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Month: November 2021

Respiratory Syncytial Virus (RSV) Infection

Respiratory syncytial virus (RSV) causes annual outbreaks of respiratory illnesses in all age groups.  It is one of the most common illnesses in children.  Though it can occur any time of the year, RSV infections are most common from the late Fall to the early Spring with a peak predominance in February.

Virtually all children get an RSV infection by the time they are 2 years old.  Most of the time, RSV will cause a mild, cold-like illness, however, it may also cause severe illness such as bronchiolitis (i.e., inflammation of the small airways in the lung) and/or pneumonia (i.e., infection of the lungs).

The initial symptoms of RSV usually include a runny nose, nasal congestion, mild fever, cough, and/or occasional wheezing.  Most individuals generally recover fully within a week.  It is important to note that the illness may be more severe in children under the age of 2 with chronic lung disease, congenital heart disease, suppressed immune systems, and neuromuscular disorders. Children who have difficulty swallowing or clearing mucus secretions are at greater risk for developing more severe disease as well.

Approximately 1 or 2 out of every 100 children younger than 6 months of age with RSV infection may need to be hospitalized.  Those who are hospitalized may require oxygen, intubation, and/or mechanical ventilation to help with breathing.  Most affected children improve with this type of supportive care and are usually discharged in a few days.  Recently, a number of studies have established a relationship between infants with severe RSV infections and the subsequent development of asthma later in childhood.  Respiratory syncytial virus is the leading cause of lower respiratory tract (i.e., lungs) infection in children and is a common cause of wheezing in infants and young children.

In adults, RSV infections present as mild cold-like illness with symptoms of runny nose, sore throat, cough, mild fever, achiness, and/or fatigue.  In healthy adults the symptoms usually subside spontaneously within 5 days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia.  Those at high risk for severe illness from RSV include older adults (i.e., especially those 65 years and older), adults with chronic lung or heart disease, and adults with weakened immune systems.  RSV can sometimes also lead to the exacerbation of serious conditions such as asthma, chronic obstructive pulmonary disease (COPD), and/or congestive heart failure.


Clinical symptoms of RSV are nonspecific and can overlap with other viral respiratory infections, as well as some bacterial infections.  Several types of laboratory tests are available for confirming an RSV infection.  These tests may be performed on upper and lower respiratory specimens.
The most commonly used types of RSV clinical laboratory tests are real-time reverse transcriptase-polymerase chain reactions (rRT-PCR), which are more sensitive than cultures and antigen testing.  It should be noted that antigen testing is highly sensitive in children but not sensitive in adults.


RSV spreads just like a common cold virus―from one person to another.  It enters the body through the nose or eyes, usually occurring from direct person-to-person contact with saliva, nasal discharge, unclean hands, or contaminated objects/surfaces.  It should be noted that RSV can survive 30 minutes or more on unwashed hands and up to 6 hours on surfaces such as toys, keyboards, door knobs, etc.


The symptoms of respiratory syncytial virus can appear 2 to 8 days after contact with RSV. The typical symptoms may include a runny nose, nasal congestion sore throat, achiness, fatigue, mild fever, cough, and/or occasional wheezing.  According to the Centers for Disease Control and Prevention (CDC), individuals infected with RSV are usually contagious for 3 to 8 days.


There is no specific treatment to cure the infection but symptomatic relief can be obtained by nasal saline irrigation with gentle suctioning to allow easier breathing and feeding.  A cool-mist humidifier can help break up mucus which may result in easier breathing.  Hydration by means of drinking plenty of fluids is also important when fighting an RSV infection.  Acetaminophen (i.e., Tylenol) and ibuprofen (i.e., Motrin, Advil) may help relieve body aches and fevers.  Antibiotics and corticosteroids are not helpful.  Aspirin should be avoided.]


Frequent hand washing, covering coughs and sneezes, avoiding people who are ill, cleaning and disinfecting surfaces, and staying home when sick will go a long way to help prevent spreading the infection.

A vaccine for RSV is not currently available but intense research is going on to develop one.  A medication named Synagis (i.e., palivizumab)) may reduce the risk of severe RSV infection in some high-risk infants.  It is a monoclonal antibody that is administered by means of an intramuscular injection.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating upper respiratory infections in both adults and children for more than 50 years.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  To schedule 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, recurrent upper respiratory infections, asthma, sinus-related symptoms, or have had an RSV infection, we are here to help you manage and alleviate your symptoms.  Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a caring, relaxed,, and professional environment.

Are You Allergic to Turkey on Thanksgiving?

Homemade Sliced Turkey Breast on a Thanksgiving plate

We have all felt it and we have all heard it.  “Turkey on Thanksgiving makes you sleepy!”  If so, is it an allergy to turkey that causes this sleepiness?  Is it just a side effect of something in the turkey that causes this tiredness and lethargy?  Some have blamed the high amounts of the essential amino acid L-tryptophan for the somnolence.  Regardless of what you have heard, the fact is that turkey does not cause sleepiness.  Why then do people tend to feel sleepier on Thanksgiving?

Let’s begin with the fact that there are high amounts of the essential amino acid L-tryptophan in turkey.  But what is L-tryptophan?  L-tryptophan is an essential amino acid that must be acquired from foods we eat since the body does not produce L-tryptophan on its own.  Amino acids are the precursors to proteins.  It takes multiple amino acids to make a protein.  Thus, amino acids are considered the “building blocks” of proteins.  It is also important to note that there are a variety of other foods besides turkey that are rich in L-tryptophan.  Some of these foods include fish, canned tuna, eggs, legumes (e.g., peanuts, lima beans, soybeans), milk, yogurt, seeds (e.g., sesame, sunflower, pumpkin), oats, cheese, chocolate, bread, and some fruits.  It should be noted that turkey and chicken both have similar amounts of L-tryptophan.  Another interesting fact is that the white turkey meat has more L-tryptophan than the dark turkey meat, but with chicken, it is the reverse, as there is more L-tryptophan in dark chicken meat than white chicken meat.

L-tryptophan is needed for the body to produce serotonin, a chemical in the brain that plays a role in one’s mood, as well as one’s pain intolerance.  When serotonin levels are high, one’s mood is elevated and a sense of relaxation ensues.  In addition, one may also have a higher pain tolerance.  Thus, L-tryptophan is thought to have a beneficial effect on memory, learning, mood, and depression.  It may also have beneficial effects on reducing anxiety, seasonal affective disorder, and premenstrual pain although more research is needed to confirm this.

Many people often experience sleepiness and fatigue after eating a Thanksgiving Day meal.  Many attribute this lethargy to the turkey eaten on Thanksgiving.  Many feel that they are having an allergic reaction to turkey due to this somnolence, however, it is not an allergy at all.  Allergies to turkey meat are not common, but a true allergy to turkey can occur in some individuals.  Rather than sleepiness and fatigue, the symptoms of a true turkey allergy more typically may include generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), abdominal pain, diarrhea, vomiting, wheezing, shortness of breath, feeling faint, and/or a drop in blood pressure.  These individuals should see a board certified allergist for proper diagnosis and treatment which would include an epinephrine self-injectable device (e.g., EpiPen, Auvi-Q, Adrenaclick) for emergency use.  It should be noted that if an individual uses an epinephrine self-injectable device, that individual should go immediately to the closest emergency room.

Even though turkey allergy exists, the vast majority of individuals that experience sleepiness or fatigue after eating a Thanksgiving Day meal most likely get these symptoms from a variety of factors not associated with the turkey.  During Thanksgiving, it is well known that people overeat.  In addition, they tend to overdo it with alcohol consumption.  These 2 factors may easily explain the lethargy and sleepiness many find themselves suffering after a Thanksgiving Day meal.  It is well known that a high carbohydrate, high fat meal can lead to sleepiness and fatigue approximately 1-2 hours after eating.  Alcohol is also known to cause excessive sleepiness.  Thus, the combination of a high carbohydrate, high fat meal with alcohol seems like the perfect storm to cause sleepiness and fatigue.

In order to minimize or prevent any somnolence that may occur during Thanksgiving Day, or any other holiday, try to limit one’s eating and drinking so that it is not excessive.  Try to eat smaller portions and reduce alcoholic consumption.  In addition, try to get enough sleep and have a nice holiday!

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults and children with food allergies, food sensitivities, other allergies, asthma, sinus disease, and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is 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 our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the allergy and asthma needs of the Washington, DC metropolitan area community for more than 50 years and we strive to administer high quality allergy and asthma care in a welcoming professional environment.