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Month: October 2020

Hypereosinophilic Syndrome

Eosinophils are types of white blood cells which are part of our normal immune system. They tend to be elevated in allergic disorders. Eosinophils also play an important role in protecting us from certain infections and infestations from parasitic organisms.

Hypereosinophilic syndrome (HES) refers to a condition where there are excessive numbers of eosinophils in the bloodstream. Normally there are less than 500 eosinophils per microliter of blood. HES is defined as having equal or more than 1,500 eosinophils per microliter consistently for more than 6 months.

Though we need eosinophils for defending us from microbes and helminths (i.e., parasitic worms), excessive numbers can be deleterious. These cells accumulate in tissues and cause inflammation. The resultant inflammation may lead to dysfunction of various organs. The most common organs that are typically affected are the skin, heart, lungs, bone marrow, gastrointestinal tract, and nervous system.

The exact prevalence of this condition is unknown however, it is estimated to occur in between 1 and 9 persons per 100,000 population. It is found equally in both sexes and is most common in middle-aged individuals, though it can occur in any age group.


Certain genetic abnormalities in chromosome 4 were observed in some affected individuals. Infestations by helminths (e.g., roundworm, hookworm) could be a trigger for this condition in a few individuals. In a vast majority of cases however, no cause can be identified. When no cause is recognized, the condition is called idiopathic hypereosinophilic syndrome.


The organ system and corresponding symptoms of hypereosinophilic syndrome may include the following:


The diagnostic tests are individualized according to the particular symptoms of the patient and may include:

  • Blood test to screen for number of eosinophils
  • Stool evaluation to detect a parasitic infection
  • Allergy testing to diagnose environmental, medication, and/or food allergies
  • Biopsies of the skin or other organs
  • Blood tests to screen for autoimmunity
  • CT imaging of the affected organs
  • Genetic and molecular studies
  • Chest X-ray and echocardiogram
  • Liver and kidney function tests
  • Serum tryptase levels
  • Miscellaneous tests to evaluate for cancers


The treatment for hypereosinophilic syndrome is aimed at reducing the numbers of eosinophils in order to prevent or restrict tissue damage and preserve organ function. Some of the medications that are used to treat HES may include:

  • Corticosteroids: Prednisone, dexamethasone
  • Chemotherapeutic agents: Hydroxyurea, chlorambucil, vincristine
  • Cytokines: Interferon alpha
  • Tyrosine kinase inhibitors: Gleevec (i.e., imatinib) is also used to treat acute lymphocytic leukemia and chronic myelogenous leukemia that are Philadelphia chromosome-positive, certain types of gastrointestinal stromal tumors, chronic eosinophilic leukemia, systemic mastocytosis, and myelodysplastic syndrome.
  • Monoclonal antibodies: Nucala (i.e., mepolizumab was approved by the FDA for the treatment of hypereosinophilic syndrome in the last week of September 2020 for patients 12 years of age and above at the dose of 300 mg. subcutaneous injection every 4 weeks.


The outlook for hypereosinophilic syndrome has improved significantly in recent years. In 1975, only 12% of HES patients survived 3 years. Today in 2020, more than 80% of HES patients survive 5 years or more.

The board certified allergists of Black & Kletz Allergy have been diagnosing and treating both adults and children in the Washington, DC, Northern VA, and Maryland metropolitan area for over 5 decades. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at all of the offices. The Washington, DC and McLean, VA office locations are Metro accessible and there is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. Our allergy doctors of Black & Kletz Allergy specialize in all types of allergic conditions including hypereosinophilic syndrome. They are also experts in the treatment of allergic rhinitis (i.e., hay fever), asthma, sinus disease, hives (i.e., urticaria) , eczema (atopic dermatitis), swelling problems, medication and food allergies, and immunological disorders. If you would like to schedule an appointment, please call us or alternatively you can click Request an Appointment and we will respond back to you within 24 hours on the next business day. Our goal at Black & Kletz Allergy is to serve the greater Washington, DC metropolitan community with top-notch allergy care with boundless dedication and great pride as we have done for many years.

Sinus Infections

Sinus infections are quite common. They can vary in severity from being a nuisance on one end of the spectrum to severe and debilitating on the other end. The sinuses referred to in “sinus infections” are actually called “paranasal” sinuses because they are “near the nose.” Paranasal sinuses are cavities in the cranial and facial bones (i.e, skull) near the nose which help in filtering and moisturizing inhaled air that is inhaled through the nose. They also lighten the weight of the skull and are involved with voice resonance. There are 4 pairs of sinuses named for the corresponding bone that they are situated upon:

  • Maxillary sinuses: Located on the cheekbones to the right and left of the nostrils.
  • Frontal sinuses: Located above the eyes in the forehead region.
  • Ethmoid sinuses: Located on each side of the upper nose between the eyes.
  • Sphenoid sinuses: Located behind the eyes in the deeper recesses of the skull.

In the medical field, sinus infections are referred to as “sinusitis.” Technically, the word sinusitis means inflammation of the sinuses. Sinusitis can be classified into 4 main types: acute sinusitis, subacute sinusitis, chronic sinusitis, and recurrent sinusitis.

  • Acute sinusitis: Lasts less than 4 weeks. Usually comes on suddenly. Most often caused by viruses such as the common cold, although bacteria and less often, fungi are responsible for this type of sinusitis. Allergic rhinitis (i.e., hay fever) is a risk factor.
  • Subacute sinusitis: Lasts 4-12 weeks. Commonly occurs with bacterial infections or partially treated infections. Allergic rhinitis is a risk factor.
  • Chronic sinusitis: Lasts greater than 12 weeks. Commonly occurs with bacterial or rarely fungal sinus infections. Partially treated acute or subacute sinus infections may fester into a chronic sinus infection. Allergic rhinitis is a risk factor.
  • Recurrent sinusitis: Sinus infection occurs 4 or more times a year.

Sinus infections are usually caused by viruses; however, bacteria, fungi, and parasites can also infect the sinuses. It should be noted that bacterial sinus infections are much more common than fungal infections and parasitic infections of the sinuses are quite rare. Sinus infections occur when fluid builds up in the air-filled sinus cavities. In addition to the fluid buildup, the affected sinuses become inflamed. This inflammation causes an increase in the internal pressure of these sinuses. As a result, some common symptoms of a sinus infection may include the following:
Nasal congestion

  • Post-nasal drip (i.e., mucus dripping down the back of the throat)
  • Sore throat
  • Cough
  • Facial pain or pressure
  • Headache
  • Bad breath
  • Exacerbation of asthma

Although anyone can come down with a sinus infection, there are a number of risk factors that facilitate one’s likelihood of developing a sinus infection. Some risk factors for sinus infections may include:

  • Allergic rhinitis (i.e., hay fever)
  • Previous “cold” or viral upper respiratory infection (URI)
  • Structural abnormalities of the nose or sinuses
  • Smoking and/or exposure to smoke
  • Nasal polyps
  • Immunodeficiency (i.e., weakened immune system)


The diagnosis of an acute or subacute sinus infection is often made by the history and physical examination alone. Rhinoscopy is sometimes utilized as a tool to visualize the nasal passages and sinuses in individuals with any type of sinus infection. During rhinoscopy, a thin flexible tube with a fiber-optic light at the end is inserted in the nose. In patients with either chronic or recurrent sinus infections, a CT scan of the sinuses may be needed in order to establish the diagnosis. Rarely, a culture from the sinus is taken in order to either diagnose fungal sinusitis or to determine which antibiotic is necessary to treat a recalcitrant bacterial sinus infection.


Most sinus infections resolve without any treatment. This may be because most sinus infections are viral in nature. Nasal corticosteroids are often prescribed to help treat the inflammation associated with sinus infections. Decongestants may also be recommended in certain people depending on their underlying medical history. Bacterial sinus infections are normally treated with oral antibiotics. Amoxicillin or Augmentin (i.e., amoxicillin + clavulanic acid) is the antibiotic of choice for most areas in the U.S. unless an individual is allergic to penicillin. Whereas antibiotics are typically prescribed for 10-14 days for an acute sinus infection, the course of an antibiotic for a chronic sinus infection is typically 3-4 weeks in duration. Rest and fluids are also generally recommended. Breathing in steam from a hot shower or bowl of hot water brings symptomatic relief in many sufferers. Using saline irrigation in the form of a nasal spray or a Neti pot is helpful in some people. Pain relievers may need to be taken for individuals who have accompanying fever, headache, and/or sinus pain.

It should be emphasized that allergies (i.e., allergic rhinitis) play an important role in the development of sinus infections in many individuals. It is thus important to see a board certified allergist if you or someone you know suffers from sinus infections, as an underlying allergy may make that individual more susceptible to getting sinus infections.

The board certified allergy specialist physicians at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating all types of sinus infections. We treat both pediatric and adult patients. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a friendly and pleasant environment.