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Month: November 2019

Is It the Common Cold or Allergies

As we are in the Fall season and approaching Winter, many individuals may experience a clear runny nose, post-nasal drip, sneezing, sore throat, nasal congestion, sinus pressure, headache, coughing, and/or fatigue.  The question to many becomes, “Do I have a common cold or do I have Fall/Winter allergies? It is a common question to an even more common complaint. How does someone know if they are having allergies rather than the common cold?  Well, if someone does not have a history of allergic rhinitis (i.e., hay fever) and they develop the above-mentioned symptoms, they probably are not experiencing allergies, unless these symptoms persist for several weeks or more.  If the symptoms persist, one should consult a board certified allergist like the ones at Black & Kletz Allergy.  The allergy specialist can help identify if one has allergies vs. are the symptoms a result of a lingering cold or a secondary bacterial infection (e.g., sinus infection, upper respiratory infection, pneumonia)?

The common cold is caused by a variety of viruses (e.g., rhinovirus, human coronavirus, influenza viruses, parainfluenza virus, human respiratory syncytial virus (i.e., RSV), enteroviruses other than rhinovirus, and adenoviruses).  There are over 200 viruses associated with the common cold, although rhinovirus accounts for most of them. In addition, approximately 25% of colds are caused by unknown factors, which are presumed to be due to unidentifiable viruses.

Of particular importance to infants and young children is the human respiratory syncytial virus which can be fairly severe in these age groups and cause life-threatening illness in approximately 1-2% of infants and young children who get the virus.  RSV may also cause serious symptoms in individuals whose immune systems are compromised, as well as in individuals with chronic heart or lung disease. Most of the time, RSV has a mild self-limited course in children and adults resulting in a cold-like illness.  In fact, almost all children get RSV by the age of 2. It is only this 1-2% of infants and young children, some individuals whose immune systems are compromised, and some people with chronic heart or lung disease who go on to develop more serious symptoms which may include pneumonia (i.e., infection of the lungs), and/or bronchiolitis [i.e., inflammation of the bronchioles (small breathing tubes in the lungs].  Infants and young children with this more severe course often require intravenous antibiotics and fluids, oxygen, and sometimes need to be placed on a ventilator for a short period of time in order to help them through the respiratory distress that can accompany this virus. In addition, infants and young children that develop complications from RSV may be more likely to develop asthma in the future.

While discussing the common cold, there is a common myth to debunk regarding the development of the common cold and environmental factors.  It is a myth that being out in the cold weather will cause a cold. The traditional theory is that a cold can be “caught” by the prolonged exposure to cold weather, which is probably how the disease got its name.   It is much more likely that in the Fall and Winter months, when it happens to be cold outside, some of the viruses that cause the common cold occur more frequently during this time period.  If these viruses are more prevalent during this time period, it stands to reason that we are exposed to more of these viruses at this time and therefore are more likely to “catch” a cold in these colder months.  One other factor to consider is that once a few individuals develop colds, since it is easily transmissible, more and more people who are in close contact will then develop colds. This process becomes exponentially larger and before you know it, “almost everybody” has a cold.

What about someone who does have a history of allergies?  If they develop the classic symptoms of a cold in the Fall or Winter as mentioned in the first paragraph, is it their allergies or a common cold?  The same basic formula applies to them. If the symptoms are present for a week or two, one is to assume it is a common cold. However, if the symptoms last several weeks or more, then one is to assume that their allergies are playing a role.  The allergens that typically cause allergic rhinitis symptoms in the Fall and Winter include dust mites, molds, pets, cockroaches, and other animals such as rodents. Allergy testing can be done via skin or blood testing. If an environmental allergy is identified, it is important to try to prevent exposure to the allergens.  If that does not relieve the symptoms, then there are host of medications that can be utilized in order to help mitigate one’s allergy symptoms.

If you are suffering from a prolonged “cold” and/or are not sure if your symptoms may be due to allergies and you would like to be seen at one of Black & Kletz Allergy’s 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment.  Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day.  We offer parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations.  We also offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Black & Kletz Allergy provides a friendly and caring environment for you to get the top quality allergy, asthma, and immunology treatment that we have been providing the community for more than 50 years.

Mast Cell Disorders

master cell imageA mast cell is a component of the immune system that is involved in the allergic response.  Mast cells contain histamine and other chemical mediators. These chemicals are released into the bloodstream and then into the surrounding tissues during an allergic reaction.

In a disorder called “mastocytosis,” individuals harbor excessive numbers of mast cells in the bone marrow and other organs.  It is important to note that this condition may occur both in children and adults. Individuals with mastocytosis frequently experience generalized itching, flushing, skin rashes, abdominal cramps, nausea, vomiting, diarrhea, shortness of breath, dizziness, and/or passing out (i.e., syncope). 

Children are more likely to have symptoms limited to the skin whereas the majority of adults have systemic symptoms which usually involve multiple organ systems.  These symptoms are similar to that of anaphylaxis. In addition, these individuals are more sensitive to various triggers such as temperature changes, certain medications, spicy foods, alcohol, bee stings, etc.  Occasionally they suffer anaphylaxis spontaneously without exposure to any obvious trigger(s).

The first step in the diagnosis of this condition is a comprehensive history taking note of the specific symptoms, as well as their onset, progression, and severity.  Physical examination sometimes reveals freckle-like skin lesions called “urticaria pigmentosa” which typically appear over one’s thighs, abdomen, etc. These spot-like skin lesions can lead to hives (i.e., urticaria) upon stroking the skin (also known as Darier’s sign), as well as after exposure to temperature changes (e.g., taking hot showers).  This occurs as a result of the compression of mast cells.

The most helpful diagnostic laboratory test is a serum tryptase level, which is usually elevated in systemic mastocytosis.  Urine examination also can be useful in detecting higher levels of metabolites of various chemical mediators of allergic reactions.  Confirmation of the diagnosis usually requires a skin biopsy, bone-marrow examination, evaluation of organ functions, and occasionally genetic studies.

The usual course of treatment of this condition is avoidance of exposure to the known triggers of mast cell activation in order to prevent acute symptoms. There are several medications that are utilized in order to treat this condition.  Antihistamines block the effects of histamine, which is one of the most common mediators of allergic reactions. As a result, antihistamines [e.g., Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine)] are the most commonly used medications to treat mast cell disorders.  A medication called cromolyn is helpful to alleviate the gastrointestinal symptoms (i.e., abdominal cramping, nausea, vomiting) that may occur with mast cell disorders including. Aspirin, ketotifen and leukotriene modifiers [e.g., Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileuton)] are also sometimes employed in the treatment of mast cell disease.

It is important to note that individuals with mast cell disorders are also at risk for fractures due to osteopenia and/or osteoporosis, and bone health needs special attention.  More aggressive forms of systemic mastocytosis may require interferon, immune modulators, and/or chemotherapeutic agents.

All patients with established mast cell disorders need to have ready access to epinephrine auto-injectors (e.g., EpiPen, Auvi-Q, Adrenaclick) at all times to be used at the onset of symptoms suggestive of anaphylaxis.  Once used, it is important for the individual to go to the closest emergency room. It is also important for patients with mast cell disorders to make surgeons and anesthesiologists aware of their mast cell disorder in case a surgical procedure is needed, as surgery can also be a trigger systemic symptoms.

The board certified allergists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of mast cell disorders.  Black & Kletz Allergy treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at each location 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.  Please call our office to make an appointment or 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 Washington, DC metropolitan area for more than 50 years and we pride ourselves in providing excellent allergy and asthma care in a professional and pleasant setting.