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Tree Pollen Allergies

Tree Pollen Washington DCIn the Washington, DC, Northern Virginia, and Maryland metropolitan area, tree pollen usually begins to pollinate in mid-February.  The pollination is usually dependent upon the weather such that towards the end of Winter, when it first becomes warm outside, pollen begins to be released from the trees.  Depending on the temperatures, tree pollination can occur as early as early February or as late as early March.  When the trees produce their pollen, allergy sufferers are usually the first to know because they typically will develop symptoms of hay fever (i.e., allergic rhinitis) and/or asthma.  As we approach Spring (late March), the tree pollen counts rise and so do the symptoms of individuals with tree pollen allergies.  In the Washington, DC metro area, tree pollen counts continue to rise and generally peak in April.  This milestone is usually recognized by millions of people as they become aware that all of the cars appear “yellow” in color.  The yellowish color of the cars is due to the yellow-colored tree pollen falling on and sticking to the numerous motor vehicles that dominate the DC metro area.  The tree pollen count will then decrease and usually end by the end of May.  Note that as tree pollination decreases, grass pollination begins.  Grass pollen is also a major allergen in many allergic individuals.

It is noteworthy to mention that most people in the DC metro area, who are unfamiliar with allergies, think that it is the cherry trees that are causing their allergy symptoms.  This fallacy is believed and propagated because people with tree pollen allergies usually feel miserable around the same time that the cherry trees in the Washington, DC area begin to bloom.  What most people do not realize is that in general, flowering trees and plants do not cause allergic symptoms for the most part.  The reason for this is that individuals who suffer allergy symptoms from tree pollen need to breathe in the pollen in order to develop the typical symptoms of hay fever.  The pollen of flowering trees and plants is heavy compared with non-flowering trees.  The lighter pollen found on non-flowering trees (e.g., birch, cedar, elm, ash, beech, hickory, maple, oak) are wind-dispersed.  These pollens will travel in the air for hundreds of miles sometimes in order to settle on other trees which will cause the trees to continue to reproduce.  With flowering trees and plants, since the pollen is heavy, wind will not suffice to spread the pollen.  In order to reproduce, the pollen on flowering trees and plants require the aid of bees, hummingbirds, moths, butterflies, beetles, etc. to land on the flowers to help with the cross-pollination.  For example, a bee will be attracted to a flower and as it lands on the flower, the tree pollen sticks to its abdomen.  When the bee then lands on another flowering tree or plant, the pollen is transferred to that flower and cross-pollination occurs which allows further reproduction.  An easy way to think of it is as follows:  It is the pollen of the “ugly” trees that are wind-dispersed and thus cause allergies.

The symptoms that individuals generally experience with tree pollen allergies may include one or more of the following:  sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, itchy throat, itchy ears, clogged ears, sinus pressure, headaches, snoring, fatigue, wheezing, chest tightness, coughing, shortness of breath.

The diagnosis of tree pollen allergies can be made by seeing a board certified allergist such as the ones at Black & Kletz Allergy.  A comprehensive history and physical examination are obtained and then usually allergy testing is performed in order to identify an allergy to a specific allergen (e.g., tree pollen).  Allergy tests can be done by either skin testing or blood testing, although skin testing is generally the preferred method.

Once an individual is diagnosed with tree pollen allergies, avoidance measures are discussed, although the goal of allergy treatment is to allow the person to enjoy their hobbies (e.g., gardening, golf, hiking) rather than being restricted to being indoors for 3 months every Spring.  In addition, there are numerous medications that an allergist can prescribe in order to help alleviate the unwanted allergy symptoms of the allergy sufferer.  These medications come in the forms of tablets, syrups, nasal sprays, eye drops, lung inhalers, and injections.  If an individual has additional allergies such as grasses, weeds, dust mites, molds, pets, etc., then allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may be recommended.  Allergy shots are effective in 80-85% of the patients that take them.  They have been used in the United States for more than 100 years.  They are given to little children as well as older adults.  The average person is on allergy shots for 3-5 years.

If you think that you may have tree pollen allergies, or any other type of allergy, the board certified allergists at Black & Kletz Allergy would be happy to help you.  We have 3 convenient offices in the DC metro area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our office offer on-site parking.  Our Washington, DC and McLean, VA locations are Metro accessible.  There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  The allergists at Black & Kletz Allergy have been treating both adults and children in the Washington, DC metropolitan area for allergies, asthma, sinus disease, and immunologic disorders for more than 50 years.  We strive to provide top-of-the-line allergy relief in a caring and professional environment.

Acute Sinusitis

Acute sinusitis may also be referred to as acute rhinosinusitis or more commonly as a classic “sinus infection.”  By definition, the symptoms of acute sinusitis will last less than 4 weeks in duration, rather than the 12 weeks or more necessary to characterize a sinus infection as chronic sinusitis or a chronic sinus infection.  Of note, some physicians classify a sinus infection that lasts from 4 to 12 weeks as subacute sinusitis.  The term recurrent sinusitis refers to repeated acute sinus infections but can easily be confused with a chronic sinus infection.  This distinction is particularly important to differentiate as an allergist because the workup and treatment of recurrent sinus infections is quite different than the workup and treatment of a chronic sinus infection.

Acute sinusitis is most commonly caused by the “common cold” or another type of virus.  Most of the time, the acute sinusitis is self-limited and resolves without treatment in 7-10 days.  Approximately 1-2% of sinusitis caused by viruses will result in a subsequent bacterial sinus infection.  Rarely, a fungus may be the cause of a sinus infection.  Other factors that predispose an individual to develop acute sinusitis include allergic rhinitis (i.e., hay fever), a deviated nasal septum, nasal polyps, a fixed nasal obstruction (e.g., tumor, foreign body), cystic fibrosis,  immunological deficiencies (e.g., HIV/AIDS, diabetes mellitus, common variable immunodeficiency), immunosuppressant medications (i.e., medications that suppress the immune system such as azathioprine, cyclosporine, corticosteroids, and many “biological” medications such as adalimumab, secukinumab, abatacept, infliximab, etanercept), dental and/or periodontal infections, and chemical irritation (e.g., cigarette smoke, chemical fumes).

The symptoms of acute sinusitis typically involves one or more of the following:

  • Nasal congestion
  • Discolored nasal discharge (e.g., yellow, green, brown discharge)
  • Post-nasal drip
  • Sore throat
  • Sinus pressure
  • Sinus headaches
  • Bad breath
  • Fatigue
  • Fever
  • Radiation of pain to the teeth and/or ears
  • Clogged ears
  • Cough

Complications from acute sinusitis is uncommon nowadays in the era of better diagnostic techniques and antibiotics, however, a few complications can still occur and are as follows:

  • Meningitis
  • Osteomyelitis (i.e., bone infection)
  • Cellulitis (i.e., skin infection)
  • Chronic sinusitis
  • Visual disturbances (if the infection spreads to one’s eye)
  • Decreased or loss of sense of smell

The diagnosis of acute sinusitis is usually a clinical one.  The history that the patient describes along with certain findings on physical examination in most cases is usually enough to diagnose the individual.  Other methods that are utilized by physicians may include allergy testing, rhinolaryngoscopy (i.e., small endoscopic instrument used to obtain direct visual inspection of the nose, throat, and vocal cords), radiological studies (e.g., CT scan, MRI), and/or nasal cultures.

The treatment of acute sinusitis most of the time requires no treatment at all.  This is so because most cases of acute sinusitis are caused by a virus which usually resolves on its own.  In patients who have a bacterial sinus infection or who develop a secondary bacterial infection, antibiotics may be needed to eradicate the infection, particularly if the symptoms persist, worsen, or are severe.  In addition, supplemental use of saline nasal irrigation, nasal corticosteroids, decongestants, and/or over-the-counter analgesics are quite helpful in many cases of acute sinusitis to reduce symptoms.  It is also recommended to stay hydrated by drinking water.

The prevention of episodes of acute sinusitis can be facilitated by seeing a board certified allergist, like the ones at Black & Kletz Allergy.  The allergy specialist will perform a comprehensive history and physical and if necessary will do allergy skin testing to identify if and what allergens are allergenic to the patient.  Depending on the frequency of episodes of acute sinusitis and/or allergy symptoms, the allergy doctor will prescribe different medications (i.e., antihistamines, decongestants, nasal sprays, eye drops) used to alleviate the individual’s allergy symptoms.  He may also recommend allergy shots (i.e., allergy injections, allergy immunotherapy, allergy hyposensitization) which is effective in 80-85% of patients receiving allergy shots.  The allergists at Black & Kletz Allergy treat both adults and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than one half a century.

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.  The allergists at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of acute sinusitis and other sinus diseases.  In addition, we treat patients with environmental allergies, medication allergies, insect sting allergies, food allergies, eczema, asthma, hives, swelling episodes, generalized itching, contact dermatitis, eosinophilic esophagitis, and immune disorders.  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 area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a friendly and professional environment.

Nasal Polyps

Nasal polyps (i.e., nasal polyposis) are soft tissue growths that form on the lining of the nasal passages and inside the sinuses (i.e., air-filled cavities within the facial bones).  They are painless and non-cancerous.  They are usually in the shape of teardrops and characteristically look like glistening moist grapes.  Nasal polyps generally develop when the mucus membranes of the nose and/or sinuses are chronically inflamed.  This results the tissue to swell up over a prolonged period of time.

When the nasal polyps grow large enough, they can obstruct the nasal passages and cause breathing difficulties due to the polys blocking the flow of air through the nose.  They can also block the free passage of secretions from the sinuses into the nose and predispose individuals to sinus infections.

Any condition which results in chronic inflammation inside the nose and sinuses can lead to nasal polyp formation.   Some of these conditions include:

What are the causes of nasal polyposis?

It is believed that inflammation causes the buildup of fluid within the mucus membranes.  When this buildup of fluid occurs, it results in the formation of fluid-filled growths, which over time expand to become polyps.

There is a condition known as Samter’s triad which is characterized by nasal polyps, asthma, and aspirin intolerance.  Samter’s triad is also known as aspirin exacerbated respiratory disease (i.e., AERD) or aspirin triad.

What are the symptoms of nasal polyps?

  • Nasal congestion
  • Runny nose
  • Post-nasal drip
  • Decreased or lack of the sense of taste and/or smell
  • Sinus and/or facial pressure
  • Sinus headaches
  • Snoring

How is the diagnosis of nasal polyps established?

  • Endoscopic examination of the nose
  • Imaging studies (e.g., X-rays, CT scans)
  • Allergy testing (e.g., skin testing or blood testing)
  • Sweat test to rule out cystic fibrosis (particularly in children)

What are some complications that may arise as a result of having nasal polyps?

  • Long-term or repeated sinus infections
  • Nose bleeds (i.e., epistaxis)
  • Exacerbations of asthma
  • Obstructive sleep apnea
  • Double vision (i.e., diplopia)

How are nasal polyps treated?

Corticosteroid nasal sprays are the usual first line of treatment.  Decongestants are sometimes useful to help shrink the size of the nasal polyps.  Antibiotics may be needed in the event that a bacterial sinus infections occurs due to the nasal polyps.

If the nasal polyps continue to grow in spite of treatment with various medications and/or if complications arise, the polyps may need to be surgically removed.  It must be noted, that it is not uncommon for nasal polyps to “grow back” after they are surgically removed, especially if an underlying untreated allergy causing chronic inflammation is still present.  The recurrence of the nasal polyps can be as quick as a few months after surgical intervention, however, it also may take a couple of years for the nasal polyps to return.  Some studies have demonstrated that regular use of a corticosteroid nasal sprays can reduce the chances of polyp regrowth after surgery.

How can nasal polyps be prevented?

The aggressive treatment of predisposing conditions such as hay fever (i.e., allergic rhinitis) with a combination of environmental controls [a reduction of the exposure to offending aeroallergens (e.g., dust mites, molds, pollens, cats, dogs, cockroaches)], medications, and desensitization procedures (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) may inhibit polyp formation.  Avoidance of exposure to smoke, strong odors, and chemicals is important in order to reduce nasal irritation and excessive tissue growth.

Patients with established chronic sinusitis may require antibiotics, nasal/sinus irrigations, and/or sinus surgery.  Patients with a history of aspirin sensitivity will do better after desensitization to aspirin in terms of better asthma control, as well as a reduction in recurrences of nasal polyps.

The board certified allergists at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding nasal polyps and/or allergy symptoms.  We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  In addition, the Washington, DC and McLean, VA offices are accessible by Metro.  There is also a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will respond to your request within 24 hours by the next business day.  Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 50 years.

 

Can Fatigue be a Symptom of Allergies?

Can Fatigue be a Symptom of Allergies?In this ever increasing complicated and stressful world that we live in, many individuals find themselves complaining of fatigue.  Most people chalk it up to being overworked or to too much stress in their lives, but fatigue can be a symptom of a multitude of illnesses.  Amongst these ailments, fatigue is often a symptom of allergies.  When an individual suffers from allergies such as hay fever (i.e., allergic rhinitis), asthma, or sinus disease (as a result of allergies), it is not uncommon to feel fatigued.  This is often from the body becoming “worn down” from constantly “fighting” the offending allergens.  In asthmatics, patients may also complain of fatigue because the shortness of breath that frequently accompanies asthma contributes to their lethargy.  In patients with sinus disease, there is often an associated sinus infection (e.g., acute sinusitis, chronic sinusitis) which also may “wear down” the body as most infections typically do, and as a result, fatigue develops in these individuals.

There are some patients with allergies where the only symptom is fatigue.  It is important however for the board certified allergist such as the ones at Black & Kletz Allergy, to recognize that not everyone with fatigue suffers from allergies.  In addition, even if someone has allergies, their fatigue may not be the cause or sole cause.  There are many other diseases and/or conditions where an individual may complain of fatigue.  These conditions should be ruled out rather than just assume that their allergies are the sole cause of their fatigue.

What are some conditions that can cause fatigue other than allergies, asthma, or sinus disease?  Below are some of the more common factors and/or disorders that can be associated with fatigue not including the aforementioned allergies, asthma, and sinus disease:

  • Anemia
  • Chronic obstructive pulmonary disease (COPD) (e.g., chronic bronchitis, emphysema)
  • Depression
  • Liver disease
  • Kidney disease
  • Heart disease
  • Thyroid disease
  • Diabetes
  • Autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis)
  • Fibromyalgia
  • Sleep apnea
  • Inflammatory bowel disease (e.g., chronic ulcerative colitis, Crohn’s disease)
  • Medications (e.g., antihistamines, antidepressants, anti-anxiety medications, blood pressure medications)
  • Alcohol or drug use

There are numerous other factors and/or conditions that may play a role in causing fatigue and it is advisable to also be examined by your primary care physician when you are experiencing fatigue.

The diagnosis of allergies begins with a comprehensive history and physical examination.  Allergy testing is usually performed by utilizing the skin testing method, however, blood tests can also be done.  The treatment of allergies begins with avoidance measures in order to reduce the exposure of an individual with the offending allergen.  If avoidance measures are not satisfactory, medications are used in order to alleviate the symptoms.  There are a wide variety of medications used to treat allergies and thus the fatigue that may be associated with them.  Ironically, many over the counter allergy medications (e.g., antihistamines) can cause fatigue and/or drowsiness.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) is a very effective treatment modality used for the treatment of allergies and allergic asthma.  It is effective in 80 – 85% of the patients that undergo allergy immunotherapy.  The usual course of treatment with allergy shots is usually between 3 – 5 years.

The board certified allergy specialists at Black & Kletz Allergy has 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our office locations have on-site parking.  In addition, our Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergists of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have been helping patients with fatigue, hay fever, asthma, sinus disease, hives, eczema, medication allergies, food allergies, insect sting allergies, and immunological disorders for more than a half a century.  If you suffer from fatigue and want to decipher if they are being caused by allergies, it is our mission to determine if your fatigue is stemming from allergies.  Then it is our goal to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms including fatigue.

 

Can Allergies be Prevented?

Do probiotics have a role in preventing allergies?Can Allergies be Prevented?

While some studies demonstrated a protective effect of probiotics on the development of eczema, other studies have shown no effect on the development of other allergic diseases.  In view of the conflicting results of various studies, probiotics are not currently recommended for preventing allergies.

How about fish oils?

There is no convincing evidence at this time that taking fish oil supplements have any significant benefit in preventing allergies.

Will dust mite avoidance measures cut down the risk of developing allergies and/or asthma?

Unless an individual is already sensitized to dust mites, avoidance measures to reduce the exposure to dust mites have not proved to reduce the chances of developing allergies, eczema, or asthma.

Should I avoid pets?

There is no reason to remove pets from the household unless a person’s allergies and/or asthma flares up when he or she is exposed to the pets.  Even if an individual’s symptoms are tied to their exposure to pets, it is often very difficult for them to get rid of their pets, as the pets are considered part of the family.  If an allergy sufferer’s symptoms appear to worsen when exposed to their pets and he or she is unwilling to remove the pets from their home, it is advised to keep the pets out of the bedroom where that individual usually spends at least 7-8 hours per day or night.

If I restrict some foods while I am pregnant and/or while breastfeeding, would that prevent my child from having food allergies?

Avoidance of common allergy-causing foods such as peanuts, tree nuts (e.g., almonds, Brazil nuts, cashews, hazelnuts, pecans, walnuts), eggs, fish, shellfish, soy, dairy, etc. has not been shown to reduce the risk of children developing food allergies.  In fact, restrictions in one’s diet during pregnancy and lactation have been linked to a decreased weight gain by babies and should be avoided.

Should I delay introduction of any foods to my infant to prevent food allergies?

Some studies showed that babies exclusively breastfed for the first 3 to 4 months of life are less likely to develop food allergies and eczema during the first 2 years of life.  As a general rule, solid foods should be introduced around 6 months of age, preferably while still breastfeeding.  This however should be confirmed by your pediatrician.  Common allergenic foods containing peanut, egg, fish, cow’s milk and soy should be given to babies before 12 months of age.  Again, this should be determined by your pediatrician.  Studies of children at high risk of developing allergies (i.e., children with eczema and/or with a family history of allergies) have demonstrated that early introduction of these foods will reduce the risk of developing food allergies in later life.

Is soy milk or goat’s milk better to prevent allergies than cow’s milk formula?

No.  Studies have showed that soy-based formulas or goat’s milk does not prevent the development of food allergies in children.

What should I do if I suspect that my child has a food allergy?

Accurate diagnosis by standardized testing is essential before treatments are contemplated.  If the tests confirm allergies to specific foods, avoidance of those foods and substitution with suitable alternatives, supervised by your board certified allergist, like the allergy specialists at Black & Kletz Allergy are recommended.  Special alternative formulas are available for children with cow’s milk and/or soy milk allergies.

Will allergy injections (i.e., immunotherapy, desensitization) prevent allergies?

The current indications for allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is to treat established environmental allergies.  However, there is emerging evidence that treating children with allergic rhinitis (i.e., hay fever) with allergy injections to “switch off” their allergies may reduce the risk of them developing new allergies and asthma later in life.

The board certified allergists at Black and Kletz Allergy have been diagnosing and treating allergies and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We see both adults and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each of our 3 locations.  Our Washington, DC and McLean, VA offices are Metro accessible.  Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line.  If you suffer from allergies, asthma, sinus problems, hives, or immunological disorders, please call us to make an appointment.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated in providing the most state-of-the-art allergy treatment in a warm, caring, and professional environment.

Winter Allergy Symptoms

Winter Allergy Symptoms Washington DCAs we approach the Winter in the Washington, DC, Northern Virginia, and Maryland metropolitan (Mid-Atlantic) area, the temperatures naturally fall and the resulting cold air can play havoc with many people.  “Allergic” signs and symptoms may appear in allergic patients as well as non-allergic individuals.  The “allergic” symptoms can vary in intensity and they commonly affect different parts of the body such as the nose, eyes, lungs, and/or skin.

Symptoms based on the parts of the body:

Nose:  The cold air of Winter can act as an irritant to anyone whether the individual has allergies or does not have allergies.  The typical symptoms that may occur include runny nose, nasal congestion, post-nasal drip, and nosebleeds (i.e., epistaxis). 

Patients with nonallergic rhinitis (i.e., vasomotor rhinitis) will experience these symptoms despite the fact that allergy testing is negative because these individuals are bothered by irritants such as cold air, cigarette smoke, air pollution, dusts, strong odors, chemicals, etc.  Nosebleeds are usually a result of the cold dry air which is common during the Winter.

On the other hand, patients with allergic rhinitis (i.e., hay fever) can exhibit the same symptoms during the Winter as the patient with nonallergic rhinitis, however, their symptoms are generally due to a true allergy to allergens that are prevalent in the Winter months.  The most common allergens during these months include dust mites, molds, pets, and cockroaches.  Nosebleeds may be due to either a side effect of a corticosteroid nasal spray (e.g., Flonase, Nasacort, Rhinocort, Nasonex, Qnasl, Omnaris) used in the treatment of allergic rhinitis or the result of the cold dry air that accompanies the Winter weather.

Eyes:  Similar to the effects that the cold air has on the nose, the cold air can affect ones’ eyes in very much the same way.  The two characteristic symptoms exhibited when the eyes come in contact with cold air in an allergic or nonallergic individual include watery eyes and redness of the eyes.  Itching of the eyes is generally not seen unless an individual is allergic and is reacting to one of the allergens common during the Winter (e.g., dust mites, molds, pets, cockroach).

Lungs:  Cold air is a common trigger that exacerbates asthma symptoms (e.g., chest tightness, shortness of breath, wheezing, coughing) in asthmatic individuals.  Most asthmatics have an underlying allergic diathesis and in turn their asthma may also be exacerbated by common Winter allergens such as molds, dust mites, pets, and/or cockroaches.  Of note, cockroaches are a very common and potent allergen that aggravates the symptoms of asthma in asthmatic children living in inner cities.  In nonallergic, non-asthmatic people, the cold air can also cause asthma-like symptoms, but generally the symptoms are milder in severity.

Skin:  When the temperature drops in the Winter, the cold air can cause two similar conditions referred to as Raynaud’s disease (i.e., primary Raynaud’s) and Raynaud’s phenomenon (i.e., secondary Raynaud’s) depending on whether there is an underlying medical problem.  Raynaud’s disease is not associated with another medical condition and is more common than Raynaud’s phenomenon which is associated with other medical conditions.  The most common underlying medical problems that may be associated with Raynaud’s phenomenon may include connective tissue diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjögren’s syndrome), smoking, atherosclerosis, carpal tunnel syndrome, injuries to the hands and/or feet, and certain medications (e.g., migraine headache medications, beta blockers, ADHD medications).

Regarding the skin, there are 4 conditions that all act on the skin and can be lumped into one entity as they are all very similar.  The only difference between them is the severity of the reaction when an individual is exposed to the cold. The 4 conditions include cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis.  In cold-induced pruritus, the cold air will cause a susceptible person to have itchy skin. In cold-induced urticaria, the individual will develop hives upon contact with something cold. People with cold-induced angioedema will develop swelling episodes when exposed to the cold.  Lastly, some individuals may develop anaphylaxis when they are exposed to the cold which obviously can be very serious and potentially fatal. It is important to see a board certified allergist if you have one of these conditions, as a self-administered epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) is typically prescribed, particularly for cold-induced angioedema and cold-induced anaphylaxis.  It is also important to note that any person who needs to use a self-administered epinephrine device should go immediately to the closest emergency room after using the device.

Winter is almost here and the temperatures outside have already begun to drop into the “cold” range.  The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergy doctors of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  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.  The allergy specialists at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, hives, eczema, generalized itching, anaphylaxis, medication allergies, insect sting allergies, food allergies, and immunological disorders for more than 50 years.  If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms.

Cow’s Milk Allergy

49669476_306459563314751_2875648138461315072_nAbout 2% of children in the United States are allergic to cow’s milk.  The condition usually begins in the first year of life and can affect both breastfed and formula-fed infants.  A majority of the children usually “outgrow” the allergy by 5 years of age, however not all children “outgrow” milk allergies.

Immediate hypersensitivity reactions (Type I allergy reactions) to cow’s milk are mediated by an antibody (i.e., Immunoglobulin E or IgE) to the protein in milk.

Symptoms:

The symptoms of milk allergy usually appear within minutes of ingestion and may involve multiple body systems.  Below are some common symptoms that may be associated with cow’s milk allergy:

Skin:  Itching, redness, hives, swelling

Respiratory:

Upper:  Nasal congestion, runny nose, sneezing, hoarseness

Lower:  Coughing, wheezing, chest tightness, shortness of breath

Eyes:  Redness, itching, puffiness of eyelids

Heart:  Pallor, fainting, dizziness

Gastrointestinal:  Abdominal pain and/or cramping, vomiting, diarrhea

Diagnosis:

  • Skin prick testing
  • Cow’s milk specific serum IgE via blood testing
  • Oral food challenge

A double-blind oral challenge with food under controlled conditions under medical supervision is considered the gold standard in the diagnosis of food allergies. It may not be needed however when the clinical presentation is highly suggestive of the diagnosis and when it is supported by appropriate test results.

Treatment:

Currently, the only FDA-approved treatment for cow’s milk allergy is strict avoidance of all exposure to cow’s milk protein.  It is also very important to have an emergency treatment plan in case of an accidental ingestion and/or exposure.

Cow’s milk proteins are found in all dairy products including milk, cheese, yogurt, butter, ice cream, and pudding.  Other foods such as breads, cookies, crackers, and cakes may also contain milk products. In packaged foods, milk may be listed as a major ingredient or in the “may contain” list.  Sometimes, a product will convey that the food was made in the same facility as other foods that contain milk. Parents also must be aware of the possibility of cross contamination of milk with other foods, especially in restaurants.  Other products that contain casein, whey, hydrolysates, lactose, lactulose, lactoglobulin, lactoferrin, lactalbumin, ghee, rennet, artificial butter flavor, artificial cheese flavor, and/or curd should also be avoided. It is also a good idea for parents of a child with cow’s milk allergy to share his or her allergy with caregivers, teachers, principals, school nurses, neighbors, relatives, and parents of the child’s friends so that they are all aware of the allergy and what to do if the child comes in contact with cow’s milk.

Some children with cow’s milk allergy may be able to tolerate baked milk foods as prolonged heating at high temperatures can denature the protein making it less allergenic.  However children with established cow’s milk allergy should be fed baked milk foods only if they pass the oral challenge with baked food under medical supervision. It is best and recommended, however, to avoid baked milk foods just to be on the safe side.

Medications:

Self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q, Adrenaclick) should be readily available to treat a severe reaction after accidental exposures.  Milder reactions may be treated with antihistamines such as Benadryl (i.e., diphenhydramine).

Resolution:

As mentioned before, an oral food challenge is the gold standard to establish if the allergy has been “outgrown,” however, in some cases, this may not be feasible to do in a doctor’s office.  The board certified allergist may repeat food allergy tests may every year to determine whether it is safe to perform oral food challenges.

Cow’s milk is a very important source of nutrition in infants and young children, as it contains carbohydrates, fats, protein, and various essential minerals and vitamins. When milk is being avoided, children should be fed proper nutritional substitutes in adequate quantities and parents may need guidance from a certified dietician to choose the alternative foods.

The board certified allergists at Black & Kletz Allergy have 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.  The allergy specialists at Black & Kletz Allergy are extremely knowledgeable regarding cow’s milk allergies as well as other food allergies.  We diagnose and treat both pediatric and adult patients.  In addition, we treat patients with environmental, medication, insect sting, and skin allergies, asthma, sinus disease, and immunological disorders.  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 area for more than 50 years and we look forward to providing you with excellent state of the art allergy care in a friendly and professional environment.

Vaccines for Adults with Lung Disease

Vaccines for Adults with Lung Disease   Every year, thousands of people in the U.S. get very sick from diseases that could be prevented by vaccines.  People with asthma and chronic obstructive pulmonary disease (COPD) (e.g., emphysema, chronic bronchitis) are at a higher risk than the general population for complications from vaccine-preventable diseases.

Asthma and COPD cause the airways of the lungs to swell.  In addition, these conditions cause mucus secretions to become thick, resulting in the blockage of the swollen airways which may lead to breathing difficulties.  Certain viral and bacterial infections affecting the lungs can also cause swelling of the airways and thicken the secretions. This combination can lead to serious complications such as pneumonia and/or respiratory failure.

Immunizations provide the best protection against infections which may aggravate asthma and/or COPD.  The side effects from vaccinations are generally mild and self-limited.

The following vaccinations are strongly recommended for people with lung diseases:

  1. 1. Influenza:

The 2018-2019 vaccine has been updated from last season’s vaccine to better match circulating viruses.  Immunity from this vaccination usually begins to develop after approximately 2 weeks.

Injectable influenza vaccines (i.e., flu shots) are approved for use in individuals aged 6 months and older.  Flu shots have a long established safety record in people with asthma. Individuals with asthma can receive either a trivalent or a quadrivalent vaccine.

The nasal spray vaccine is recommended as an option for use in people 2 through 49 years of age.  It should be noted that anyone with asthma is at increased risk for wheezing after receiving the nasal spray flu vaccine.  Nasal spray vaccine is also not recommended for pregnant women, individuals with weakened immune systems and their care givers, and children 2 through 4 years of age who have had a history of wheezing in the past 12 months.  It is important to note that the influenza virus in the nasal spray vaccine a live attenuated (i.e., weakened) virus compared with a killed virus that is used in a flu shot.

People with egg allergies can receive any recommended age-appropriate influenza vaccine that is otherwise appropriate, if given the approval by their primary care physician.  Individuals who have a history of severe egg allergy (i.e., those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a physician who is able to recognize and manage severe allergic reactions.  Again, if one has an egg allergy, one should always check with their primary care physician about getting a flu vaccination and only receive it, if approved by the primary care physician.

In addition to getting a flu vaccine, people with asthma should take everyday preventive actions including covering coughs, washing hands often, and avoiding individuals who are sick.

  1. Pneumococcal Vaccines:

Pneumococcus is a bacteria that causes thousands of infections, such as meningitis, bloodstream infections (e.g., sepsis), pneumonia, and ear infections. Pneumococcal vaccines are very good at preventing severe disease.  Two types of vaccines are available:

The pneumococcal conjugate vaccine (e.g., PCV13 or Prevnar) protects against 13 strains of pneumococcal bacteria.  It is recommended for young children and adults 65 years of age or older. Older children and adults younger than 65 years of age who are at increased risk for getting pneumococcal disease may also need a dose of PCV13.

The pneumococcal polysaccharide vaccine (e.g., PPSV23 or Pneumovax) protects against 23 types of pneumococcal bacteria.  It is recommended for all adults 65 years of age and older, as well as for individuals 2 years of age and older who are at increased risk, such as those with asthma and/or COPD.

Both vaccines are recommended and generally they should be given 1 year apart.

  1. Diphtheria, Tetanus, Pertussis:

This combination vaccine protects against 3 serious bacterial infections, namely diphtheria, tetanus, and pertussis (i.e., whooping cough).  DTaP is the childhood vaccine, and Tdap is the pertussis booster vaccine for preteens, teens, and adults. A Td booster is recommended once every 10 years.  Most Ob/Gyn doctors will recommend the Tdap to all pregnant women. It is usually recommended in the 3rd trimester.  The Tdap is also usually recommended for each subsequent pregnancy.  In addition, pediatricians generally recommend that all care-givers and individuals that will be in close and frequent proximity to the newborn also be vaccinated with Tdap.

  1. Shingles:

Shingles is a painful and/or itchy rash that usually develops on one side of the body, often the face or torso.  It is caused by the re-activation of the chickenpox virus (i.e., varicella-zoster virus) that has been lying dormant in a nerve of an individual.  The rash consists of small blisters that typically scab over in 7 to 10 days and generally clears up within 2 to 4 weeks. For some individuals, the pain can last for months or even years after the rash disappears.

A new shingles vaccine called Shingrix (i.e., recombinant zoster vaccine) was licensed by the U.S. Food and Drug Administration (FDA) in 2017.  It is recommended that healthy adults 50 years of age and older receive two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and the complication of long term pain.  Patients who have previously received Zostavax, an older shingles vaccine, are recommended to subsequently receive Shingrix, as it is more efficacious.

The board certified allergists/immunologists at Black & Kletz Allergy have expertise is immunizations as well as the diagnosis and treatment of immunological conditions.  In addition to diagnosing and treating immune disorders, the allergy specialists at Black & Kletz Allergy diagnose and treat a wide array of allergic conditions such as hay fever (i.e., allergic rhinitis)sinus disease, asthma, hives (i.e., urticaria)swelling episodes (i.e., angioedema)generalized itching (i.e., pruritus)anaphylaxisinsect sting allergiesfood allergies, medication allergies, and eosinophilic esophagitis.  We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer parking at each location and the Washington, DC and McLean, VA locations 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.

If you would like to schedule an appointment, please call us to schedule a visit at your desired location.  Alternatively, you may click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been treating allergy, asthma, and immune-related conditions for more than 50 years in the Washington, DC and Northern Virginia metropolitan area.  We are board certified to see both adult and pediatric patients and we are determined to improve the quality of life in individuals who may suffer from unwanted allergies, asthma, sinus disease, or immune dysfunction.