Month: June 2018

Mold Allergies and How They Can Affect You

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Molds are fungi that grow in the form of multicellular filaments that are called hyphae.  Fungi that grow in a single celled environment are called yeasts. Mildew is also a fungus that closely resembles mold; however, the color of mildew tends to be white whereas mold tends to be black, blue, green, or red.  Regardless, mold, mildew, and yeast can all play havoc to individuals who are either sensitive or allergic to them. Mold and mildew produce unwanted odors that many individuals find offensive or downright problematic as they can cause ailments to those exposed.

The physical appearance of molds usually is recognized by a discoloration and fuzziness presentation.  Molds can be found anywhere outdoors or indoors and are typically found on old or expired foods, rotten decaying debris (e.g. wet fallen leaves in the Fall, compost piles, grasses, rotting wood), and in places where increased moisture or water exists (e.g., basements, bathrooms, kitchens).  Molds produce mold spores which are their tiny microscopic reproductive structures. The size of a mold spore generally ranges from 3 to 45 microns in diameter which is less than half the width of a human hair. These spores begin to germinate and multiply. The spores multiply by producing reproductive hyphae.  They and are released into the air and given their microscopic size, they are able to float in the air sight unseen. Mold spores can grow in any environment with a constant source of moisture. There are even types of molds that can survive in very arid conditions such as deserts. During the growth process, mold spores begin to undergo chemical reactions that allow them to consume nutrients and further multiply.  These chemical reactions cause fumes to be released into the atmosphere. These fumes are responsible for the unpleasant musty mold odor. Of note, there are over 400,000 types of molds.

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the numbers of mold spores in the environment are generally higher than in many other parts of the country.  Washington, DC was built on a swamp. In addition, the Washington, DC metropolitan area tends to have a fairly high relative humidity when compared to many other areas of the U.S.  This combination exposes the residents of our metro area to a higher concentration of molds. In turn, it places us at a greater risk to develop mold allergies and other non-allergic mold-related conditions that may occur in sensitive individuals.  Non-allergic mold-related illnesses may result from either the growth of pathogenic molds within the body or from the effects of ingested or inhaled toxic compounds called mycotoxins which are produced by molds. The molds that produce mycotoxins can pose serious health risks to humans and animals.  Some studies claim that exposure to high levels of mycotoxins can lead to neurological problems and prolonged exposure may be particularly harmful. The research on the health effects of these types of molds has not been conclusive. The term “toxic mold” refers to molds that produce mycotoxins, such as Stachybotrys chartarum and not to all molds in general.

Mold allergies are very common and the symptoms are the same as other causes of hay fever (i.e., allergic rhinitis) and/or asthma.  The symptoms may include runny nose, sneezing, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, sinus headaches, wheezing, coughing, chest tightness, and/or shortness of breath.  Symptoms often worsen when a sensitive individual is in a damp or moldy environment such as a basement or crawl space.

Approximately 1-2% of patients with asthma have an allergic or hypersensitive reaction to a type of mold known as Aspergillus fumigatus.  Similarly, 2-15% of children with cystic fibrosis have the same reaction to this mold.  Aspergillus fumigatus is generally found in the soil.  Asthmatics and cystic fibrosis patients with that react to this mold have a condition called allergic bronchopulmonary aspergillosis (ABPA).  ABPA is more common in adolescents and male individuals.  The symptoms of ABPA are very much the same symptoms of asthma; however they may also cough up mucus with brownish flecks and may also have a mild fever.  The diagnostic workup may include radiographic studies, bloodwork, sputum culture, pulmonary function tests, and allergy skin testing. The treatment may involve the use of oral corticosteroids and/or antifungal medication in addition to the typical asthma medications such as corticosteroid inhalers, long-acting beta agonists, leukotriene antagonists, short-acting beta agonists, and/or theophyllines.

The diagnosis of mold allergy is done by a board certified allergist who will do a comprehensive history and physical examination.  Allergy testing to molds can be done via skin testing or blood testing.

Treatment of mold allergy should always begin by trying to prevent exposure to mold.  There are many things that can be done in one’s home or workplace that may help reduce one’s exposure.  Reducing the humidity, fixing any leaks, wearing a mask when doing yardwork, limiting outdoor activities when the mold counts are high, using air conditioning with a HEPA filter, installing a dehumidifier, and removing carpeting from places where it can get wet are some of the ways to reduce mold exposure.  The allergist may prescribe allergy medications (e.g., antihistamines, decongestants, nasal corticosteroids, nasal antihistamines, eye drops, leukotriene antagonists, asthma inhalers) to help alleviate one’s symptoms. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are extremely effective in the treatment of mold allergy.  They are effective in 80-85% of the patients who take them. They have been utilized in the U.S. for more than 100 years and get more to the root of the underlying problem by causing an individual to develop protective antibodies against mold as well as other allergens (e.g., pollens, dust mite, pets, cockroach).

The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean, VA offices are also Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergy doctors at Black & Kletz Allergy diagnose and treat both adult and pediatric patients.  To make an appointment, please call our office or you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been helping patients with mold allergies and other causes of hay fever, asthma, hivessinus diseaseeczemafood allergies, medication allergies, insect sting allergies, and immunological disorders for more than half a century.  If you suffer from mold allergies or any other type of allergies it is our mission to improve your quality of life by reducing or preventing your undesirable and irritating allergy symptoms.

Chronic Sinusitis

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Sinuses are air filled cavities within the facial bones.  They are located behind the forehead (e.g., frontal), behind the eyes (e.g., ethmoid, sphenoid), and behind the cheek bones (i.e., maxillary).  The membranes lining the inside of these cavities secrete mucus which normally drains into the nasal cavity through small openings.

When the nasal cavity becomes inflamed (i.e., rhinitis) either due to allergen or irritant exposure or due to microbial infections, the pores through which the sinuses drain can become clogged.  This clogging of the pores may lead to the back up of secretions within the enclosed sinus cavities. Accumulation of mucus within the sinuses can result in proliferation of viruses and bacteria and can lead to chronic sinus infections (i.e., chronic sinusitis), defined as persisting sinus-related symptoms lasting for more than 12 weeks.

The common symptoms of a chronic sinus infection or chronic inflammation of the sinuses may include facial pressure/pain, headache, discolored nasal and post-nasal secretions, cough and/or malaise.  The diagnosis of this condition requires a detailed history of onset and progression of specific symptoms, a physical examination, and imaging studies such as sinus X-rays and/or CT scans.

Some common medical treatments of chronic sinusitis are as follows and may include combinations of the treatment regimens listed below:

  1. Saline nasal sprays and/or irrigations:  These are useful in the mechanical clearance of irritants, allergens, and microbes from nasal and sinus cavities.  They are inexpensive and easy to use although they can cause some discomfort during usage is some individuals. Their main use is as an adjunctive therapy to other more specific treatments.
  2. Topical steroid sprays:  These are considered first-line treatments for chronic sinusitis.  They act by controlling inflammation and reducing the swelling of the tissues and decreasing excessive secretions. They are useful both in chronic sinusitis with nasal polyps and chronic sinusitis without polyps.  They are widely available and easy to use. Some of the potential drawbacks of topical steroids may include a burning sensation of the nose, headaches, sore throat, and/or occasional nosebleeds.
  3. 3. Topical antibiotics:  These are sometimes useful in local treatment of bacterial infections.  The effects are usually short-lived. These agents are not currently recommended for routine use but offer the potential for improved directed treatment as the ability to identify the effects of specific pathogens evolves.
  4. 4. Surfactants:  Some clinical trials demonstrated benefits of surfactants in the control of biofilms.  Surfactants are widely used as detergents, emulsifiers, foaming agents and dispersants in the cosmetics, hygiene, food, and oil industries. Their use in the medical field is also common, particularly within the field of wound care.  Many wound cleansers contain surfactants and help in the enhancement of wound closure. Their use however can be associated with considerable discomfort and their role in management of chronic sinusitis is not clearly determined at this time.
  5. Oral steroids:  They can effectively reduce inflammation and are especially useful for shrinking nasal polyps, though they also may result in the multisystem improvement of symptoms.  Due to their significant systemic side effects (e.g., weight gain, endocrine dysfunction, thinning of bones, peptic ulcers, cataract formation, depression), they are utilized judiciously and only for short periods of time.
  6. Oral antibiotics:  These are often used to control acute flare-ups of bacterial infections.  Some classes of drugs such as macrolides [(e.g., Biaxin (clarithromycin), Zithromax (azithromycin), erythromycin] also have anti-inflammatory effects in addition to their antibacterial properties.  Potential side effects include gastrointestinal distress and possible development of bacterial resistance on repeated usage.
  7. Biologicals:  As more research sheds light on specific inflammatory molecules and pathways driving the inflammation in chronic sinusitis (i.e., phenotypes and endotypes), biological medications can offer targeted and more effective treatment options.  The potential advantages are the reduced need for oral or topical steroids as well as the need for sinus surgery. A few of these agents are currently being used for the control of asthma but none of them have been currently approved for chronic sinusitis.

Preventive measures for chronic sinusitis include identification of specific allergen sensitivities by allergy testing by a board certified allergist.  Allergy testing can be done by skin testing or blood testing depending upon the circumstance and age of the patient.  The aggressive treatment of allergic seasonal and/or perennial rhinitis (i.e., hay fever) promotes proper sinus drainage and improves upper airway function.

The board certified allergists and immunologists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland  metropolitan area.  Our allergists have been treating chronic sinusitis as well as acute sinusitis and other sinus-related conditions for many years.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices 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 or someone you know has an allergic condition that predisposes you to sinus problems or sinus infections, please make an appointment so that we may help you.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years and would be happy to provide allergy and sinus relief for you in a caring and professional atmosphere.