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Trick-or-Treat Allergies on Halloween

Every year, several children are taken to emergency departments on Halloween day for the management of severe allergic reactions.  What is meant to be a fun-filled activity can turn out to be a harrowing experience for some families. A few general precautions made by families can prevent most allergic emergencies in children and are as follows: 

  1. Many families understand how to read labels on foods and avoid those that contain ingredients that their children are sensitized to. However, most “fun-sized” candies handed out while trick-or-treating either do not have any labeling at all or they may contain different ingredients than regular sized packages.
  2. Preventing children with food allergies to trick-or-treat without adult supervision as well as avoiding candies without proper labeling can prevent a life-threatening reaction.  It is a good practice for severely allergic individuals to carry epinephrine self-injectable devices (e.g., EpiPen, Auvi-Q, Adrenaclick) while trick or treating.
  3. Children with food allergies should be taught to politely refuse homemade foods such as cookies and cupcakes that may be unsafe for them.
  4. Ragweed and mold spores are the most common environmental aeroallergens in the Fall in many geographical areas in late October.  In addition, exposure to cats and dogs are not uncommon while trick or treating. Exposure to these allergens may trigger allergic rhinitis (i.e., hay fever) and/or severe respiratory allergic reactions.  The use of allergy and/or asthma medications before heading out may be protective.  Showering, washing one’s hair, and changing into fresh new clothes after trick or treating will reduce airborne allergen exposure.
  5. Cold air is a known irritant and prolonged exposure to cold air may aggravate asthma in susceptible children.  Frequent indoor breaks and covering the nose and mouth while outdoors can minimize this risk. Children with a history of asthma should also take their rescue inhalers [e.g., albuterol (Proventil, ProAir, Ventolin), levalbuterol (Xopenex)] with them while trick-or-treating.
  6. Haunted houses with smoke machines may pose a danger to children and adults with severe asthma.  Exposure to smoke of any kind can cause an acute asthma exacerbation. Preparation and avoidance are necessary in order to prevent severe asthma attacks.
  7. Halloween costumes containing strong chemicals may be irritating to children with sensitive skin and as a result a flare-up of their eczema (i.e., atopic dermatitis) may occur.  Latex-containing masks as part of the costume may be especially deleterious to children with a history of latex allergy.  Children with a sensitivity to metals such as nickel may be exposed to nickel buttons and buckles in costumes which may lead to itching and skin rashes

 

To help insure that a food allergic child can participate in Halloween and have as much fun as the next child, although nothing is guaranteed, there is a program run by the Food Allergy Research and Education (FARE) organization called the “Teal Pumpkin Project”.  This FARE-sponsored international program has been in place since 2014.  It began in Tennessee by the mother of a severely food allergic child.  The Teal Pumpkin Project’s purpose is to raise awareness of the severity of food allergies and show support to families who have food allergic children.  This is done by painting a pumpkin the color teal and then placing it on one’s front porch to signify that “non-food” treats are available at that location on Halloween night.  The color teal is used because it represents food allergy awareness.  Typically, “non-food” treats may include toys, crayons, stickers, rings, bracelets, necklaces, glow sticks, hair accessories, coins, finger puppets, balls, bookmarks, spider rings, vampire fangs, whistles, etc.

It important to point out that the Teal Pumpkin Project is not exclusionary and it still promotes the option of distributing normal trick-or-treat candy to children without food allergies.  It recommends that the “non-food” items be kept in a different bowl than the traditional candy bowl.  FARE provides a “Teal Pumpkin Project Participation Map” on its website so that participating houses can be easily assessed by the parents of food allergic children.

 

Being cognizant of the hidden dangers of trick-or-treating and proactive in preventing allergen exposures can greatly reduce parents’ anxiety as well as help children fully enjoy the Halloween experience.  The board certified allergists at Black & Kletz Allergy have had over 5 decades of experience in diagnosing and managing food and environmental allergies, asthma, and eczema in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Both food and environmental allergies can be diagnosed by a thorough history and physical examination along with prick skin testing and/or blood testing.  We would be happy to see you in one of our 3 convenient locations with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.   There is on-site parking at each location and both the Washington, DC and McLean, VA offices are 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 schedule an appointment, please call our office or alternatively, you may click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy is proud to provide quality allergy, asthma, and immunology care in a relaxed compassionate environment.

New Treatment for Peanut Allergy

There is some exciting news for children and their families with a history of peanut allergies. On September 13, 2019, the Allergenic Products Advisory Committee of the Food and Drug Administration (FDA) voted to recommend approval of a new oral immunotherapy product for children with peanut allergy.

Peanut is one of the most common foods that can be allergenic in children. It is also responsible for more severe and occasionally life-threatening reactions in highly sensitive children and adults. Adding to the concerns, in the U.S., peanut allergy in children has increased 21% since 2010, and nearly 2.5% of U.S. children may have an allergy to peanuts.

The current standard of care for the treatment of food allergies is the avoidance of the allergen (e.g., peanut) in conjunction with the treatment of anaphylaxis with self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q, and/or Adrenaclick). It should be noted that parents of children with severe sensitivity to peanut live with constant fear of a life-threatening reaction triggered by an accidental exposure to peanut products.

Oral immunotherapy (OIT) refers to feeding an allergic individual an increasing amount of an allergen with the goal of increasing the threshold that triggers a reaction. The procedure entails feeding the allergenic food to the child, beginning with an extremely small dose and gradually increasing the dose at regular intervals while closely monitoring for adverse reactions. This must be done by in a hospital or in an allergist’s office where the allergist and staff are prepared to treat an adverse reaction without delay. The “escalation” of doses, as mentioned above, is typically performed in an allergist’s office, which is equipped to monitor and treat potential reactions whereas maintenance doses can be given at home.

“Desensitization” refers to the improvement in food challenge outcomes after therapy and relies on ongoing exposure to the allergen. If successfully accomplished, desensitization has the potential to substantially reduce the risk of a severe reaction following accidental exposure to the allergen and would hopefully minimize the anxiety of parents. This form of treatment also requires regular exposure to the food indefinitely in order to maintain the “desensitized” or “tolerant” state. OIT with peanut is unlikely to induce “sustained unresponsiveness” which refers to the retention of the protective benefit achieved through therapy. This sustained unresponsiveness is not reliant on the ongoing exposure to peanut.

The possible side effects of OIT include symptoms limited to the gastrointestinal tract such as itching of the mouth and/or lips, abdominal cramping, and diarrhea. Rarely more severe systemic reactions such as generalized hives (i.e., urticaria), swelling of tongue and/or throat (i.e., angioedema), difficulty in swallowing, shortness of breath, wheezing, and drop in blood pressure may occur.

The FDA has not yet approved the new treatment but they are likely to approve it soon based on the recommendations of its Allergenic Products Advisory Committee. “Palforzia” will be the brand name of the new drug, which is a powder containing 12 peanut proteins (Ara h 1, Ara h 2, Ara h 3, etc.) thought to be the principal allergens in peanuts. The letters of the terminology, Ara h, correspond to the genus and species of the peanut plant, Arachis hypogaea, and the number (1, 2, 3, etc.) distinguishes each discrete protein component. In peanut allergy, 5 proteins are associated with clinical reactions of varying severity: Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9. Ara h1, Ara h 2, Ara h 3, and Ara h 9 are associated with severe symptoms whereas Ara h 8 is associated with much milder or no symptoms to peanut. This protein component of peanut is also linked to oral allergy syndrome, also known as pollen-food allergy syndrome. This syndrome is caused by cross-reacting allergens found in both pollen and raw fruits, vegetables, and/or some tree nuts. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it. People affected by oral allergy syndrome can usually eat the same fruits or vegetables in a cooked form because the proteins are denatured during the heating process, and the immune system no longer recognizes the food. Palforzia will come packaged in pull-apart capsules or sachets, to be mixed into age-appropriate foods such as applesauce or pudding.

The manufacturer is seeking FDA approval for Palforzia for use only in children between 4 and 17 years of age. In the clinical trials, the starting dose was 0.5 mg. of the product, gradually increasing to a maintenance dose of 600 mg. requiring about 8 biweekly visits to allergist’s office.
The new treatment will also likely carry a “black box” warning about possible anaphylaxis and a requirement to carry a self-injectable epinephrine device at all times.

It is likely that patients will need to continue therapy indefinitely, particularly in light of a recent study published online in Lancet on September 13, 2019. The study found that, in patients treated to a point where they could eat peanuts without incident, withdrawal of treatment led to waning tolerance over time. This implies that treatment may be life-long.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies for over 50 years. This new medication to treat peanut allergy is exciting and very promising. If this new medication is a success, we feel that there will be other drugs containing other food allergens such as fish, shellfish, milk, egg, wheat, and soy. This is of course pure speculation at this time, but it would make sense to develop other food-related OIT protocols, if Palforzia is successful.

The allergy doctors at Black & Kletz Allergy treat both adult and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan community for over 5 decades for our outstanding services for the diagnosis and treatment of allergic, asthmatic, and immunological conditions.

The Diagnosis and Treatment of Hives

Hives (i.e., urticaria) is a type of skin rash that usually presents with red, raised, and itchy bumps, usually similar in appearance to mosquito bites. Other colloquial terms for hives include welts or wheals. They may occur anywhere on the body and appear in various shapes and sizes. They usually blanch with pressure. In some instances, they may look like small red dots or even be flush with the skin. The borders of each hive may be sharply demarcated or they may blend in with the surrounding skin. If the hives are deep enough in the skin layer, the result may be swelling of that area commonly referred to as angioedema.

Hives are quite common as they affect 20% to 25% of the population at some point in their lives. Hives generally, as a rule, are intermittent and usually last less than 24 hours in duration. They may occur very frequently (i.e., multiple times per day) or they may occur very rarely (i.e., one isolated episode). If an episode of hives resolves within 6 weeks, it is known as “acute urticaria.” If the episode lasts more than 6 weeks in duration, it is known as “chronic urticaria.”
You may be asking yourself, what are the causes of hives, since they are so common. Many times, the cause is fairly obvious in such cases where the hives develop shortly after eating a certain food, or immediately after a bee sting. They may occur during the course of or shortly after completing a course of antibiotics. Other medications may be the causative agent in others affected with hives. Aspirin and nonsteroidal anti-inflammatory drugs (NSAID’s) are the most common classes of medications that cause hives besides antibiotics. Some of the most commonly prescribed NSAID’s include ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn, Anaprox), salsalate (Disalcid), indomethacin (Indocin), etodolac (Lodine), diclofenac (Voltaren, Arthrotec, Cataflam), ketorolac (Toradol), piroxicam (Feldene), meloxicam (Mobic), Oxaprozin (Daypro), nabumetone (Relafen), tolmetin (Tolectin), fenoprofen (Asaid), sulindac (Clinoril), and celecoxib (Celebrex). It is important to note that any medication or food can cause hives in any individual, despite the fact that they may have ingested the food or medication in the past without reactions. An assortment of other conditions such as infections (viral, bacterial, fungal, or parasitic), inflammatory conditions, autoimmune disorders (when the immune system fights an individual’s own tissues and organs instead of defending them against outside intruders), and rarely even cancers can play a role in causing hives.  If the hives persist longer than 24 hours and/or they leave residual marks on the skin, it may indicate inflammation of the small blood vessels, a condition known as “vasculitis.” Other factors that may cause or exacerbate hives may include exercise, cold, heat, vibration, pressure, sun exposure, and/or water, to name a few.

If you suffer from hives, it is important to see a board certified allergist such as the allergists at Black & Kletz Allergy. Our allergy specialists see numerous cases of hives and/or swelling episodes each week. We have over 5 decades of experience in the Washington, DC, Northern Virginia, and Maryland metropolitan area in diagnosing and treating hives. We see patients of all ages ranging from newborns to the elderly. At your first consultation with our allergists, a comprehensive history and physical examination will be performed. Depending upon your history and examination, diagnostic tests may include bloodwork, allergy skin testing, urinalysis, X-rays, and/or a skin biopsy.
Since histamine is the principal chemical that is responsible for the development of hives, most of the cases are responsive to medications that block the action of histamine on the skin. In some individuals, avoidance of a particular food or medication is all that is needed. For others, there are a variety of treatment options, some of which include antihistamines, leukotriene antagonists, histamine-2 blockers, corticosteroids, immune modulators, and “biologicals” [e.g., omalizumab (Xolair) injections] or various combinations of the aforementioned medications.

Black &Kletz Allergy has 3 convenient locations in the Washington, DC metro area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking.  The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergy specialists of Black & Kletz Allergy are eager to help you with your hives, swelling episodes, allergic rhinitis (i.e., hay fever), asthma, sinus conditions, and immunology needs.  We are dedicated to providing excellent care to you as we have been doing in the Washington, DC metro area for more than 50 years.

Allergies Associated with Acid Reflux Medications

Proton pump inhibitors (PPIs) are a group of medications commonly used to treat symptoms caused by excessive stomach acid.  The most common PPIs available in the U.S. are Nexium (i.e., esomeprazole), Protonix (i.e., pantoprazole), Prilosec (i.e., omeprazole), Prevacid (i.e., lansoprazole), Aciphex (i.e., rabeprazole), and Dexilant (i.e., dexlansoprazole).  These medications act by reducing the amount of acid secretion produced by the parietal cells in the lining of the stomach. In addition to lifestyle and dietary modifications, they are usually the first line medications prescribed to treat common conditions such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), erosive esophagitis, Zollinger-Ellison syndrome, and peptic ulcers (duodenal or stomach ulcers).  GERD is commonly referred to as “heartburn” by the general public.  These PPIs are also used in combination with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and/or some antibiotics to protect the stomach.

These medications are considered relatively safe and some are also available over the counter.  Even though they are available over the counter, there are side effects, particularly if used long-term.  Some of the more common side effects may include headaches, rashes, fever, abdominal pain, nausea, vomiting, diarrhea, constipation, lightheadedness, and change in or unpleasant taste.  Long-term use has been linked to osteoporosis (i.e., thinning of the bones) which may lead to bone fractures. Other more severe side effects may include acute interstitial nephritis (i.e., kidney failure), lupus, pneumonia, low magnesium levels, muscle spasms, heart palpitations, and clostridium difficile-associated diarrhea, to name a few.

In addition to the side effects of PPIs, there have been a few recent publications that have reported their association with possible allergic reactions.

In an article published in The Journal of Allergy and Clinical Immunology: In Practice, the authors reported serious allergic reactions in five patients receiving PPIs.  These patients developed allergic reactions within 30 to 60 minutes of taking the medications orally.  One patient developed a more rapid reaction after receiving the drug intravenously.

All patients were subsequently evaluated for sensitivity to PPIs using skin prick testing and intradermal skin testing techniques.  All patients showed positive reactions indicating an immediate allergic sensitivity that was mediated by the IgE antibody. 

When patients develop life-threatening anaphylactic reactions, foods and insect stings are usually thought to be the causative agents as medications other than penicillins cause anaphylaxis very rarely.  However, this report highlights the need for a high index of suspicion for medications such as PPIs being the culprits in causes of anaphylaxis.

A more recent publication in the journal Nature Communications, the authors reported an increase in allergic symptoms in patients receiving PPIs on a regular basis.  The data revealed that people taking PPIs for any reason had a two-to-three times higher chance of receiving prescriptions for medications used to treat allergies at a later date.

Stomach acid is needed for proper digestion of ingested food.  It contains various enzymes which help break down the complex proteins in the food before they are further processed.  It also protects the digestive system from infections caused by bacteria and other harmful substances. 

Reducing the acid production by PPIs can impede the proper digestion of proteins.  PPIs also alter the microbiome of the stomach. Consequently harmful proteins and other substances can get absorbed into the bloodstream unchallenged. This has the potential to weaken the natural defense mechanisms and can either cause or aggravate allergic sensitization to certain foods and environmental triggers.

The authors of this publication caution people not to use acid suppressor medications any longer than absolutely necessary.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan region and have been providing allergy and asthma care to this area for more than 5 decades.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking.  For further convenience, our Washington, DC and McLean, VA offices are Metro accessible.  In addition, 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.  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 your unwanted symptoms, so that you can enjoy a better quality of life.

Black & Kletz Allergy is dedicated to providing the highest quality allergy and asthma care in a compassionate, relaxed, and professional environment. 

Air Pollution and Allergies

Air PollutionAir pollution is a major problem in many parts of the world particularly in major cities in the U.S. including Washington, DC. Air pollution occurs when excessive amounts of gases and/or particles reach harmful levels. It can occur both outdoors as well as indoors. When it is indoors in the workplace, it is often referred to as “sick building syndrome.” Sick building causes are frequently due to failings in the air conditioning, heating, and/or ventilation systems. Other reasons have been attributed to pollutants produced by volatile organic compounds (VOC’s), molds, outgassing of some types of building materials, ozone, lack of adequate filtration or fresh air, and/or chemicals used within a building.

Outdoor air pollution is caused by a multitude of gases, chemicals, and particulates. Carbon dioxide is a known gas which is usually a result of burning fossil fuels such as gasoline, natural gas, and coal. The carbon dioxide in the air causes heat to be trapped in the earth’s atmosphere which is known as the “greenhouse effect.” Many scientists feel that this greenhouse effect can lead to global warming. Another greenhouse gas is methane, which may come from gas emitted by livestock, landfills, and the natural gas industry. Chlorofluorocarbons (CFC’s) are another type of greenhouse gas. They were used in aerosol propellants and refrigerants until the 1980’s when they were banned because of they contributed to the breaking down of the Earth’s ozone layer. Other causes of outdoor pollution include sulfur dioxide and particulates. It should be noted that sulfur dioxide is a component of smog and is the primary cause of acid rain. Smog is a visible form of air pollution and is composed of sulfur oxides (e.g., sulfur dioxide), ozone, nitrogen oxides, smoke and other particulates. Smog is usually thought of to be a summer phenomenon. During the summer when the temperatures are warmer and there is more sunlight present, a photochemical reaction of sunlight, nitrogen oxides, and volatile organic compounds (VOC’s) occurs which produces ground-level ozone that is visible. It looks like smoke and in fact, the word “smog” is a combination of the two words “smoke” and “fog.”

Similar to how allergy sufferers monitor the pollen count, individuals interested in monitoring air pollution can follow the air quality index (AQI). The higher the AQI number, the greater the level of air pollution, and thus the greater the health concern. The AQI ranges from 0 to 500 whereby levels between 151 and 500 are “unhealthy.” An AQI number between 0 and 100 is considered to be acceptable by the Environmental Protection Agency (EPA). An AQI value between 101 and 150 may be unhealthy for sensitive (e.g., allergy sufferers, asthmatics, people with other lung diseases and/or heart disease, the elderly, children) individuals. An AQI value of over 300 is hazardous to one’s health. The EPA has assigned a color with each designated specific range of the AQI. The level of health concern, AQI values and colors (e.g., green, yellow, orange, red, purple, maroon), and their meaning are as follows:

Air Quality Index
(AQI) Values
Levels of Health Concern Colors
When the AQI is in this range: ..air quality conditions are: …as symbolized by this color:
0 to 50 Good Green
51 to 100 Moderate Yellow
101 to 150 Unhealthy for Sensitive Groups Orange
151 to 200 Unhealthy Red
201 to 300 Very Unhealthy Purple
301 to 500 Hazardous Maroon

Note: Values above 500 are considered Beyond the AQI. Follow recommendations for the Hazardous category. Additional information on reducing exposure to extremely high levels of particle pollution is available here.

Individuals with allergies and asthma are generally more susceptible to the side effects of air pollution. In many cases the particulates, gases, and chemicals can trigger asthma and/or incite nasal and eyes symptoms consistent with allergic rhinitis and allergic conjunctivitis. Others are affected by air pollution as a direct irritant-type nonallergic reaction. The most common symptoms caused by air pollution may include irritated eyes, burning of the eyes, red eyes, watery eyes, runny nose, burning of the nose, sore throat, fatigue, headaches, coughing chest tightness, chest pain, and/or shortness of breath.

There are some preventive measures as well as recommended treatments that should be undertaken when the AQI values rise. In consultation with one of our board certified allergists at Black & Kletz Allergy, we discuss these issues as well as others in order to prevent untoward and unnecessary reactions to all types of pollution.

The allergists at Black & Kletz Allergy have been diagnosing and treating allergies, asthma, sinus conditions, and immunological disorders for more than 50 years. We have been a proponent of a clean environment for a long time and Dr. Kletz has done volunteer work for the American Lung Association. Black & Kletz Allergy has 3 convenient locations in the Washington, DC metro area with 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 offices are Metro accessible. 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 today to make an appointment at the office of your choice. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergists at Black & Kletz Allergy pride themselves in the delivery of the highest quality allergy care in the Washington, DC metropolitan area. In addition, we strive to provide excellent customer service in a friendly and affable environment.

Reactions to Food Additives

More and more natural and artificial chemicals are being added to our food as preservatives, flavor enhancers, and coloring agents.  The U.S. Food and Drug Administration (FDA) lists close to 4,000 substances as food additives.

Despite widespread use of these chemicals in food, adverse reactions are fortunately uncommon.  Most cases are described in the literature as single case reports or reports of a small cluster of patients.

Preservatives:

Sulfites:  These chemicals in the gaseous form can cause lung irritation and may trigger asthma in sensitive asthmatics.  They are commonly found in liquid form in processed cold drinks and fruit juice concentrates in order to extend their shelf lives.  Sulfites are also added to most wines and sprayed onto cut foods in order to keep them fresh and prevent discoloration or browning. They are used to preserve smoked and processed meats, dried fruit (e.g., apricots), and salads.  In its solid form, sulfites can cause hives when ingested.

Benzoic acid (i.e., benzoate) and Parabens:  Benzoates and parabens have antibacterial and anti-fungal properties in order to help with the prevention of food spoilage.  These agents are added to pharmaceutical and food products such as drinks (e.g., sugar-free cola). They occur naturally in prunes, cinnamon, tea, and berries.  These substances may cause urticaria (i.e., hives), asthma and angioedema (i.e., swelling) in sensitive individuals.

Antioxidants:  Synthetic phenolic antioxidants [e.g., BHA (butylated hydroxyanisole) and BHT (butylated hydroxytoluene)] are typically added to processed foods such as dry cereals and potato flakes in order to prevent the fats and oils in these foods from turning rancid when exposed to air.  Unfortunately these antioxidants may trigger asthma, rhinitis, and urticarial in some sensitive individuals.

Flavor Enhancers:

Aspartame (e.g., NutraSweet, Equal), a low-calorie sweetener, can occasionally trigger itchy hives and swelling of the body.  It is also important to note that individuals with genetic condition phenylketonuria should avoid aspartame. Aspartame breaks down into an essential amino acid called phenyalanine which is toxic to individuals with phenylketonuria since these patients are unable to metabolize phenyalanine.

Colorings:

Azo dyes [e.g., tartrazine (i.e., yellow dye #5)] and Non-azo dyes (e.g., erythrocine) can trigger hives, asthma, and generalized allergic reactions.

Nitrates and Nitrites give meat a pink color to look more attractive.  These food colorings are typically found in bacon, salami, and frankfurters.

Monosodium Glutamate (MSG) may trigger the “Chinese Restaurant Syndrome” which causes individuals to experience headaches as well as burning and/or tightening of the chest, neck, and face.  MSG may be found in soups, pot noodles, and instant drinks, among other foods.

Naturally Occurring Substances:

Vasoactive amines: Natural histamine, serotonin, and tyramine occur in some ripe cheeses, fish, cured sausage, red wine, chocolate, and pickled vegetables and may induce cramping, flushing, headache, and palpitations in a dose-related manner.  Of note, there is a condition known as “scombroid poisoning” which occurs in individuals who eat spoiled fish. In this condition, there are abnormally high quantities of histamine in the fish due to improper storage or processing.  The typical fish affected may include tuna, mackerel, herring, sardine, anchovy, marlin, and bluefish. The symptoms may include flushing, headache, generalized itching, blurred vision, abdominal cramps, and/or diarrhea. Scombroid poisoning is often wrongly diagnosed as a fish allergy since similar symptoms may be associated with a true fish allergy.  One key factor to look for is to see if other individuals eating the same piece of fish exhibited symptoms. If so, it is more likely to be scombroid poisoning due to eating spoiled fish as opposed to a fish allergy.

Caffeine found in foods, medication, tea, coffee, and carbonated beverages induces dose-dependent agitation, palpitations, nausea, and/or tremors.

Salicylates (i.e., aspirin-like naturally occurring chemicals) may induce urticaria, asthma, and/or nasal polyp growth.  They are found in curry powder, paprika, oranges, apricots, ginger, honey, berries, fruit skins, tea, and almonds.  Salicylate sensitive individuals also tend to have adverse reactions to benzoates and tartrazine.

Diagnosis:

The precise mechanism how food additives cause reactions is not well understood in many instances.  The IgE antibody, which plays a crucial role in immediate-type (i.e., Type I) allergic reactions to food, is usually not involved in adverse reactions caused by food additives.

Skin prick tests and allergy blood tests are not helpful in identifying the food additive culprit in most cases.  Careful observation and maintaining food and symptom diaries are sometimes useful in narrowing down the offending additive. Oral challenges under close monitoring in controlled environments may be needed to arrive at a specific diagnosis.

Management:

Avoidance of the suspected food additive is the only certain way of preventing adverse effects.  One should be vigilant about reading food labels and asking restaurants about ingredients and cooking methods.

If there is a history of anaphylaxis, carrying an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) is extremely helpful in emergency treatment.  It is important to emphasize that if a self-injectable epinephrine device is used, one should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy have been diagnosing food additive sensitivitis, food allergies, and food intolerances routinely for many years on both adults and children.  Black &Kletz Allergy has 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking.  The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergists of Black & Kletz Allergy are eager to help you with your allergy, asthma, sinus, and immunology needs.  We are dedicated to providing excellent care and service to you as we have been doing in the Washington, DC metro area for more than 5 decades.

Fatigue Can Be Due to Allergies?

In the hectic days we live in, many individuals feel fatigued or exhausted.  Fatigue is a very common symptom that can be either chronic or intermittent. Many people seek help by seeing a physician in order to find out the cause of their fatigue, as there are many potential causes.  Despite the numerous causes of fatigue, underlying allergies is a fairly common reason for fatigue in many individuals.

Usually patients with allergic rhinitis (i.e., hay fever) and allergic conjunctivitis exhibit many of the classic symptoms of allergies which may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, itchy ears, clogged ears, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sinus pressure, and/or sinus headaches.  The typical symptoms in individuals with asthma may include wheezing, chest tightness, shortness of breath, and/or coughing.  It should also be noted that food allergies can cause fatigue in certain individuals in addition to the more typical abdominal symptoms (e.g., abdominal pain, diarrhea), skin symptoms (e.g., hives, itching, swelling), lung symptoms (e.g., wheezing, shortness of breath, coughing), and of course anaphylaxis.  Even though the symptoms listed above are the “more typical” symptoms associated with allergies, asthma, and food allergies one should realize that fatigue is not an uncommon symptom that occurs in allergic individuals. There are in fact people that only complain of fatigue and do not have any of the more typical symptoms of allergies.  You may be asking: How do you know if your fatigue is due to allergies?  It should be noted that there are a whole host of conditions and/or reasons that can cause fatigue.  Likewise, it is important to rule out these “other” causes of fatigue before declaring one’s fatigue is due to allergies.

What are some common causes of fatigue besides allergies?  Here are some of the more common reasons/conditions that may cause fatigue, but keep in mind that there are numerous other conditions or reasons that may cause fatigue that are not listed below:

  • Thyroid disorders (e.g., hypothyroidism)
  • Anemia
  • Sleep apnea
  • Heart disease
  • Lack of sleep
  • Infection (e.g., hepatitis, mononucleosis, urinary tract infection)
  • Diabetes mellitus
  • Autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome)
  • Fibromyalgia
  • Anxiety/Depression
  • Dehydration
  • Chronic obstructive pulmonary disease (COPD)
  • Medication side effects

Fatigue Can Be Due to Allergies?Assuming that there are no other reasons for one’s fatigue, seeing a board certified allergist in the Washington, DC, Northern Virginia, and Maryland metropolitan area is important in order to rule out allergies as a cause.  In fact, even if you have another condition that can cause fatigue, it is still possible that some or all of your fatigue may be coming from allergies.  The board certified allergists at Black & Kletz Allergy are experts in the field and can find out if you have allergies via blood and/or skin testing.  It is first important for the allergist to perform a comprehensive history and physical examination.  Allergy testing is done in order to identify if, what, and how allergic one is to specific allergens. Once an allergy is identified, preventive measures are discussed in order to minimize one’s exposure to the offending allergens.  In addition, the use of allergy medications are usually beneficial in alleviating those unwanted allergy symptoms which also includes fatigue. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization) may be utilized to treat the underlying allergies as they are very efficacious and are beneficial in 80-85% of individuals who take them.  Most individuals are on allergy shot for 3-5 years.

The allergists at Black & Kletz Allergy see both pediatric and adult patients and have over 50 years of experience in the field of allergy, asthma, and immunology.  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 over 5 decades and we look forward to providing you with the highest state-of-the-art allergy care in a friendly and comfortable environment.

Nasal Congestion – Do You Have Sinusitis?

If you are like a lot of individuals in the Washington, DC, Northern Virginia, and Maryland metropolitan area, then you may suffer from allergies. There is an old adage that says that if you move to the Washington, DC area and you do not have allergies, you eventually will! This is not true of course, however, many individuals in the area (whether or not they grew up or moved to the Washington, DC area) do in fact have allergies, particularly allergic rhinitis (i.e., hay fever).

The classic symptoms of allergic rhinitis as well as non-allergic rhinitis may include any or all of the following: nasal congestion, runny nose, post-nasal drip, itchy nose, sneezing, itchy throat, itchy eyes, watery eyes, red eyes, puffy eyes, snoring, fatigue, sinus congestion, headaches, and dark circles under the eyes. Allergies commonly trigger asthma as well. Affected individuals may experience chest tightness, wheezing, coughing, and/or shortness of breath.

It should also be noted that allergies increase the risk of sinus disease, sinus infections, and nasal polyps. Sinus infections can be categorized into 3 distinct types: acute, chronic, and recurrent. It is important for the allergist to be able to distinguish between the three, as the treatment is different for each type.
Acute sinusitis: This type of sinus infection is the most common of the three types and often presents with nasal congestion, sinus pressure and/or pain which can radiate to the teeth, discolored nasal discharge, and a post-nasal drip. Occasionally, a fever may be present in some individuals with acute sinusitis. The diagnosis is usually made by a detailed history and a physical examination. Treatment may necessitate the use of antibiotics, nasal corticosteroids, saline irrigation of the nose, and/or decongestants. Rarely, it may be beneficial to use oral corticosteroids is severe cases.

Chronic sinusitis: The common manifestations of a chronic sinus infection generally include nasal congestion, facial pressure/pain, headache, discolored nasal discharge, post-nasal drip, cough, loss of taste and smell, and/or malaise. The diagnosis requires a comprehensive history of onset and progression of specific symptoms, a detailed physical examination, and imaging studies such as CT scans and/or sinus X-rays. The management of chronic sinusitis usually entails a prolonged course (e.g., 30 days) of antibiotics in addition to nasal corticosteroids, saline irrigation of the nose, and/or decongestants. It may be necessary to give another prolonged course of antibiotics in recalcitrant cases. Surgical intervention may also be necessary if medical therapy is unsuccessful. It is important to note that some individuals may only present with chronic nasal congestion as their only symptom.

Recurrent sinusitis: This type of sinus condition is merely repetitive acute sinus infections. Individuals that get repeated episodes of acute sinusitis may have an immune disorder or a weakened immune system. It is thus important to see a board certified allergist/immunologist like the ones at Black & Kletz Allergy. Blood tests to assess a patient’s immune system are often ordered in individuals who suffer from recurrent sinusitis in order to rule out or diagnose an immune defect. Patients who are found to have an immunodeficiency are then treated with appropriate therapy depending upon their specific immune defect. In addition, the sinus infection is treated with antibiotics, topical nasal corticosteroids, saline irrigation of the nose, and/or decongestants.

The prevention of sinusitis includes identification of specific allergen sensitivities by allergy testing by a board certified allergist. Allergy testing may be done by skin testing or blood testing depending upon the circumstance and age of the patient. The aggressive treatment of allergic seasonal and/or perennial rhinitis (i.e., hay fever) promotes proper sinus drainage and improves upper airway function.

Therapies used to treat allergic rhinitis may include antihistamines, nasal corticosteroids, nasal antihistamines, saline irrigation of the nose, decongestants, leukotriene antagonists, and/or allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization). Allergy shots are effective in 80-85% of patients who take them. They have been used in the U.S. for more than 100 years and are used in both children and adults.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating sinusitis for more than 50 years. We treat both adult and pediatric 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 sinus-related symptoms, we are here to help alleviate or hopefully end these undesirable symptoms that have been so troublesome, 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, caring, and professional environment.