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Month: January 2024

Allergies and Asthma Due to Cockroaches

It is estimated that approximately 33% of people are allergic to cockroaches. Cockroaches are quite allergenic, which may attribute to the high number of individuals who are allergic to these nasty insects. There are over 3,500 species of cockroaches worldwide. Cockroaches have been around for more than 300 million years. They have adapted to living in all types of climates and are found all over the world. Cockroaches prefer to live in moist and warmer environments, so it quite common for them to live in bathrooms, basements, and kitchens. They are nocturnal, so they are rarely seen during the day.

Cockroaches also tend to be more common in the inner cities where between 30-60% of asthmatics living in an urban area are said to be allergic to cockroaches. This is particularly true of children living in inner cities where cockroaches are a major cause of asthma in these children. In fact, the percentage of cockroach sensitivity increases to between 55-80% in inner city children with asthma.

Most urban settings, including Washington, DC and Baltimore, MD, have quite a number of cockroaches living amongst them.  It is estimated that more than 75% of homes and apartments in the inner city have cockroaches present.  Even more appalling is that the number of cockroaches living in each home or apartment ranges from between 1,000 to over 300,000 insects.  If you do the math, then for every cockroach you see in the home, there are approximately 800 cockroaches in that home that you don’t see.

When one talks about cockroaches causing allergies, it refers mostly to symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and asthma. The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus headaches, and/or fatigue. Allergic conjunctivitis symptoms may include itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Asthma symptoms are usually characterized by wheezing, chest tightness, coughing, and/or shortness of breath. There is a very strong correlation between chronic asthma and cockroach allergy. Other environmental allergens such as dust mites, mold, and pets can also cause year-round allergy symptoms and must also be evaluated when diagnosing an allergic or asthmatic patient for perennial symptoms.  In addition to causing allergies and asthma, cockroaches can also carry and transmit various diseases such as gastroenteritis, cholera, dysentery, hepatitis, salmonella, typhoid fever, leprosy, parasites (i.e., roundworms, Giardia, Toxoplasmosis), polio, etc.

The causative agent of cockroach allergy is the cockroach allergens themselves.  These allergens are found in the feces, saliva, and exoskeleton of the cockroach.  The most common cockroach allergens are Bla g 1, Bla g 2, and Per a 1.  Other cockroach allergens include Bla g 4, Bla g 5, Bla g 6, Bla g 7, Bla g 8, Bla g 9, Per a 2, Per a 3, Per a 4, Per a 5, Per a 6, Per a 7, Per a 8, Per a 9, and Per a 10. The latter are not as important in causing allergy symptoms to cockroach but they may play a role in some individuals.

The diagnosis of cockroach allergy begins with a comprehensive history and physical examination. Allergy skin testing or blood testing is often performed in order to confirm a cockroach allergy. In individuals with asthma, particularly inner city residents, a pulmonary function test is often performed. The management of cockroach allergies begins with preventing exposure to cockroaches. If there are cockroaches at home, getting a pest control company to help eliminate the cockroaches is your best start. In addition, there are some things that should be tried at home which may include:  making sure to close up any holes in the walls or baseboards in order to decrease entry and exit paths for cockroaches; not leaving dirty dishes in the sink or on kitchen countertops; not bringing food into the bedrooms; keeping the garbage and food in closed containers; and/or making sure that there are no leaky pipes or faucets. For the treatment of cockroach allergy, there are a plethora of medications that may be used to help alleviate the unwanted symptoms. Oral antihistamines, oral decongestants, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular mast cell stabilizers and/or ocular antihistamines all can be used to decrease allergy symptoms caused by cockroach allergy. Asthma symptoms may be controlled with oral leukotriene antagonists, inhaled corticosteroids, inhaled long acting beta agonists, and/or inhaled short acting beta agonists. Oral corticosteroids may be needed in recalcitrant cases. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are a very effective means to treat cockroach allergy and are used in both adult and pediatric patients. They are efficacious in about 80-85% of the cases of allergic rhinitis, allergic conjunctivitis, and/or asthma. Most individuals are on allergy injections for approximately 3-5 years.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating cockroach allergies and asthma for more than 5 decades. We treat both pediatric and adult patients. 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. For an appointment, please call our office 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 and/or asthma symptoms, we are here to help lessen or hopefully end these undesirable symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, thoughtful, and professional environment.

Prevention of Food Allergies

LEAP and EAT Studies

A landmark study published in 2015 called “Learning Early About Peanut Allergy (LEAP),” revolutionized our understanding of the development of peanut allergy in children and transformed the guidance that pediatricians and allergists/immunologists give to parents about when to introduce peanut foods to children at high risk for food allergies.

Babies enrolled in the LEAP study were at high risk for developing peanut allergy because they already had severe eczema (i.e., atopic dermatitis), egg allergy, or both. Beginning at age 4-10 months, babies in the LEAP study were split into 2 groups and were followed for 4 years. One group avoided peanut foods, while the other group was given age-appropriate peanut foods several times a week. By age 5, the children who had begun eating peanut as infants were much less likely to be allergic to peanuts. Eating peanut foods early and regularly reduced the risk of peanut allergy by more than 80% compared to the group of children who avoided peanuts.

In a follow-up study called “Persistence of Oral Tolerance to Peanut (LEAP-On),” the results showed that peanut tolerance promoted by early introduction to peanut foods could be long-lasting. Children who ate peanuts from infancy to age 5 and then avoided peanuts from age 5 to age 6 were still 74% less likely to have peanut allergy than children who had consistently avoided peanut foods from infancy to age 6.

Does introducing allergenic foods early in life put a baby at a greater risk for food allergy?

A study published in 2016, called the “Enquiring About Tolerance (EAT)” study randomly assigned 1,300 breastfed infants to 1 of 2 treatment groups at age 3 months. One group was introduced to a sequence of 6 allergenic foods (i.e., milk, peanut, egg, sesame, fish and wheat), while the other group continued breastfeeding exclusively until age 6 months.

The EAT study revealed that rates of allergy to the 6 foods were not significantly different when the early introduction group and the exclusively breastfed group were compared at ages 1 and 3. This showed that early introduction of allergenic foods did not increase a baby’s risk for food allergy.

Does early introduction of egg products reduce the risk of developing egg allergy too?

In 2019, a new analysis of the EAT study data showed that early introduction of allergenic foods did protect against food allergies for some children at high risk. Children were considered at high risk if their blood tests showed specific IgE antibodies to the foods. They were considered sensitized. These specific IgE antibodies mediate allergic reactions.

  • Compared to exclusive breastfeeding, early food introduction reduced the likelihood that a baby would be sensitized to 1 or more of the 6 foods. It also made it less likely for the baby to develop an allergy to 1 or more of the 6 foods.
  • Early introduction of peanuts lowered the risk of developing peanut allergy in babies sensitized to peanuts. This finding is consistent with the LEAP study.
  • Early introduction of egg lowered the risk of developing egg allergy in babies sensitized to egg. Early introduction of foods including egg also provided protection against egg allergy in babies with moderate or severe eczema at age 3 months.
  • For babies who were not sensitized to any of the 6 foods at the beginning of the study, the risk of developing an allergy to 1 or more of the foods was similar in both the early introduction and exclusive breastfeeding groups.

These new findings from the EAT study indicate that early introduction of egg can provide protection against egg allergy for at least some children at high risk for developing egg allergy.

Guidance from American Academy of Allergy, Asthma & Immunology (AAAAI), American College of Allergy, Asthma & Immunology (ACAAI), and the Canadian Society for Allergy and Clinical Immunology:

To prevent peanut and/or egg allergy, both peanut and egg should be introduced around 6 months of life, but not before 4 months. Screening before introduction is not required. Other food allergens should be introduced around this time as well. Upon introducing complementary foods, infants should be fed a diverse diet, because this may help foster the prevention of a food allergy. Maternal exclusion of common allergens during pregnancy and/or lactation as a means to prevent food allergy is not recommended.

The board certified allergy doctors of Black & Kletz Allergy have had over half a century of experience dealing with food allergies in both children and adults. Black & Kletz Allergy has 3 office locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area. The allergists at Black & Kletz Allergy diagnose and treat individuals with allergies (e.g., hay fever, food allergies, medication allergies), asthma, hives, swelling episodes, eczema, contact dermatitis, insect bites, bee sting allergies, sinus disease, and immunologic problems. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have on-site parking at each location. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call us 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 striving to provide high quality allergy and asthma care to the residents of the Washington, DC metro area for more than 50 years. We are committed to continue delivering state-of-the-art allergy and asthma care in the future.