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Month: April 2019

Allergy Shots for Eczema?

Allergy shotsEczema (i.e., atopic dermatitis) is a genetically determined condition which causes long term inflammation of the skin which may result in itching, thickening, redness, and occasionally ulcerations of the skin.  A similar appearance can sometimes be seen in other chronic skin conditions.

Eczema or atopic dermatitis affects an estimated 7% of the population with varying degrees of severity.  It often begins in early childhood and may wax and wane throughout a lifetime.  The severity can vary from mild dryness and/or excessive creasing of the skin to a severe debilitating illness presenting with painful sores and/or skin infections.  The intractable itching often does not respond to medications and may lead to loss of sleep, inability to focus on work and/or school, and/or emotional problems.

Unfortunately there is no known cure for the condition yet.  The flare-ups of this disorder are typically treated with topical and/or oral corticosteroid medications, which usually offer only short-term relief.  The numerous topical corticosteroids available vary in potency and should be prescribed based on the severity of the eczema as well as the location of the eczema on the body.  The side effects of the corticosteroid medications can also be worrisome, so it is important to use them sparingly and to avoid excessive use.  A few new non-steroidal topical medications and injectable biological medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis.  It is important to note that the response rates to these medications are highly variable.  There are also side effects one should be aware of regarding the biological medications in particular.

Allergy shots (i.e., allergen immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) is a systematic treatment option which helps the immune system to develop tolerance to the offending allergens that cause allergy symptoms.  As a result, individuals have less or even no allergy symptoms when subsequently exposed to these allergens.  This method has been practiced for over 100 years in the United States and is highly effective in reducing the symptoms and lessening the need for medications for patients with respiratory and eye allergies such as hay fever (i.e., allergic rhinitis), asthma, and allergic conjunctivitis.

Despite the fact that allergy immunotherapy is so efficacious in allergies of the respiratory tract and eyes, allergy immunotherapy has not been studied extensively in patients with eczema.  A case-study, however, presented at a recent annual scientific meeting of the American College of Asthma, Asthma & Immunology, offers hope.

In this case-study, a 48 year-old man who had suffered from severe eczema involving a large part of his body since his childhood was observed.  He had tried many therapies for years including both mild and high-strength topical corticosteroid creams, other topical anti-inflammatory creams, and topical moisturizer creams without adequate relief.

Since he also had respiratory allergy-related symptoms, his doctors tested him for environmental allergies and diagnosed him with sensitivity to dust mites, molds, animal dander, trees, grasses, and weeds.  In fact allergic rhinitis, asthma and eczema constitute the “atopic triad” and share a similar genetic predisposition.

Because his allergies could all be treated with allergy shots, his doctors thought that treating his allergies may also be beneficial for his eczema.  After one year of allergy shots, he reported significant improvement of his eczema symptoms.  Once he reached a maintenance dose on his allergy shots, he no longer needed high dose corticosteroid treatment for his eczema.

There is a need for more extensive controlled studies investigating the benefits of allergy shots for individuals with moderate to severe eczema.  If further studies substantiate the data observed in this patient, allergy shots have the potential to benefit thousands of people with severe recalcitrant eczema.

The board certified allergists at Black & Kletz Allergy see patients of all ages and have over 50 years of experience in the field of allergy, asthma, and immunology.  In addition to allergic rhinitis, allergic conjunctivitis, and asthma, skin disorders such as eczema, contact dermatitis, poison ivy, poison oak, poison sumac, hives (i.e., urticaria), generalized itching (i.e., pruritus) are common skin ailments that we routinely diagnose and treat.  Black & Kletz Allergy has 3 offices 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 and all locations have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy are happy to answer any questions or concerns you may have about any allergic, asthmatic, or immunologic concern.




Less Common Seasonal Allergy Symptoms

Seasonal AllergiesAs we enter the Spring season in the Washington, DC, Northern Virginia, and Maryland metropolitan area, many allergy sufferers will begin to experience the classic hay fever (i.e., allergic rhinitis and allergic conjunctivitis) and/or asthma symptoms.

The typical hay fever signs and symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, a horizontal crease at the bottom third of the nose, itchy nose, itchy eyes, watery eyes, redness of the eyes, puffy eyes, dark circles under the eyes, a line or fold in the skin below the lower eyelids, itchy mouth and throat, itchy ears, clogged ears, coughing, itchy skin, and/or sinus pressure.  In the Spring in the Washington, DC metro area, the tree and grass pollens as well as molds are generally to blame for these annoying allergy symptoms.  In the Fall, ragweed and molds are generally the culprits when it comes to causing hay fever symptoms.  Ragweed generally begins to pollinate in mid-August and is typically ends at the first frost which is usually at the end of October.

In asthmatics, the characteristic symptoms that may occur include chest tightness, wheezing, shortness of breath, and/or coughing.  The most common allergens that cause an increase of these asthma symptoms include tree pollens in the early Spring, grass pollens in the late Spring, and molds, which occur throughout the Spring.  It is important to know that molds are prevalent throughout every month of the year and are present both indoors and outdoors.  As mentioned in the paragraph above, ragweed, along with molds are the principle allergens that cause asthma exacerbations in the Fall.

It is interesting to note that there are a variety of other rarer symptoms that some individuals may notice in the Spring and Fall.  In fact, these symptoms may be perennial in nature which can be confusing since they can signify other medical conditions.  These less common allergy symptoms may include fatigue, “fogginess” feeling of the head, ringing of the ears (i.e., tinnitus), joint achiness, headaches, itchy mouth, abdominal pain, diarrhea, sore throat, behavioral issues (e.g., moodiness, hyperactivity, inability to concentrate), snoring, and/or rashes.

Note that the combination of fatigue, achiness, runny nose, nasal congestion, and sneezing can easily be misconstrued for the common cold.  One should be aware that the common cold is caused by a virus, and that in general, “colds” usually last no more than 7-10 days.  This means that if an individual is experiencing “cold” symptoms for a long period of time (i.e., greater than 2 weeks) and/or if he or she is experiencing recurrent “cold” symptoms every Spring or Fall, then allergies should be seriously considered and one should make an appointment with a board certified allergist such as the ones at Black & Kletz Allergy.

A few words about some of the less common seasonal allergy symptoms are discussed below:

  • Fatigue: Usually occurs due to poor quality or quantity of sleep as a result of poorly controlled allergies.  In some individuals, this fatigue can be rather severe.
  • “Fogginess” feeling of the head: May be due to increased sinus pressure.
  • Ringing of the ears: Usually due to blockage of the Eustachian tube which stems from sinus congestion.
  • Joint achiness: May be due to inflammation caused by allergies
  • Headaches: Seasonal allergic headaches are usually due to increased nasal and sinus congestion.  They tend to be in the forehead and cheek regions of the face.
  • Itchy mouth, Abdominal pain, and/or Diarrhea: Some pollen-allergic individuals have a condition called oral allergy syndrome (i.e., pollen-food allergy syndrome) whereby they have a local reaction in the gastrointestinal tract (i.e., mouth, esophagus, stomach) to certain foods (usually fresh fruits and/or vegetables).  Usually these individuals will experience an itchy mouth or throat from eating these raw fruits and vegetables, however, sometimes more severe gastrointestinal reactions may occur such as abdominal pain and/or diarrhea.  Some common cross-reactive foods and pollens include:  birch tree pollen – apples, pears, peaches, celery, carrots; ragweed pollen – melons, bananas, kiwi.
  • Sore throat: Usually associated with a post-nasal drip but can also be caused by excessive dryness due to the use of antihistamines.
  • Behavioral issues: Usually die to poor quality or quantity of sleep.
  • Snoring: Usually due to increased nasal congestion.  Note that an increase in nasal congestion may also worsen obstructive sleep apnea and thereby cause an increase in snoring.
  • Rashes: Seasonal allergies can cause a flare-up of eczema (i.e., atopic dermatitis).  Some allergic individuals may develop itching and rashes when they come in direct contact with an allergen such as grass.


The board certified allergy specialists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC metro area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean, VA office location offers a complementary shuttle that runs between this office and the Spring Hill metro station on the silver line.  For an appointment, please call one of our offices or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies or asthma, it is our mission to help alleviate or end your undesirable symptoms, so that you can enjoy a better quality of life.  We have been serving the community’s allergy and asthma needs for more than 50 years.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a caring, relaxed, and professional environment.