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Allergist Northern VA

Posted by Black & Kletz Allergy on November 23, 2015

Hay fever and asthma are the most common conditions treated by allergists in the Washington, DC, Northern Virginia, and Maryland metropolitan area.

“Hay fever” is a colloquial term used to describe symptoms caused by allergic rhinitis (i.e., inflammation of the tissues inside the nostrils). An allergist northern VA residents trust is a physician who is an expert and who has received special training in diagnosis and treatment of allergic rhinitis. Our board certified allergist that northern VA inhabitants admire, treats patients at Black & Kletz Allergy. Our allergist has many years of experience in treating both allergic and non-allergic rhinitis as well as many other related conditions such as asthma, hives, sinus problems, and immunological disorders.

Allergic rhinitis is caused by the sensitization of our immune system to allergens in the environment. Re-exposure to these allergens is the actual trigger for symptoms. Allergens include indoor agents such as dust mites, mold spores, and animal dander, as well as outdoor allergens such as pollen from trees, grasses, and weeds. Irritants are agents that can trigger the same symptoms as allergens, however, they do not technically cause allergic reactions like allergens. The symptoms caused by irritants are said to induce non-allergic rhinitis instead of allergic rhinitis which is as previously mentioned caused by allergens. Some examples of irritants may include smoke, chemical sprays, strong odors, exhaust fumes, and other pollutants.

Our allergist northern VA residents respect can test individuals with allergy symptoms in order to identify their specific triggers. Our allergist northern VA inhabitants trust may prescribe various medications such as oral antihistamines, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, and a variety of ocular medications in order to alleviate the unwanted allergy symptoms and improve their quality of life. Our allergist northern VA residents have confidence in can also desensitize individuals to allergens so that their symptoms can be lessened and their medication can be reduced or eliminated.

At Black & Kletz Allergy, asthma is another condition that our allergist northern VA inhabitants trust has expertise in diagnosing and treating. Our allergist northern VA residents admire has many years of experience in treating both allergic and non-allergic asthma.

Both indoor and outdoor allergens play a role in aggravating allergic asthma. Exposure to non-specific irritants such as smoke and strong chemicals can also trigger asthma flare-ups and result in emergency room visits. Coughing, wheezing, chest tightness, and shortness of breath are some of the most common symptoms of asthma. Too many patients end up in emergency departments of hospitals. Many of them require hospitalizations for the management of severe asthma. It is our goal at Black & Kletz Allergy to prevent the need for hospital visits for asthma. Our allergist northern VA residents respect can help in identifying the triggers, minimizing the symptoms and preventing emergency room visits and hospitalizations by prescribing medications and providing an individualized asthma treatment plan.

Our allergist northern VA inhabitants have confidence in also treats hives (i.e., urticaria). Hives or “welts” are itchy, red, swollen blotches on the skin of various sizes and shapes which can occur anywhere on the body. They can last from minutes to days and can be very frustrating for the patient. The condition may last from days to years. Hives interfere with day-to-day activities and may also affect one’s sleep at night. They can be caused by allergies to foods and medications, as well as be triggered by infections. There are numerous causes of hives that need to be addressed when seeing an allergist.

Our allergist northern VA residents trust will perform a comprehensive history in order to try to identify a cause of the hives. History taking is supplemented by a thorough physical examination. Our allergist northern VA residents respect may also order laboratory tests which may help in the diagnosis. The cause however may remain unidentifiable (i.e., idiopathic) in a majority of instances where the hives are of a chronic nature. For acute cases of hives, the likelihood of establishing a cause is much greater than for chronic cases. Our allergist northern VA inhabitants admire has specialized training and long-term experience in identifying the possible cause(s) of hives. It should be noted that even when the cause cannot be identified, our allergist northern VA residents respect can usually provide relief from the annoying symptoms of hives, by prescribing a variety of helpful medications.

The allergists 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 office locations 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 50 years for our outstanding services for the diagnosis and treatment of allergies, asthma, and immunological disorders.

Respiratory Infections and Asthma

Posted by Black & Kletz Allergy on November 6, 2015

As we enter into the “cold and flu” season, children and adults with a history of asthma may experience an increase in the frequency and severity of their asthma symptoms triggered by these infections.

Most of us have to contend with a few upper respiratory infections (e.g., cold, flu, sinusitis) each year. Viruses are the usual culprits and the rhinovirus is the most common virus causing upper respiratoryinfections in all age groups. Respiratory syncytial virus (RSV) usually affects the upper and lowerrespiratory tracts in infants and young children.

Upper respiratory tract infections are usually mild self-limited illnesses in otherwise healthy children and adults. The common symptoms of nasal congestion, runny nose, post-nasal drip, sneezing, sore throat, achiness, and an occasional dry cough may last for about a week. However, in individuals with a history of asthma, these infections can trigger a flare-up of their asthma by causing wheezing, coughing, chest tightness, and/or shortness of breath. Once the asthma symptoms are triggered, they can linger for several days to weeks, even after recovery from the infection.

Viral infections also can predispose one to secondary bacterial infections which can lead to complications like sinus infections causing discolored nasal discharge, facial (sinus) pressure and pain, persistent mucus drainage into throat, and coughing. Fever, chills, night sweats, fatigue, coughing up discolored sputum, and/or soreness in the chest while breathing, may be indicative of pneumonia. A few precautions may help prevent or alleviate respiratory infections and reduce the risk of asthma exacerbations:

Viruses causing respiratory infections are highly contagious. Avoid contact with others with active infections can minimize the risk of contracting the illness.

Wash hands frequently with soap and water. This will eliminate most germs causing infections. Hand sanitizers are useful while traveling.

Refrain from touching one’s eyes, nose, and mouth which can minimize the germs from entering into the body.

An annual influenza vaccine (i.e., flu shot) is highly recommended in all children (above 6 months of age) and adults with asthma. FluMist (the flu nasal spray vaccine) is not indicated in asthmatics and only approved for use in persons 2 through 49 years of age.

Many children and adults also benefit immensely from a pneumonia vaccine to prevent bacterial infections from pneumococcus, a type of bacteria that causes respiratory tract infections. The two most common vaccines available are Prevnar 13 and Pneumovax. It is important to check with your primary care physician to check for documentation of what type of pneumonia shot you may have had and when it was administered. Depending on this information, your physician will recommend which type of pneumonia vaccine may be needed and when it should be given. The age of the patient, underlying diseases, and history of previous vaccinations all will play a role in determining what, when, and if the vaccine is needed.

Rest, drinking plenty of fluids, and the use of certain over the counter medications may alleviate some of the symptoms.

Prescription antiviral medications can reduce the duration of the flu and they may also decrease the risk of an increase in asthma symptoms.

Monitoring peak flows is helpful in predicting asthma exacerbations.

If the infection ends up triggering asthma symptoms, one should begin using a rescue inhaler or nebulized medications at regular intervals for symptom relief.

Either initiating the preventative controller medications or increasing their doses at the onset of cold or flu symptoms, (as directed by the physician), may be useful in preventing or reducing the severity of asthma flare-ups triggered by viral infections.

The board certified allergists of Black & Kletz Allergy have been treating adult and pediatric patients with asthma for over 5 decades. We are very familiar with upper respiratory tract infections as well as other triggers that cause asthma exacerbations. In addition, we also treat all kinds of upper respiratory infections. Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office. All 3 locations offer on-site parking. To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day. The allergy doctors at Black & Kletz Allergy strive to manage your asthma to your utmost satisfaction in a professional caring environment.

Pink Eye: Allergies or Infection?

Posted by Black & Kletz Allergy on October 19, 2015

Conjunctivitis is the term used to describe the inflammation of the transparent membrane that lines the inside of the eyelids and the eyeballs. Inflammation leads to widening of the small blood vessels in the membrane which causes the redness of the eyes.

Various types and causes:

Allergic Conjunctivitis: Some of us are genetically predisposed to form antibodies called IgE (as opposed to infection fighting antibodies called IgG) against common environmental agents like pollen, dust mites, molds, and animal dander. When these agents come in contact with the conjunctival membrane, the IgE interacts with them causing chemicals like histamine to be released from certain cells. These chemicals produce symptoms like itching, redness, excessive tearing, etc. Pollens from trees and grasses cause these symptoms mainly in spring and pollen from ragweed causes the fall symptoms, whereas indoor allergens like dust mites, pets, and cockroach cause symptoms throughout the year. This allergic eye condition is very common.

Vernal Keratoconjunctivitis: This allergic eye disorder causes long term and severe inflammation of the conjunctivae which is typically seen around the spring and the summer. It is rare in cold climates and much more common in subtropical and tropical areas. It predominantly involves pre-pubertal boys and usually resolves itself after a few years. Patients frequently have a personal or family history of allergic rhinitis, asthma, and/or eczema. In addition to redness and intense itching, a thick ropy discharge from the eyes is a common feature. The insides of the eyelids appear like a cobblestone due to swollen tissues. The junction between the white part and the iris (the part of the eye that is usually brown, blue, hazel, etc.) of the eye called the limbus also becomes swollen and looks more prominent. In about 6% of individuals, it can affect the cornea, which may cause photophobia (difficulty in looking at bright light) and can lead to corneal scarring, glaucoma, or cataracts, resulting in decreased vision and/or blindness. In these cases laser therapy and/or surgical intervention may be necessary to treat the corneal involvement.

Atopic Keratoconjunctivitis: This allergic eye condition is usually associated with eczema of the skin in various parts of the body. The skin over the eyelids is often involved causing swelling and excessive wrinkling of the skin. The predominant symptom is severe itching of the skin over the eyelids (more commonly involves the lower eyelids on both sides). Atopic keratoconjunctivitis usually starts in second or third decade of life and can become less or more severe over the years, often paralleling the activity level of skin eczema. The symptoms are perennial in nature with this disorder. It is also more common in individuals who have asthma and/or allergic rhinitis. As with vernal keratoconjunctivitis, in some individuals, it may affect their cornea which can cause photophobia and potentially lead to decreased vision and/or blindness by causing scarring of the cornea.

Giant Papillary Conjunctivitis: Excessive tissue growths called papillae form under the upper eyelids on both sides causing severe itching and discomfort, a foreign body sensation, and/or blurry vision. There is often a ropy discharge from the eyes in this allergic eye condition. This condition is thought to result from an allergic reaction either to contact lenses or to the solution used to clean the lenses. Deposits over the contact lenses in conjunction with constant rubbing with the insides of the lids lead to friction and severe irritation eventually leading to the formation of large papillae.

Reactive Conjunctivitis: Excessive sensitivity to chemicals in swimming pools, fumes, smoke, foreign bodies, etc. can result in irritation of the conjunctivae causing redness, burning, and/or watery eyes.

Infectious Conjunctivitis: This highly contagious form of eye infection is most commonly caused either by a virus or bacteria. Viral infections generally produce copious amounts of clear discharge from the eyes in addition to redness and itching. Bacterial infections, on the other hand, are usually associated with thicker and discolored secretions. Dried up secretions cause the eyelids to mat together making it difficult to open one’s eyes in the morning. Apart from redness and a gritty feeling in the eyes, some people also experience photophobia. Infectious conjunctivitis tends to affect one eye more often than allergic eye disorders which usually involve both eyes. Nevertheless, infectious conjunctivitis may also affect both eyes. Most infections resolve spontaneously in about a week to ten days, though the duration of the bacterial conjunctivitis can sometimes be cut short by using antibiotic eye drops.

Treatment:

Avoidance of exposure to the known triggering agents is the predominant modality of prevention, as is the case with most other allergic disorders.

Antihistamine pills and/or eye drops are helpful in relieving the itching and redness of the eyes. It should be noted that some types of over the counter eye drops containing medications that constrict the blood vessels may cause rebound symptoms which may paradoxically worsen the condition over the long term. In severe cases unresponsive to antihistamines, steroid and non-steroidal eye medications may need to be employed to provide relief. Allergy immunotherapy (i.e., allergy shots, allergy injections) is very effective in the treatment and prevention of various allergic eye disorders. Laser and/or surgical intervention may occasionally be necessary in cases of corneal involvement with both vernal keratoconjunctivitis and atopic keratoconjunctivitis.

The board certified allergists at Black & Kletz Allergy have decades of experience and expertise in evaluating and treating the various conditions which cause itching, redness, and/or excessive discharge from the eyes. We see both adults and children and have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area, with on-site parking at all 3 offices. The Washington, DC and McLean, VA locations are also Metro accessible with a free shuttle that takes patients to and from the Spring Hill station to our McLean, VA office. If you are suffering from any one of the eye symptoms mentioned above or any other allergy symptoms, please call our office for an appointment. Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.

Exercise-Induced Hives, Angioedema, Anaphylaxis, and Asthma

Posted by Black & Kletz Allergy on October 2, 2015

In a small percentage of individuals, exercise can cause an array of allergic symptoms ranging from itching, to hives, to swelling episodes, to asthma symptoms, to a life-threatening anaphylactic reaction. The reactions can occur either during or after exercise. If you are experiencing any allergic symptom associated with exercise, you should see a board certified allergist.

In a subset of the population, exercise can induce generalized hives. This is called “exercise-induced urticaria.” The hives are itchy and can range in size from small red dots to large “welts” resembling mosquito bites. Other associated symptoms may include flushing, headache, and/or abdominal cramping. Individuals with this condition can develop hives when participating in exercise of any severity, but they tend to have more episodes when involved with moderate exercise such as jogging or running. In addition, aspirin and/or NSAID’s (i.e., ibuprofen, naproxen, diclofenac) and/or exercising in warm, humid, and/or cold climates, may increase the likelihood of developing hives in certain individuals. There is even a smaller population of individuals that have “food-dependent exercise-induced urticaria.” In this variant, individuals will get hives only if they eat a specific food and exercise within a certain amount of time (usually within 5 hours). This group of people can eat that specific food without problems and they can exercise without problems, but if they eat that food and exercise within 5 hours, they will get hives. The most commonly associated food linked with this condition is wheat. Other foods that have been most associated with food-dependent exercise-induced urticaria include crustaceans, buckwheat, celery, tomatoes, dairy products, chicken, octopuses, squid, and/or grapes, however, any food may cause this condition. There is an even a smaller population of individuals that develop hives after eating any food within 5 hours of exercising. Luckily, this condition is even rarer.

“Exercise-induced angioedema” is identical to exercise-induced urticaria except instead of developing hives, one develops swelling of a particular part of their body (usually of the face, lips, tongue, and/or eyes). This can be more serious if the swelling occurs in the throat which can lead to shortness of breath and complete constriction of the throat.

“Exercise-induced anaphylaxis” is a life-threatening condition that needs immediate attention. It essentially is the same condition as exercise-induced urticaria and exercise-induced angioedema, however, other systemic symptoms occur in addition to the itching, hives, flushing, and/or swelling. These systemic symptoms may include wheezing, shortness of breath, constriction of the throat, abdominal pain, diarrhea, vomiting, headache, anxiety, rapid or slow pulse rate, drop in blood pressure, and/or shock. Like exercise-induced urticaria and exercise-induced angioedema, exercise-induced anaphylaxis can be triggered by certain foods in select individuals. This condition also may be more likely to occur in individuals using aspirin and/or NSAID’s and/or exercising in warm, humid, and/or cold climates.

“Exercise-induced asthma” manifests itself with asthma symptoms such as shortness of breath, wheezing, chest tightness, and/or cough. It occurs much more frequently during exercise in allergic individuals and/or asthmatics compared to nonallergic and/or nonasthmatic individuals. However, it is important to note that even in these nonallergic and/or nonasthmatic people, exercise can still cause asthma symptoms. The asthma symptoms typically begin within 10-20 minutes after the start of exercise, but may not occur until 5-10 minutes after the conclusion of exercise. Exercising in the cold air is a common trigger. Air pollution, high pollen or mold levels and upper respiratory tract infections (e.g., sinus infections, “colds”, flu) also predispose a person to exercise-induced asthma. Warming up and cooling down exercises before and after exercise may decrease the likelihood and/or severity of the asthma symptoms.

Although each one of the above conditions is unique, they are all similar with respect to exercise as being the primary trigger. They all can be very serious and dangerous. At Black & Kletz Allergy, our board certified allergists have been treating both adults and children with exercise-induced conditions for over 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We perform a comprehensive history and physical examination in conjunction with allergy skin and/or blood testing, pulmonary function testing, and/or other non-allergic blood testing to obtain an accurate diagnosis. We will discuss non-medication preventive measures with you as well as provide you with prescriptions for the necessary medications (e.g., EpiPen, antihistamines, asthma inhalers) to help prevent and/or treat your condition. Black & Kletz Allergy has office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA offices are also Metro accessible. If you have exercise-induced allergy or asthma symptoms, please call for an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.

Can Allergies Cause Flushing?

Posted by Black & Kletz Allergy on September 21, 2015

Flushing occurs when the blood vessels dilate and increase the blood supply to the skin. It is manifested as rapid reddening of the skin usually associated with a feeling of warmth. The episodes usually last for a few minutes at a time, but can last longer. If the blood vessels are dilated due to the activity of the nerves on them, flushing is also accompanied by sweating. Irritant chemicals and allergens may also directly act on the vessels producing “dry” flushing. Common triggers of flushing:

Eating:

Hot beverages and/or spicy food may cause flushing in normal people.
“Gustatory” flushing usually involves the face and can be associated with increased tear production, salivation, and nasal secretions, commonly seen after eating a hot pepper.
Injury to a parotid gland (a salivary gland) can cause flushing, warmth and sweating on one side of the face. This is called “Frey’s Syndrome” or “Auriculotemporal Nerve Syndrome.”
“Dumping syndrome”: Flushing of the face, sweating, diarrhea, increased heart rate, and fatigue may occur after eating a meal in people who have had certain types of surgeries on their stomachs.

Alcohol:

Certain fermented alcoholic beverages like beer and wine contain tyramine or histamine, which can cause flushing reactions.
Some Asians have a defective enzyme which leads to a build-up of acetaldehyde which causes flushing after consumption of alcohol. It is referred to as the “Asian Flush Syndrome.”
A few drugs like Antabuse (disulfiram), Flagyl (metronidazole) and cephalosporin antibiotics can also contribute to alcohol-induced flushing when used with alcohol.

Food additives:

“Chinese restaurant syndrome” refers to generalized flushing caused by MSG (monosodium glutamate) which is used a lot in Chinese restaurants in the U.S.
Sulfites, especially potassium metabisulfite, used as a preservative in beers, dried fruits, ciders, dairy products, wines, shrimp, and canned fruit and vegetable products, can induce flushing and wheezing. Asthmatics and people with aspirin sensitivity are more likely to react to sulfites.
Nitrites and nitrates in cured meats may cause flushing and headache in susceptible individuals.

Drugs:

Niacin (nicotinic acid) present in many multi-vitamin preparations in large doses can result in recurrent flushing. These episodes can be effectively blocked by aspirin or ibuprofen.
Medications used to lower blood pressure like vasodilators and calcium channel blockers, thyroid hormones and certain oral steroids can also produce flushing.

Neurologic causes:

Anxiety
Migraines
Spinal cord lesions above T6 level
Brain tumors
Parkinson’s disease

Menopause:

About 80% of postmenopausal woman have flushing associated with sweating.

Rosacea:

Chronic flushing from any cause can develop into rosacea. Individuals with rosacea typically have flushing of the cheeks and nose and occasionally on other areas of the face.

Scombroid fish poisoning:

Bacteria acting on inadequately refrigerated fish like mackerel, tuna, etc. convert the naturally occurring amino acid, histidine, in the fish to histamine which causes abdominal cramping, diarrhea, vomiting, hives, and flushing on consumption. The histamine can survive cooking so cooked and even canned tuna may also cause facial flushing.

Mastocytosis:

High levels of circulating histamine released from excessive numbers of mast cells in one’s body causes flushing, fainting, and shortness of breath.

Tumors:

Carcinoid tumors, (mostly of the stomach, small intestine, pancreas, ovaries, testis, and lung) can cause flushing in addition to wheezing, sweating, diarrhea, shortness of breath, palpitations of the heart, and abdominal cramping. If the primary tumor metastasizes to the liver, serotonin production is increased which causes severe flushing reactions.
Adrenal tumors like pheochromocytoma secrete catecholamines (epinephrine and norepinephrine) which induce flushing episodes.
Brain tumors

As the treatment depends on the cause, an attempt should be made to establish the precise underlying cause in all cases of recurrent flushing reactions with help of a detailed history, physical examination, and relevant blood and urine tests. The board certified allergists at Black & Kletz Allergy have had many decades of experience diagnosing patients who suffer from flushing. Once the cause is identified, the patient is told to avoid the offending trigger or they are referred to the appropriate specialist to treat the underlying condition. If you suffer from flushing, please do not hesitate to call us at Black & Kletz Allergy for an appointment. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all with on-site parking. Our Washington, DC and McLean, VA locations are also Metro accessible. Alternatively, you can Request an Appointment and we will respond within 24 hours of the next business day.

Mosquito Bite Allergy

Posted by Black & Kletz Allergy on September 18, 2015

Signs and Symptoms

Although mosquito bites are quite common among the general population, allergies to mosquito bites are luckily rather rare. Most individuals experience localized itching, swelling, and/or redness of the skin at the site of the bite. However, if someone is allergic to the mosquito, they may have more severe skin reactions which can include extremely large areas of swelling and redness, blistering, and/or bruising. In rare cases, some individuals may experience anaphylaxis (a severe life-threatening systemic reaction) after a mosquito bite. Such individuals experience symptoms which may include some or all of the following:

1. Throat closing sensation 2. Hives (Urticaria) 3. Generalized itching of the skin 4. Drop in blood pressure 5. Shortness of breath and/or wheezing 6. Dizziness, lightheadedness, and/or fainting 7. Abdominal cramping, nausea, vomiting, and/or diarrhea 8. Rapid and weak pulse 9. Feeling of warmth

Mosquito Facts

Mosquitoes are flying insects that tend to be more prevalent where there is standing water. They are more active early in the morning and early in the evening. Female mosquitoes lay their eggs in stagnant water. Only the female mosquito bites and feeds on human blood, as they need this blood in order to produce their eggs. Male mosquitoes feed on water and nectar. When a person is bitten, the mosquito injects its saliva into the skin which contains proteins that prevent the human blood from clotting. This allows the blood to be transferred to the mosquito’s mouth. The typical localized itching, swelling, and/or redness of the skin that results from the bite is not directly due to the bite itself, but rather caused by the body’s immune response to the proteins in the mosquito’s saliva. An “allergic reaction” to a mosquito bite is defined when there is a severe immune reaction against the salivary proteins of the mosquito, thus causing the more severe symptoms mentioned above.

Diseases Transmitted by Mosquitoes

In addition to causing allergies in selected individuals, mosquitoes are well known for transmitting many infectious diseases such as dengue fever, malaria, West Nile virus, filariasis (elephantiasis), yellow fever, chikungunya, Eastern equine encephalitis, Western equine encephalitis, Venezuelan equine encephalitis, Japanese encephalitis, St. Louis encephalitis, La Crosse encephalitis, Rift Valley fever, Ross River fever, and Zika fever.

Risk Factors

Mosquitoes are attracted to certain people more than others for a variety of reasons. They are more attracted to individuals with the following characteristics: Type O blood, males, obese or overweight people due to increased carbon dioxide (CO 2) levels, specific body odors that are present because of large numbers of certain bacteria, people wearing dark clothing, individuals that are exercising, and increased body heat.

Diagnosis, Prevention, and Treatment

The diagnosis of mosquito allergy can be done via a blood or skin test and is only done in individuals that have had severe reactions that can be ascertained after a thorough history from the patient. Prevention, however, is the key to treatment. One should avoid areas with standing water such as swamps or fresh water reservoirs. Wear light colored long sleeved clothing and hats. Consider wearing permethrin-treated clothing. Use citronella-scented candles when at outdoor events. Use a bed net if sleeping outdoors. Stay in screened in or air conditioned rooms. Apply insect repellent that preferably contains a 10-25% concentration of DEET (N,N-diethyl-3-methyl-benzamide or N,N- diethyl-meta-toluamide). One can alternatively use insect repellents containing either picaridin or oil of lemon eucalyptus.

Besides prevention, the treatment of mosquito bites is aimed at treating the symptoms of the bite. Since most mosquito bites cause only a local reaction, various topical medications can be used which can include calamine lotion, corticosteroid creams, anti-itch creams, and/or topical antihistamines. It may also be advantageous to apply ice or a cold pack to the site of the local reaction. Oral antihistamines may offer more relief in certain individuals. In the cases where anaphylaxis occurs, the individual should use a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick), call 911, and go immediately to the closest emergency room. Fortunately, anaphylaxis is quite rare when it comes to mosquito bite allergies, however, it is a possibility and anyone who has symptoms of mosquito bite allergy should see a board certified allergist.

The board certified allergists at Black & Kletz Allergy have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 5 decades and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA with on-site parking. The Washington, DC and McLean, VA office locations are also Metro accessible. Please call us for an appointment or alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day. Black & Kletz Allergy prides itself in providing quality allergy care to both adults and children in a friendly professional environment.

A Spike in Allergy Symptoms in the Autumn?

Posted by Black & Kletz Allergy on August 18, 2015

As we enter into the ragweed season, some of us with seasonal allergies may experience a flare-up of symptoms.

Ragweed is one of the several weeds that pollinate in late Summer and the early Fall. Seventeen different species of ragweed grow in the United States. Common ragweed grows up to five feet tall. It has hairy stems and light green leaves, up to four inches long. Ragweed grows in fields, gardens, and along roadsides. It is an annual plant, which means it only lives for one season.

Ragweed flowers are yellowish-green in color and small in size. They grow in clusters of up to six inches long near the top of the plant. Ragweed flowers produce large amounts of pollen. The pollen is transferred from one plant to another by the wind as well as insects.

Ragweed allergy occurs when an individual’s immune system produces a forceful response to a foreign substance (i.e., ragweed pollen) that is actually harmless in most circumstances. As a result, the individual experiences hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthmasymptoms (see below).

Certain cells of the body begin releasing antibodies to proteins in the ragweed pollen. This results in the production of several chemicals (e.g., histamine) that cause these allergy symptoms. Some individuals with ragweed allergy may also get local itching of the mouth and throat areas when they eat fresh melons, bananas, kiwi, cucumbers, zucchini, and/or avocados. This condition is called oral allergy syndrome, which is also known as pollen-food allergy syndrome.

Each ragweed plant can release approximately one billion grains of ragweed pollen in one ragweed season. The grains are so light that the wind easily carries them into the air where individuals inhale the grains. The result is that these individuals may become sensitized and allergic to the ragweed pollen. The pollen travels very far by the wind and pollen has been detected hundreds of miles away. Some studies suggest that rising temperatures and carbon dioxide (CO2) levels are extending the ragweed season. In Northern Virginia and Washington, DC, ragweed begins to pollinate in mid-August, peaks after the Labor Day weekend in September, and lasts until the end of October when the first frost ultimately kills the plant.

What are the Symptoms?

The allergic reaction to all plants that produce pollen is commonly known as hay fever (allergic rhinitis). Symptoms can include itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, runny nose, stuffy nose, post-nasal drip, itchy throat, and sneezing. In those with severe allergies, asthma symptoms (i.e., wheezing, shortness of breath, cough, chest tightness), sinusitis, headaches, fatigue, and impaired sleep may also occur.

What Methods of Prevention are Recommended?

A few simple suggestions can dramatically diminish one’s exposure to pollen:

It is preferable to stay inside when the pollen counts are at their highest. In the Washington, DC area, this is in the mid-morning and the mid-afternoon. One can track the pollen count in our area by clicking Today’s Pollen Count at the top of our website.
After being outdoors, change your clothes after returning indoors and take a shower to remove the pollen. Do not hang clothes outdoors to dry, as the pollen will collect on them. Use a clothes dryer instead.
Keep the windows closed in your car and home. Turn on the air conditioner. Make sure to change the air filters every 1-2 months.
Shower before bed to remove pollen, especially from your face and hair.
Use HEPA air filters in your home.

Diagnosing and Treating Ragweed Allergies: When avoidance and prevention do not work, try over-the-counter medications. If symptoms continue, or complications arise, it may be time to seek the advice of a physician. The board certified allergists at Black & Kletz Allergy treat both adults and children with ragweed allergies and have done so for more than fifty years. A thorough history and physical examination will be performed and allergy skin testing and/or allergy blood testing can be done in order to diagnose your condition. Once a diagnosis of ragweed allergy is established, there are a multitude of medications available by prescription that can be tried in order to help alleviate your symptoms. These medications come in the form of pills, capsules, syrups, powders, nasal sprays, eye drops, and inhalers. Allergy shots (allergy immunotherapy, allergy injections) are an extremely effective means to treat not only ragweed allergy, but allergies (i.e., allergic rhinitis, allergic conjunctivitis, allergic asthma) in general. They work in approximately 80-85% of individuals, but take about 4-6 months before they are effective for most individuals. They have been around for over 100 years and can be given in children, adults, pregnant women, and the elderly with great success.

Black and Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, Virginia (Tysons Corner, Virginia), and Manassas, Virginia. The Washington, DC and McLean, VA offices are Metro accessible and all 3 locations offer on-site parking. The allergists and staff at Black and Kletz Allergy will gladly answer any of your questions or concerns. We strive to offer individualized treatment plans in order to alleviate your unwanted allergy symptoms in a caring and professional setting.

Can Clogged Ears be Caused by Allergies?

Posted by Black & Kletz Allergy on August 4, 2015

The simple answer to this question is yes.

Eustachian tube dysfunction is a condition where the the eustachian tubes of the middle ear do not open and close the correct way. The eustachian tubes are small tubes that go from the middle ear (the part of the ear behind the eardrum) to the back of the throat. There is one eustachian tube for each ear. The eustachian tubes are about 1 1/2 inches long and regulate the air pressure between the middle ear and the atmosphere outside the ear. The eustachian tubes also serve the purpose of draining fluid and mucus from the middle ear. Normally, the tubes are closed. When there is an increase in atmospheric pressure ( e.g., high altitudes, deep water) people typically will intentionally swallow, yawn, or chew gum in order to force the eustachian tube open which will cause an equalization in pressure. If someone is unable to equalize this pressure difference, one may experience ear pain, a clogged or blocked feeling of the ears, decreased hearing, ringing of the ears (tinnitus), a fullness of the ears, popping of the ears, and/or dizziness.

There are a variety of causes of eustachian tube dysfunction. Swelling of the eustachian tubes can occur due to allergies (i.e., allergic rhinitis, hay fever), upper respiratory infections (URI’s), and sinus infections. The swelling causes the tubes to stay closed, preventing them from opening with the normal everyday functions such as swallowing and yawning. As a result, a pressure difference occurs between the middle ear and the outside atmospheric pressure causing the symptoms of eustachian tube dysfunction to develop. One may complain of ears that are painful, blocked, full, popping, etc. Fluid may also collect in the middle ear which can further increase one’s symptoms. In addition, the fluid can get infected which will often lead to ear infections (otitis media). Note that the length of the eustachian tubes is shorter, and thus more easily blocked, in children than in adults, predisposing them to a higher risk of ear infections; this is a reason to see a pediatric allergist here in McLean, Manassas or Washington, DC as soon as possible. /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ /2015/08/04/can-clogged-ears-be-caused-by-allergies/ Cigarette smoking, enlarged adenoids, and obesity are other factors that can predispose and/or cause eustachian tube dysfunction.

As mentioned above, allergies play an important role in causing eustachian tube dysfunction. Allergic rhinitis (hay fever) is a condition where there is inflammation and swelling in the nasal and sinus regions due to an allergen such as pollen, dust mites, molds, and animals. It is the swelling component of this allergic condition which contributes to the symptoms of eustachian tube dysfunction.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating children and adults with “clogged ears” for over 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Diagnosing and treating the underlying condition, which often is due to allergies, is the primary way to alleviate the “clogged ears.” There are numerous allergy medications (i.e., decongestants, nasal corticosteroid sprays, antihistamines), as well as allergy immunotherapy (allergy shots) that can be utilized in order to treat and/or prevent “clogged ears.” If you suffer from these symptoms or other allergy symptoms, please call any one of our 3 convenient office locations in the DC metro area. We have offices in Washington, DC, McLean, VA, (Tyson’s Corner, VA), and Manassas, VA. All 3 offices have on-site parking and the Washington, DC and McLean, VA locations are Metro accessible. You can also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated to help you get relief from your allergy symptoms in a caring professional environment.

Summer Itch or Rash?

Posted by Black & Kletz Allergy on July 27, 2015

Outdoor activities in the summer can result in skin irritation and itching due to a variety of causes.

PAPULAR URTICARIA: It is an excessive skin reaction to insect bites. Crops of itchy, red bumps usually less than a half-inch in diameter appear over the exposed areas of the body. They sometimes progress into fluid filled blisters grouped together. Scratching them may lead to crusting and/or infected pustules. The lesions usually last for days to weeks. Despite the name urticaria, they are not hives, which are raised wheals usually resolving in hours. The most common insects causing these reactions are mosquitoes, gnats, fleas, etc. Treatments like topical corticosteroids to lessen the inflammation and oral antihistamines to relieve the itching can be helpful. Application of insect repellants to exposed areas before outdoor activities may help prevent the problem.

CONTACT DERMATITIS: Skin exposure to the urushiol oil from the leaves of plants like poison ivy, poison oak, and poison sumac can cause severe redness, blistering, and burning sensation in sensitized individuals. About 60-80% of individuals exposed to the urushiol oil become sensitized to it. The condition usually begins 24-36 hours after exposure and can last a few weeks. The lesions cannot be spread to other areas of the body through scratching or oozing of the blister fluid. Because it can be a severe reaction, many patients will need corticosteroids by mouth for about a week to 10 days to control the condition. Wearing long sleeves and pants, in addition to application of barrier creams before outdoor activities can be helpful in warding off the reaction in susceptible people.

MILIARIA: Prickly heat manifests as tiny red or pink spots over the face, neck, upper back, chest, etc. This condition is caused by clogged up sweat pores which results in retention of excessive sweat which then leads to irritation and itching. Friction caused by clothing can aggravate the problem. This condition can be alleviated by using prickly heat powders, calamine lotion, staying in a cool environment, keeping the affected area clean and dry, and taking frequent cool and light baths or showers. Occasionally, topical corticosteroids are necessary to provide relief.

SUNBURN: Prolonged exposure to the sun can cause red, irritated, burned, and/or itchy skin which can progress to blistering and open sores over the affected area. Application of ice compresses and aloe gel can soothe the involved skin. Avoiding excessive sun exposure, liberal use of sun block creams, and hydrating the skin with consumption of good quantities of clear liquids can be helpful.

XEROSIS: Xerosis is the medical term for abnormally dry skin. Though excessive dryness is more common during the winter, prolonged exposure to air conditioned environments with little humidity can lead to dry and dehydrated skin. Frequent bathing or showering and the use of strong soaps can remove essential skin oils causing the skin to be dry and itchy. Applying a moisturizer thoroughly all over the skin immediately after a bath or shower will help in seal in the moisture and keep the water from evaporating, leaving the skin cool and moist.

The board certified allergists and trained staff at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area can answer your questions and concerns regarding many skin conditions and will provide time tested and scientifically validated advice. Our allergists specialize in both adult and pediatric patients. We have 3 convenient office locations which all offer on-site parking. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are also Metro accessible. Please click Request an Appointment and we will answer you within 24 hours on the next business day. For faster service, please call our office directly. Black & Kletz Allergy prides itself in providing prompt quality care to the community in a caring professional setting.

Can a Cough Be Due to Allergies?

Posted by Black & Kletz Allergy on July 13, 2015

There are many cause of a cough. Coughing is usually caused by a viral upper respiratory infection (URI), asthma, post-nasal drip, and/or gastroesophageal reflux disease (GERD). There are however many other conditions which may cause a cough, some of which include other infectious types of upper respiratory infections (i.e., bacterial, fungal, parasitic), occult sinus infection, vocal cord dysfunction, cystic fibrosis, laryngopharyngeal reflux, pneumonia, bronchitis, bronchiectasis, pertussis (whooping cough), croup, foreign body (which can get stuck in one’s airways), pulmonary embolism, neurogenic cough, post-infectious cough, hypersensitivity pneumonitis, sarcoidosis, psychogenic cough (due to a habit or tic), Tourette’s Syndrome, aspiration, cigarette smoking, chronic obstructive pulmonary disease (COPD) (i.e., chronic bronchitis, and/or emphysema), interstitial lung disease, tumors, congestive heart failure, exposure to air pollutants, and the side effects of certain medications such as angiotensin-converting enzyme inhibitors .

So can allergies play a role in causing a cough? Yes. Since asthma is a leading cause of cough and about 80% of individuals with asthma also have allergies, one can see right away that allergies play a large role in causing a cough. In addition, there is a sub-group of asthmatics who have a condition called cough-variant asthma where sufferers only cough as a result of their asthma. They do not have the accompanying wheezing, shortness of breath or chest tightness that most other asthmatics experience. As if this wasn’t bad enough, it is estimated that 75-80% of asthmatics have gastroesophageal reflux disease (GERD), which is also one of the most common causes of a cough. Allergies also play a major role in predisposing a person to develop a sinus infection (sinusitis) which again often causes a cough. Immunodeficiency disorders (which are diagnosed and treated by allergists/immunologists) such as hypogammaglobulinemia also predispose people with these disorders to acute sinus infections. Hypersensitivity pneumonitis is a condition where there is an inflammation of the air sacs (alveoli) of the lungs caused by an allergic reaction to inhaled antigens such as dusts, molds, and chemicals. Individuals with this condition commonly have certain hobbies and/or occupations that expose them to these antigens. Once again, cough is a primary symptom of this disease.

In individuals with a persistent cough, many tests can be done in order to diagnose the reason behind the cough. Some of these tests include blood work, chest X-rays, CT scans of the chest and/or sinuses, allergy testing, pulmonary function tests (PFT’s; breathing tests), rhinoscopy, upper endoscopy (with or without biopsy), esophageal manometry (assesses the function of the lower esophageal sphincter and esophagus), barium swallow, pH monitoring (measures the acidity in the stomach), and bronchoscopy (with or without lung biopsy). In most cases, the workup usually does not require the last six tests listed above which are generally reserved for difficult cases. After diagnosing the problem, there are a variety of medications that can be used to treat an individual’s cough.

The board certified allergists at Black & Kletz Allergy have been diagnosing the underlying conditions of coughs and treating individuals with coughs for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both adult and pediatric patients and have 3 convenient locations in the DC metro area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA) and Manassas, VA, each with on-site parking. The Washington, DC and McLean, VA offices are Metro accessible. Black and Kletz Allergy is committed to providing excellent allergy, asthma, and immunology care to the greater Washington, DC and Northern Virginia community.

Allergic Fungal Sinusitis

Posted by Black & Kletz Allergy on June 25, 2015

Allergic Fungal Sinusitis (AFS) is a chronic inflammatory condition involving the nose and sinuses caused by an allergic sensitivity to environmental fungi. It is usually seen in people with normal immune systems as opposed to invasive fungal infections which usually affect people with compromised immune systems caused by conditions which may include diabetes mellitus, certain cancers, HIV infection, and patients receiving chemotherapy or radiation treatment. It is similar to a condition that affects the lung called Allergic Bronchopulmonary Aspergillosis (ABPA).

Many patients with AFS are atopic, meaning they have a tendency to develop allergic sensitization when exposed to common harmless substances like pollens, dust mites, cats, dogs, and certain foods. About two-thirds of patients with AFS also have allergic rhinitis and up to half of them also have allergic asthma. AFS is most commonly seen in young adults with an average age of 22 years.

CAUSE:

When an atopic person breathes in air containing the fungus, it triggers an allergic inflammation of the mucus lining inside the nostrils and sinuses resulting in swelling of the tissues. This swelling leads to blockage of the sinus drainage pathways causing the mucus secretions (mucin) to accumulate within the sinus cavities. This, in turn, creates an ideal environment for further reproduction of the fungus. The sinuses are eventually filled with a viscous and tenacious fungal mucin which has the consistency and appearance of peanut butter.

SYMPTOMS:

Nasal congestion

Discolored copious nasal secretions

Semi-solid nasal crusts

Polyp formation in the nose and the sinuses

Post-nasal drip

Throat irritation

Occasional headache or facial pressure

Decreased sense of smell

In advanced stages, facial disfigurement and vision disturbances may also be encountered due to extension of the disease to the surrounding areas.

DIAGNOSIS:

Total IgE antibody levels in the blood will be elevated several times the normal limits.

Skin testing to various fungal organisms.

CT scan of the sinuses can demonstrate accumulated fungal mucin in the sinus cavities.

Mucin drained from the sinuses needs to be examined for specific histological characteristics under the microscope and cultured in the laboratory to identify the specific type of fungus.

TREATMENT:

Fungal mucin in the sinuses needs to be drained out by endoscopic sinus surgery.

Systemic and topical steroid medications to reduce the inflammatory changes and shrink the polyps.

Environmental control to reduce the exposure to the fungi and molds.

Systemic or topical antifungal medications may be used to reduce the amount of fungus.

Allergy immunotherapy (allergy shots) with the antigens identified by skin testing to develop tolerance to the fungal allergens and to control the chronic inflammatory reactions.

A comprehensive management plan incorporating medical, surgical, and immunologic care remains the most likely means of providing long-term disease control for allergic fungal sinusitis (AFS).

The board certified allergists at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area have been treating sinus disease for more than 5 decades. We have expertise in recognizing and managing individuals with allergic fungal sinusitis. Black & Kletz Allergy has 3 convenient locations in the Washington, DC area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each location. In addition, the Washington, DC and McLean, VA offices are accessible by the Metro. If you suffer from any of the above symptoms, please contact one of our offices to make an appointment. Alternatively, you can click Request an Appointment and we will contact you within 24 hours of the next business day. We strive to serve the community in a professional, friendly, and caring manner.

The Asthma and Acid Reflux (GERD) Connection

Posted by Black & Kletz Allergy on June 15, 2015

There is a surprising connection between asthma and acid reflux. Anywhere from 75-80% of asthmatics suffer from acid reflux. Acid reflux is also known by the name of gastroesophageal reflux disease (GERD). Acid reflux is a condition where the acidic stomach contents travel in the wrong direction and enter the esophagus (swallowing tube). This causes a variety of symptoms of which the main one is heartburn. People with acid reflux commonly feel a burning sensation in the chest and/or throat. They often complain of a bitter or sour taste in their mouth. Other symptoms can include wheezing, coughing, belching, abdominal bloating, sore throat, nausea, and/or the feeling that something is stuck in one’s throat. It is the wheezing and coughing symptoms that cam mimic asthma or in fact be triggered in an asthmatic who has acid reflux or GERD.

Acid reflux occurs because the lower esophageal sphincter, a muscle at the lower part of the esophagus near the entrance to the stomach, becomes too relaxed. This allows the stomach acid to go backwards into the esophagus which can cause damage to the esophagus and cause a burning sensation, commonly referred to as heartburn. In addition to causing heartburn, it also can aggravate a person’s asthma in a couple of different manners. The first way this occurs is a result of small amounts of this acid irritating the airways (like a chemical burn) which can trigger asthma symptoms. The second way may involve triggering a reflex in the airways to become narrower in order to prevent more acid from entering the airways. It is this narrowing of the airways which causes an asthmatic to wheeze, cough, and/or feel short of breath. In addition, some asthma medications can decrease the lower esophageal sphincter pressure thereby relaxing this muscle which subsequently will increase the severity of acid reflux. Asthma medications in the bronchodilator family such as Albuterol (i.e., Proventil, Ventolin, ProAir, AccuNeb), Levalbuterol (Xopenex), Terbutaline, (i.e., Brethine, Brethaire), Salmeterol (Serevent), Formoterol, (Foradil), Vilanterol, Ipatroprium (Atrovent), and Tiotropium (Spiriva) fall into this category. There are also asthma medications that are combinations of two medications, one of which is a bronchodilator, which can therefore increase acid reflux disease. The names of some of these medications include Advair, Symbicort, Dulera, Breo Ellipta, Combivent, and DuoNeb. Theophylline (i.e., Theo-Dur, Uniphyl, Theo-24, Slo-Bid), an older but still useful oral bronchodilator asthma medication, has also been linked with increasing acid reflux in individuals by causing the relaxation of the lower esophageal sphincter as well. Interestingly, the chemical structure of Theophylline is similar to caffeine which is another trigger of acid reflux.

The cause of acid reflux disease is a failure of the lower esophageal sphincter to function properly. There are several risk factors that can contribute to acid reflux disease and some of them include:

Hiatal hernia – the protrusion of part of the stomach through the diaphragm (a muscle separating the abdomen from the chest) into the chest
Obesity
Pregnancy
Use of certain medications (i.e., bronchodilators, calcium channel blockers, aspirin, prednisone)
Alcohol use
Smoking
Certain foods – caffeine, fatty foods, garlic, onions, spicy foods, and acidic foods (i.e., tomatoes, soda, citrus fruits)
Diabetes
Eating before bed
Eating large meals
Certain connective tissue disorders – Scleroderma or systemic sclerosis

The diagnosis can be made with a combination of a good history from the individual along with observing relief when prescribed medications to control reflux such as antacids and/or acid-blocking medications. If there is no improvement in symptoms of acid reflux, there are several procedures that can be performed to help diagnose acid reflux disease. Some of these procedures include upper endoscopy with or without biopsy, barium swallow, esophageal manometry (checks the function of the lower esophageal sphincter and esophagus), and pH monitoring (checks the acidity in the stomach).

The treatment of acid reflux disease is aimed at minimizing the risk factors mentioned above in addition to prescribing antacids and acid-blocking medications. By treating the underlying acid reflux disease in the asthmatics that have this condition, the symptoms of asthma (i.e., wheezing, coughing, shortness of breath, and chest tightness) may also be diminished)

The board certified allergists at Black & Kletz Allergy recognize the association between asthma and acid reflux (GERD) and we treat our asthmatics accordingly after a thorough history and physical examination. Black & Kletz Allergy has 3 offices and has been serving the Washington, DC, Northern, Virginia, and Maryland metropolitan area for more than 50 years. We have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have parking at each location and the Washington, DC and McLean, VA (Tysons Corner, VA) offices are Metro accessible. If you have asthma, think you have asthma, or have symptoms of wheezing, coughing, shortness of breath, and/or chest tightness, please call us to schedule an appointment. Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.

Do You Have a Penicillin Allergy?

Posted by Black & Kletz Allergy on May 26, 2015

Many people think that they are “allergic” to penicillin, when they may not really be truly allergic.

Penicillin is a very effective and relatively inexpensive antibiotic, used in the treatment of many bacterial infections. About 1 in 10, 000 people who receive penicillin may have a true allergic reaction, where the immune system considers the antibiotic as a harmful foreign agent and mounts a defensive attack. The chemical mediators that are released during this process can cause itchy rashes, hives, and/or swelling of the tissues. In rare cases, life threatening reactions can occur in which difficulty in breathing (i.e., wheezing, shortness of breath), cardiovascular manifestations (i.e., drop in blood pressure, shock) and other serious organ system damage can ensue.

However, two recent studies proved that most people who consider themselves allergic to penicillin can safely receive penicillin. In one study, 94 percent of 384 people who believed they were allergic to penicillin tested negative for penicillin allergy. In the second study, penicillin skin testing was performed on 38 people who believed they were allergic to the antibiotic, and all of them tested negative.

Most people with a presumptive history of sensitivity to penicillin are given alternate antibiotics to treat infections. In some instances, the replacement antibiotic may not be as effective as the preferred penicillin and in addition, the substitute antibiotic is also more expensive. Such use may also result in some bacteria developing resistance to antibiotics, harming the community at large. Hence it is important to distinguish between false and true allergy to penicillin and related antibiotics.

A standardized skin testing procedure can differentiate people who are likely to adversely react to penicillin from those who can safely tolerate it. It involves injecting small amounts of chemical determinants (reagents) of penicillin sensitivity into the layers of the skin, with appropriate positive and negative controls. A positive test manifests as an itchy, red, raised bump after 15 minutes and confirms true allergy to penicillin and the need to permanently avoid penicillin and related antibiotics.

If the skin test is negative, a related drug, amoxicillin is given by mouth at a standard dose and the person is monitored in a board certified allergist’s office for 1 to 2 hours for any adverse reactions. If the oral dose is also tolerated, he/she can safely receive penicillin and related antibiotics to treat infections in the future.

The board certified allergists at Black & Kletz Allergy can administer the penicillin skin testing and oral challenge, if needed, and can offer recommendations for appropriate antibiotic use based on the test results. Please call any of our 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with questions or concerns related to antibiotic or other medication allergies. We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have been serving this area for more than 50 years. There is parking at each one of our 3 office locations. In addition, the Washington, DC and McLean, VA offices are also accessible by the Metro. If you have wondered if your “penicillin allergy” was correct, please call us today or click Request an Appointment and we will contact you within 24 hours of the next business day. We would be happy to test you for a penicillin allergy, so that you can clarify if you are truly allergic to penicillin.

Grass Pollen Allergies in the Washington, DC Metropolitan Area

Posted by Black & Kletz Allergy on May 26, 2015

In the Washington, DC, Northern Virginia, and Maryland metropolitan area (DMV area), grass begins to pollinate in late-April to early-May, peak in late-May or early-June, and end in August. In addition to the grass pollen during this time period, molds spore counts are also highly elevated which further complicates one’s allergies. There is also an overlapping with tree pollens in the early Spring, meaning that all three allergens (trees, grasses, and molds) are in the environment at the same time during some periods in the Spring.

The most common types of grasses include Timothy, Sweet vernal, Bermuda, Rye, Kentucky blue, Orchard, Meadow fescue, Red top, Bahia, and Johnson. Grass pollens, unlike other environmental allergens, are very similar in their microscopic appearance. This fact is the reason why an individual who is sensitized with one type of grass may have allergy and/or asthma symptoms when exposed to many other types of grasses. The one major exception to this rule is Bermuda grass, which does not cross react with many other grasses.

As with the other allergens that cause hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthma, it is the wind disbursement of the grass pollen into the air that sensitizes individuals. Since the grass pollen is very light in weight, the wind causes the pollen to be carried in the air where people inhale the pollen and have direct contact with the pollen and their eyes. It is this interaction that causes some people to develop allergies to the grass pollen which in turn causes the classic symptoms of hay fever, allergic conjunctivitis, and/or asthma. These symptoms may include some or all of the following: sneezing, itchy nose, runny nose, nasal congestion, post-nasal drip, sore throat, hoarseness, itchy eyes, watery eyes, puffy eyes, sinus congestion, sinus pain, wheezing, coughing, shortness of breath, and/or fatigue.

Grasses tend to pollinate more the longer they grow. Therefore, keeping one’s lawn mowed reduces the grass pollen that enters the air. It is the tall grasses found in empty lots and by the sides of the roads, etc. that is the primary cause of the high grass pollen counts found in the Spring in the Washington, DC area. Warm, windy, and dry days tend to increase the grass pollen counts. The grass pollen counts also tend to be the highest in the early mornings.

There are preventive measures that should be practiced by all grass allergy sufferers and include the following:

Although it is better to have the lawns mowed, the allergic individual should avoid mowing lawns. If he/she must mow the lawn, wearing a filtered mask may help reduce grass pollen exposure.

Turn air conditioning on.

Change air filters monthly.

Keep sunroofs and windows closed.

Shower, wash hair, and change clothing after coming back inside.

Avoid yard work or wear a filtered mask.

Wash pets after they go outdoors.

Re-circulate air in car so it doesn’t come in from the outside.

Drive a car that has an air filter, if possible.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating grass pollen allergies in children and adults in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than half a century. If you experience any of the above symptoms in the late Spring and Summer, you may suffer from grass allergies. It is important for a board certified allergist to perform a detailed history and physical examination. Allergy testing can be performed via the skin or blood to determine if one has an allergy to grass or other environmental allergen such as trees, molds, etc. Treatment begins with prevention. It may not be possible to completely avoid exposure to grass pollen, however, certain preventive measures can still help alleviate some of the suffering. There a wide array of medications that can be tried which may include tablets, capsules, syrups, powders, nasal sprays, eye drops, and/or asthma inhalers. Allergy immunotherapy (also referred to as allergy shots or allergy desensitization) is a very effective means to treat grass and other environmental allergies. It is effective in about 80-85% of patients. They have been around for over 100 years. They can be given to almost anyone, including children and pregnant women.

If you would like to be seen at one of our 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 have parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations. 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 and that you deserve.

Is it Wheat Allergy, Gluten Sensitivity, or Celiac Disease?

Posted by Black & Kletz Allergy on April 20, 2015

Over the past decade, more people are interested in gluten-free diets in order to get relief from a variety of symptoms. It is therefore important to know a little about the differences between celiac disease, gluten sensitivity, and true wheat allergy.

CELIAC DISEASE (CELIAC SPRUE; NONTROPICAL SPRUE; GLUTEN ENTEROPATHY):

Gluten is a protein normally present in wheat, rye, and barley. Gluten is what gives dough its elasticity, ability to rise, and contributes to the dough’s chewiness. It is found mainly in foods, but may also be found in everyday products such as medicines, hair products, vitamins, cosmetics, lipsticks and lip balms, and other dermatologic preparations. Gluten is found in so many unexpected foods as additives and can be found in unsuspecting foods such as beer, ketchup, ice cream, soy sauce, processed lunch meats, to name a few. Celiac disease is a hereditary (runs in families) autoimmune disorder of the small intestine found in all age groups (infancy through adulthood) that occurs in approximately as many as 3 million Americans. It occurs when people with celiac disease eat gluten. Their body’s immune system reacts to the gluten by attacking the lining of their small intestine. The immune system’s reaction to gluten damages small, fingerlike growths called villi. When the villi are damaged, the body cannot get the nutrients it needs.

Symptoms of celiac disease can include:

Abdominal pain/cramping
Flatulence/bloating
Diarrhea/constipation
Extreme tiredness/fatigue
Change in mood/depression/irritability
Weight loss/decreased appetite
Joint pains
Iron deficiency anemia
Osteoporosis due to decreased absorption of calcium
Very itchy skin rash with blisters (Dermatitis herpetiformis)
Delayed growth in children

The diagnosis is suspected when blood tests detect elevated levels of certain antibodies to gluten. An upper endoscopy is needed to confirm the diagnosis, as one needs a biopsy that shows the abnormal villi of the small intestine.

The only treatment for celiac disease at this time is avoidance of gluten in diet. When it is no longer exposed to gluten, the villi of the small intestine heal and can absorb nutrients again.

NON-CELIAC GLUTEN SENSITIVITY (NCGS) (GLUTEN SENSITIVITY; GLUTEN INTOLERANCE):

“Non-celiac gluten sensitivity” (NCGS) is used to describe individuals who cannot tolerate gluten as they experience the same symptoms as those with celiac disease. The main difference is that individuals with NCGS do not have the gluten antibodies in the blood and there is no villi damage in the small intestine as is seen in celiac disease. Research suggests that non-celiac gluten sensitivity is an innate immune response (nonspecific first line of defense), as opposed to an adaptive immune response (or “learned” response such as an autoimmune reaction) or allergic reaction. As many as 18 million Americans may have NCGS.

People with NCGS can also have other symptoms such as headache, “foggy” feeling in the head, lack of concentration, and numbness in the legs, arms, and/ or fingers. Symptoms typically appear hours or days after gluten has been ingested, a response typical for innate immune conditions.

New research shows that it is possible that gluten may not even be responsible for the symptoms produced by NCGS. FODMAP’s (fermentable oligo-, di-, and monosaccharides and polyols), a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also interesting to note that wheat, rye and barley – the 3 grains that contain gluten – are all high in FODMAP’s. Even though wheat, rye, and barley contain high amounts of FODMAP carbohydrates, many other foods such as peaches, apples, beets, garlic, onion, asparagus, kidney beans, soybeans, milk, ice cream, and many sweeteners (fructose, mannitol, agave, sorbitol, etc.) also contain high amounts of FODMAP’s.

There are currently no confirmatory tests for NCGS and the diagnosis is by ruling out other conditions that may cause similar symptoms. As stated above, blood tests and biopsies that are positive with celiac disease are normal in these individuals. Improvement of one’s symptoms when gluten is removed from the diet makes NCGS more likely. However, there is a risk of self-diagnosis and starting oneself on a gluten-free diet. The risk is that there may be a serious gastrointestinal and/or other disorder that will be missed without the proper work-up. It is therefore important for individuals with these symptoms to see their physicians so that serious disorders can be ruled out by using proper testing to exclude them. Assuming there is no other disorder, a gluten-free diet and a FODMAP-free diet may be beneficial.

WHEAT ALLERGY:

One or more of the wheat proteins, albumin, globulin, gliadin, or gluten, can cause an allergic reaction involving IgE antibodies. The reactions usually take place within a few minutes to several hours after exposure to the allergen. The symptoms may include some or all of the following: itching in the mouth, swelling of lips and/or tongue, hives, eczema, runny or stuffy nose, itchy or watery eyes, tightening of the throat and/or trouble breathing, wheezing, drop in blood pressure, vomiting, diarrhea, abdominal cramps, abdominal pain, and/or anaphylaxis.

A thorough medical history and physical examination in conjunction with skin prick tests and/or allergen-specific IgE blood testing are useful in the diagnosis of wheat allergy. A food challenge may be necessary in some individuals. For wheat allergy, strict avoidance of wheat and wheat products is necessary.

Although classic IgE-mediated allergic reactions are most common with wheat, non-IgE-mediated reactions to wheat may occur, usually with a slower onset of symptoms and these symptoms are generally confined to the gastrointestinal tract.

The board certified allergists at Black & Kletz Allergy can provide answers to your questions and offer evidence based diagnostic and treatment options. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for many years. We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each of our 3 convenient office locations has on-site parking and the Washington, DC and McLean, VA locations are easily accessible by the Metro. Black & Kletz Allergy has been diagnosing and treating wheat and other food allergies for over 50 years. We also have the expertise to help diagnose and treat many gastrointestinal diseases associated with allergies and autoimmune disorders as well as rule out food allergies as a source of your gastrointestinal problems. Please call our office for an appointment if you have any of the above symptoms or alternatively, you can click Request an Appointment and we will be in touch with you within 24 hours of the next business day.

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