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Common Allergens in Sunscreen

Sunscreen is something that you need to wear to protect your skin from the sun’s harmful UV rays, but not all sunscreen is created equal. Some people might have no problem wearing it, but it’s also possible for your skin to have a bad reaction to the common ingredients in most sunscreen formulas. You might not be aware that sunscreen chemicals are added to some other cosmetic or lotion products, which can cause you to have an allergic reaction.

Understanding Sunscreen Sensitivities

Contact dermatitis is a rash on your skin due to contact with an irritating substance, such as those used in common sunscreen formulas. Your skin could be irritated or having an allergic reaction which is more prominent on areas that have direct exposure to the sun, such as your face or where clothing isn’t protecting you. This is a known as photo-contact dermatitis and may also be a reaction to preservatives or fragrances used.

Those Prone to Allergies

Certain groups of people or individuals are more prone to developing an allergy to sunscreen. Females are more affected particularly because they are more prone to using cosmetics that can contain potentially irritating substances. Those with sun-damaged skin, sunscreen being applied to areas of damaged skin and people who work outdoors on a regular basis such as construction workers. The American Academy of Dermatology advises that everyone wear sunscreen because one in five Americans will eventually develop skin cancer due to the sun’s harmful UV rays.

Understanding How Sunscreen Works

There are two ways sunscreen works to protect your skin. The chemical absorbers in sunscreen absorb the energy from the sun as it hits your skin and turns it into less dangerous and damaging radiation. Physical blockers reflect the sun’s rays to prevent radiation from being absorbed and are commonly found in products used by people who spend significant time at the beach.

Chemicals That Can Cause Allergies

Everyone has a different reaction to chemicals and to the active ingredients found in many sunscreen products. It can be hard to pinpoint which ingredient is causing a reaction since some have multiple active ingredients. These are some of the ingredients found in many popular sunscreen products:

  • Benzophenone – This has been used in sunscreen for quite some time and is one of the most common irritants in sunscreen formulas. Other names for it are eusolex, methanone, and diphenyl ketone.
  • Dibenzoylmethane – This has been commonly used in sunscreen since 1997 in the United States and acts as a chemical absorber.
  • Octocrylene – This is a newer chemical used in many sunscreen products and has the potential to cause contact dermatitis for individuals who have sensitive skin. It is typically used to enhance a product’s scent.

It’s important to protect your skin from the harmful rays of the sun, but experiencing an allergic reaction is less than desirable and can be very serious. Be careful when selecting sunscreen, and maybe even consider the answer to the question, “What is the best all natural sunscreen?” to avoid those common allergenic chemicals.

Summer Allergies and Asthma

Allergens (i.e., antigens) that are commonly found in the Washington, DC, Northern Virginia, and Maryland metropolitan area in the Summer may include:  pollens, molds, dust mites, pets, cockroaches, stinging insects (e.g., bees, wasps, yellow jackets, white-faced hornets, yellow-faced hornets), and non-stinging insects (e.g., mosquitoes, gnats).

Non-allergens (i.e., irritants) that cause allergy-like symptoms and/or asthma, that are found in the Summer in the Washington, DC metro area may include:  smog, smoke, ozone, diesel fuel, dust particulates, and automobile exhaust.

Grass pollens are more prevalent in the early Summer, whereas ragweed pollen generally begins to pollinate in the middle of August and typically ends in late October with the arrival of the first frost.  There are also small amounts of tree pollens that linger in the air during the beginning of the Summer in the Washington, DC metro area, although characteristically, tree pollens wreak havoc mostly in the Spring.

Molds are omnipresent in the greater Washington, DC metropolitan area since Washington, DC was built on a swamp.  In the Summer, there is higher humidity, along with warmer temperatures which provides the perfect condition for mold growth.  Molds are also found indoors and tend to gravitate to places such as basements, kitchens, and bathrooms where moisture may be worse.

Dust mites (e.g., Dermatophagoides farinae, Dermatophagoides pteronyssinus) are microscopic bugs that tend to live in carpeting, fabrics, and bedding.  They live off of dead skin that naturally sloughs off of humans and animals.  They will also eat molds.  Dust mites reach their peak concentrations during the Summer and thrive in the warm, humid environment that Washington, DC is famous for in the Summer.

Cats, dogs, horses, and furry pets (i.e., hamsters, guinea pigs, rats, mice, ferrets) are a source of allergens throughout the year, because they are generally kept indoors, except for horses.  As the weather warms up, people tend to go horseback riding more often, so people tend to complain of allergies to horses more often during the warmer months of Summer.  In addition to the actual pet allergy itself, cats and dogs often transfer pollens on their furry coats from the outside to the inside of one’s home which may add to the misery of a particular allergic individual.

Cockroaches are very common in homes, restaurants, and stores especially in inner city locations such as Washington, DC.  They are highly allergenic and are responsible for exacerbating asthma, particularly in asthmatic children who live in the inner cities.

Stinging insects are also more common in the Summer.  Bees, wasps, yellow jackets, white-faces hornets, and yellow-faced hornets are always around during this time of year.  They tend to like being around food and tend to be found quite often at picnic grounds, barbeques, swimming pools.  They also are found near gardens, lawns, and parks.  Note that stinging insects can be anywhere and sensitive individuals should always practice avoidance measures and carry an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick), if prescribed by an allergist such as the board certified allergists at Black & Kletz Allergy.  If an individual uses their epinephrine auto-injector, they should immediately go to the closest emergency room.  Life-threatening anaphylactic reactions (i.e., anaphylaxis) to stinging insects do occur and anyone who has had any type of systemic reaction in the past to a stinging insect should definitely see a board certified allergist for venom testing and possible venom immunotherapy (i.e. “bee shots”), since venom immunotherapy is highly effective in preventing anaphylactic reactions with future stings.

Non-stinging insects such as mosquitoes are more prevalent in the Summer and tend to migrate near standing fresh water.  Even a small puddle is enough standing water to act as a reservoir for the breeding of mosquitoes.  Most of the reactions to non-stinging insects involve a local redness and/or swelling of the skin.  There may be pain and/or itching associated with the bites.  In rarer situations, an individual may experience an anaphylactic reaction.  If this occurs it is important to use an epinephrine auto-injector and immediately go to the closest emergency room.

Non-allergens (i.e., irritants) such as smog, smoke, ozone, diesel fuel, dust particulates, and automobile exhaust also may cause allergy-like and/or asthma symptoms in many susceptible individuals.  Automobile exhaust in combination with the heat of summer and ultraviolet (UV) rays of the sun contribute greatly to increased levels of ozone and smog.  In addition to ozone and smog, dust particulates and smoke are two more non-allergic irritants that contribute to air pollution.  Air pollution is unhealthy to human life when the pollution level or air quality index (i.e., AQI) rises to above 150.  Note that the AQI ranges from 0 to 500.  AQI’s above 100 are unhealthy for certain sensitive groups of people (e.g., people with lung disease).  AQI’s above 300 are hazardous to everyone.

The board certified allergy specialists at Black & Kletz Allergy have over 50 years’ experience in the diagnosis and treatment of environmental allergies and insect sting and bite allergies.  Although these conditions may be more prevalent in the Summer, environmental allergies are a perennial problem and most sensitive individuals have year-round symptoms.  Black & Kletz Allergy specializes in both adults and children who have allergies and/or asthma.  We have 3 locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at each location and the Washington, DC and McLean offices 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.

If you would like us to help you with your allergies and/or asthma, please call us at one of our office locations that are convenient for you.  Alternatively, you can click Request an Appointment and we respond within 24 hours by the next business day.  We are here in order for us to make your Summers more enjoyable by eliminating or markedly reducing your allergy and/or asthma symptoms.

Mosquito Bite Reactions

The onset of summer brings with it the menace of mosquitoes.  Though we are more concerned about diseases transmitted by mosquitoes such as malaria, encephalitis, dengue fever, chikungunya, West Nile virus, yellow fever, filariasis (elephantiasis), Western equine encephalitis, Eastern equine encephalitis, Japanese encephalitis, Venezuelan equine encephalitis, St. Louis encephalitis, La Crosse encephalitis, Ross River fever, Rift Valley fever, and most recently Zika virus-related illnesses, adverse reactions to mosquito bites can be very severe in susceptible individuals.

Mosquitoes inject their saliva into the tiny blood vessels in our skin, before sucking the blood. Immunological reactions to the chemicals in the saliva of the mosquito are usually responsible for the untoward reactions.  The chemicals can also interfere with the clotting mechanism in individuals resulting in local bleeding.

Three types of reactions can occur:

  1. The most common manifestation is localized redness, swelling, and/or itching. The symptoms usually begin a few hours after the bite and usually resolve spontaneously within a few days.
  2. Blistering lesions and/or larger hives (i.e., papular urticaria), sometimes accompanied by mild fever and joint stiffness and pain, may occur and are generally more bothersome than the localized redness, swelling, and/or itching mentioned above.
  3. Very rarely mosquito bites may result in serious generalized reactions (i.e., anaphylaxis), affecting multiple organ systems.

The typical clinical course of sensitization and natural desensitization usually proceeds in five stages:

  1. People who have never been exposed to a particular species of mosquito do not develop reactions to the initial bites from such mosquitoes.
  2. Subsequent bites result in the appearance of delayed local skin reactions.
  3. After repeated bites, immediate wheals may develop.
  4. With further exposure, the delayed local reactions wane and eventually disappear, although the immediate reactions persist.
  5. People who are repeatedly exposed to bites from the same species of mosquito eventually also lose their immediate reactions.

Treatments:

  1. Application of ice and elevating the affected area can help reduce swelling and/or pain.
  2. Blisters need to be cleaned with soap and water.
  3. 1% hydrocortisone cream or ointment which can be found over-the-counter will help control inflammation. This cream or ointment may be applied twice a day for up to 1 week, as there are potential side effects of prolonged use of such steroid creams/ointments.
  4. Oral antihistamines may help relieve itching to some extent.
  5. Antibacterial medications may need to be used if the area becomes infected which is not very common.
  6. In the case of systemic reactions, carrying an epinephrine auto-injector (i.e., EpiPen, Auvi-Q, Adrenaclick) is highly recommended.

Avoidance:

  1. Mosquitoes usually breed in pools of standing water. Keeping outdoor areas free of standing water will discourage mosquito breeding.
  2. Mosquito bites occur more often from dusk to dawn. Staying indoors also is advantageous to reduce one’s exposure to mosquitoes.  Using screened windows and screened porches are helpful in reducing mosquito exposure.
  3. Wear protective clothing with long sleeves and pants. Avoid bright colors and heavy perfumes and colognes which can attract mosquitoes.
  4. Insect repellants containing DEET (i.e., N,N-diethyl-3-methyl-benzamide or N,N- diethyl-meta-toluamide) as the active ingredient are most effective. Repellants containing 10 to 25% DEET provide approximately 2 to 6 hours of protection.
  5. Some individuals can be sensitive to DEET, which may cause irritant reactions (e.g., skin rashes, itchy skin, redness of the eyes, watery eyes). Testing the insect repellant on a small area of skin before application over extensive areas is helpful in determining if it is an irritant to a particular individual.  Utilizing only the lowest effective concentration is preferable.
  6. Products containing the active ingredients picaridin, oil of lemon eucalyptus, and IR 3535 (i.e., 3-[N-Butyl-N- acetyl]-aminopropionic acid, ethyl ester or Ethyl 3-[acetyl(butyl)amino]propanoate) are also effective repellants in individuals that do not want to use DEET or react to DEET.

The board certified allergists of Black & Kletz Allergy have had over 50 years of experience dealing with mosquito bite reactions.  Black & Kletz Allergy has 3 office locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergy doctors at Black & Kletz Allergy diagnose and treat both adults and children with allergies (e.g., hay fever, food allergies, medication allergies), asthma, hives, swelling episodes, eczema, contact dermatitis, insect bites, bee sting allergies, sinus disease, and immunologic problems.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have on-site parking at each location.  The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro    station on the silver line.  Please call us to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been striving to provide high quality allergy and asthma care to the residents of the Washington, DC metro area for more than a half a century and we are dedicated to continue delivering state of the art allergy and asthma care in the future.

Thunderstorms and Asthma

A very interesting article was published in the current issue of the Journal of Allergy and Clinical Immunology in the section “Paradigms and Perspectives.”

In Melbourne, Australia, on Monday, November 21, 2016, hospitals were swamped with emergency patients affected by severe asthma exacerbations.  There were more than 8,500 patients from Monday night to Tuesday and 9 of them died.  Firefighters and police were called in to help physicians and paramedics respond to thousands of calls after the outside conditions caused breathing problems for its many citizens.  It caused many individuals, including those with a history of hay fever (i.e., allergic rhinitis), without a prior history of asthma, to experience breathing difficulties.  Many had severe and/or near-fatal asthma exacerbations.  The epidemic in Melbourne was due to a very unusual weather occurrence.  There were thunderstorms with high wind velocities and torrential rain combined with a high pollen count sending a large amount of grass pollen allergens into the air across the city.

In normal circumstances, pollen grains penetrate into the upper airways of individuals but only reach these larger airways in the lungs due to their large size.   However, it is postulated that during thunderstorms, pollen grains can rupture due to osmotic shock and release their content into the atmosphere.  As a result, the very small granules released into the air are now able to reach the lower smaller airways which then in turn induce asthma symptoms.

During the first 20 to 30 minutes of a thunderstorm, a high concentration of allergenic material released by the pollen is dispersed into the atmosphere.  People who have been previously sensitized to the pollen can experience acute and severe flare-ups of coughing, wheezing, chest tightness, and/or shortness of breath after inhaling these allergens.  This situation described above constitutes a major concern nowadays because of the ‘‘highly likely’’ increase in the frequency of heavy precipitation events, including thunderstorms, projected by climate change scenarios for future decades.

Ironically, rainfall is usually known to remove pollens from the air.  During a thunderstorm, however, dry updrafts force whole pollens into the high humidity at the cloud level, where pollens can rupture and cold downdrafts can carry pollen fragments to the ground level.  The relationship between allergen exposure, airway inflammation, and clinical symptoms is complex.  Factors other than allergens such as cold air and perhaps electrical charges of the atmosphere may also be playing a role in triggering asthma.

It is important to realize that people who previously had only hay fever symptoms are also at a higher risk for asthma during a thunderstorm.  Patients affected by pollen allergies should be aware of the danger of being outdoors during a thunderstorm in the pollen seasons.  Staying indoors with the windows closed significantly reduces the risk of asthma exacerbations.  Using inhaled asthma medications (e.g., bronchodilators, corticosteroids) at the onset of symptoms can minimize the severity of the asthma “attacks.”  Allergy shots (i.e., allergy immunotherapy, allergy injections) can also minimize or prevent asthma exacerbations caused by pollens, as well as dust mites, molds, pets, and cockroaches.

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 your asthma 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 answer you 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.

Pet Allergies – What are They and What Can Be Done to Help?

Individuals who are allergic to their pets generally have the same symptoms as people who have allergic rhinitis and allergic conjunctivitis to other allergens such as dust mites, molds, pollens, and, cockroaches.  These symptoms may include some or all of the following:  sneezing, runny nose, nasal congestion, itchy nose, post-nasal drip, itchy ears, clogged ears, itchy throat, itchy eyes, red eyes, watery eyes, puffy eyes, sinus congestion, sinus headaches, snoring, hives, generalized itchiness, swelling episodes, fatigue, wheezing, chest tightness, coughing, and/or shortness of breath.

It is the proteins found in the pet’s dander, urine, and saliva that act as the allergens which cause pet allergic individuals to react when exposed to pets.  In cats, the major allergenic protein is called Fel d 1.  Fel d 1 is primarily produced in cat saliva as well as in the skin itself.  Male cats produce more Fel d 1 than female cats.  Other cat allergens include Fel d 2, Fel d 3, Fel d 4, Feld 5, and Fel d 6.  Fel d 4 seems to be the 2nd most potent cat allergen after the major cat allergen which is Fel d 1.  Can f 1 and Can f 2 are the two major dog protein allergens which are found on a dog’s dander.  They are produced by the dog’s tongue tissue as well as other salivary glands.

In addition to cats and dogs, there are numerous other animals that people have as pets, some of which include birds, rabbits, ferrets, hamsters, guinea pigs, gerbils, mice, rats, spiders, snakes, lizards, turtles, fish, and horses.  In general, fish, reptiles, and amphibians as pets do not cause significant allergies to most individuals.

If you or someone you know has allergy and/or asthma symptoms when exposed to pets or has allergy and/or asthma symptoms and they live with a pet, they should seek a board certified allergist’s care to determine if they are in fact allergic to that pet.  At Black & Kletz Allergy, our board certified allergy doctors have the expertise in determining if someone has a pet allergy.  It begins with a comprehensive history and physical examination to identify any signs or symptoms that appear to be attributable to a pet allergy.  The diagnosis can be confirmed with allergy testing which can be done via blood tests or allergy skin tests, with the latter being a more sensitive testing method.

Once the diagnosis is made, our allergists will make recommendations on how to best avoid the pets as well as reduce exposure to the pet allergens, since in almost every circumstance, the person does not want to part with their pet as it is a beloved member of their family.  Black & Kletz Allergy offers many tips to pet-allergic individuals that help reduce exposure to the pet allergen proteins that cause allergic symptoms.  Allergy medications are usually prescribed in order for the individual to be able to tolerate being around the pet.  These medications may include oral antihistamines, nasal sprays, eye drops, inhalers, and/or leukotriene antagonists.  Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) has been found to be extremely effective in the management of pet allergies.  In addition, allergy shots may also contain other allergens such as dust mites, molds, and/or pollen, depending upon the individual’s sensitivities and his or her allergy history.  Allergy shots are effective in the treatment of allergic rhinitis in about 80-85% of the patients that take them.  The average length of treatment on allergy shots usually ranges from 3-5 years.

Black & Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  If you suffer from pet allergies and/or asthma related to animals, as well as any other type of allergy, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been providing excellent allergy and asthma care in the Washington, DC metro area for more than 50 years and we look forward to helping you.

Grass Allergy and What Can Be Done to Help You

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, grass pollinates mostly from the end of April through the end of August.  The peak grass pollen levels tend to be from May through July, however.  Grass is a very common allergen as it affects millions of individuals.

There are thousands of types (i.e., species) of grasses and many cross-react with one another.  This means that if you are allergic to a particular type of grass, then you are likely to exhibit allergic symptoms if you are exposed to another type of grass if it is within the same grass subfamily.  Pooideae is the largest subfamily of the grass family Poaceae.  These grasses are common grasses known to cause allergic rhinitis (i.e., hay fever) in sensitized individuals.  They tend to occur in temperate climates in the U.S.  Some of the grasses in this subfamily include Timothy, Red top, Sweet vernal, Orchard, Meadow fescue, Kentucky blue, and June.  They also include the common cereal grasses (e.g., rye, wheat, barley, oat).  Panicoideae, also in the grass family Poaceae, is another common grass subfamily and its’ grasses are also a common cause of allergic rhinitis.  Common grasses in this subfamily include Johnson and Bahia.  In the grass family Poaceae, subfamily Chloridoideae, the most common grass to cause allergy symptoms is Bermuda.  Bermuda grass tends to occur mostly in the southern half of the U.S. where there are warmer temperatures.

The typical allergic rhinitis symptoms that most allergic individuals suffer from may include all or some of the following:  sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, clogged ears, itchy ears, itchy eyes, watery eyes, puffy eyes, hoarseness, snoring, sinus congestion, sinus headaches, wheezing, chest tightness, shortness of breath, and coughing.  In very allergic individuals, contact with grasses may cause itchy skin and hives.  Rarely, a very grass-allergic person may develop anaphylaxis if he or she scrapes their skin on grass and it gets into the bloodstream, as is not uncommon in certain sports such as football, baseball, and soccer.

In order to manage one’s grass allergies, the following tips are recommended:

  • Avoid mowing the lawn, but if you need to mow it, wear a mask.
  • Remove your clothes after coming inside from outdoors. Take a shower to wash the pollen off of you as well as wash your clothes.
  • Keep your lawn short, as grass pollinates when the grass is tall.
  • Keep an eye on the pollen count. You check it daily by clicking Today’s Pollen Count.
  • Wash your pets when they come indoors, as their fur will transport grass pollen into your home.
  • Avoid hanging wet clothes outdoors to dry, as pollen will gather on the clothes.
  • Keep your windows and sunroofs closed in your motor vehicles.
  • Keep your doors and windows closed in your house.
  • Use over the counter allergy medications such as oral antihistamines, nasal sprays, and/or eye drops, if approved by your physician.
  • See a board certified allergist, like the ones at Black & Kletz Allergy, if your symptoms are not alleviated by over the counter medications.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating grass allergies as well as other environmental allergies such as trees, weeds, dust mites, molds, cockroaches, pets, and other animals.  We diagnose and treat both children and adults.  In addition, we also see patients with a variety of other allergic/immunologic conditions such as asthma, eczema, sinus problems, hives, swelling episodes, generalized itching, food allergies, poison ivy, poison oak, poison sumac, contact dermatitis, insect sting allergies, medication allergies, eosinophilic esophagitis, hypogammaglobulinemia, and other immune disorders.

Black & Kletz Allergy has 3 convenient locations in the Washington, DC metropolitan area.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Each office has on-site parking and the Washington, DC and McLean offices are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office location that is most convenient for you or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy strive to provide our patients with the highest quality allergy and asthma care in the Washington, DC and Northern Virginia metropolitan area.

New Treatments for Eczema

Atopic dermatitis is a common genetically determined chronic inflammatory disorder of the skin. Eczema is a term used to describe the appearance of the skin in atopic dermatitis, as well as in other skin diseases. Though atopic dermatitis generally tends to be more severe in childhood and improve in adulthood, most people with this condition continue to have remissions and exacerbations throughout their lifetimes.

Environmental factors such as weather changes and food allergies can exacerbate the eczema and itching.  Atopic dermatitis is usually more bothersome during the winter months due to excessive dryness.  Individuals with atopic dermatitis are more likely to have sensitivities to foods and exposure to these foods can worsen their eczema.  Individuals with eczema tend to be most sensitive to the following foods:  milk, wheat, soy, peanut, egg, and seafood.

Though there is no known cure for atopic dermatitis, many treatments are available to relieve the symptoms and improve one’s quality of life.

Traditionally, management of atopic dermatitis consists of:

  1. Identifying the triggering and aggravating factors (which can vary from patient to patient) for eczema and avoiding exposure as best as possible.
  2. Hydrating the skin with daily application of emollients (i.e., moisturizing creams and lotions) all over the body immediately after bathing or showering.
  3. Limiting the duration of bathing or showering to a few minutes, if possible.
  4. Oral antihistamines to relieve the troublesome itching. The goal is to break the itch-scratch cycle which can perpetuate eczema.
  5. Antibiotics to reduce the colonization of the inflamed skin with bacteria, especially when there are open sores in order to prevent secondary skin infections such as staph.
  6. Topical calcineurin inhibitors [e.g., Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment] are immunomodulators which can help in controlling inflammation of the skin. Note that this group of drugs carries an FDA “black box” warning that certain type of tumors (e.g., lymphomas) were observed in rodents receiving these medications.
  7. Corticosteroid creams and ointments are the mainstay of controlling the flare-ups of eczema due to their anti-inflammatory properties. More than a dozen varieties of topical steroids are available with varying degrees of potency.  Due to their potential side effects which can include thinning of the skin and whitish discoloration (i.e., hypopigmentation), among their use is generally restricted to 10 days to 2 weeks at a time.
  8. In severe cases of atopic dermatitis unresponsive to the usual treatments, systemic immuno-suppressants (e.g., cyclosporine, dapsone) are employed to control severe inflammation. However their use is limited by their toxicity to other organs such as the liver and kidneys.

Very recently, two new forms of treatments for atopic dermatitis were approved by FDA.

  1. Eucrisa (i.e., crisaborole) belongs to a class of drugs called phosphodiesterase-4 (PDE-4) inhibitors. It is available as a 2% ointment and indicated for treatment of mild to moderate atopic dermatitis in patients 2 years of age and older.  It should be applied in a thin layer to the affected area twice a day.  Since it is not a steroid, it can be applied even to the face.
  2. Dupixent (i.e., dupilumab) is a biologic injectable medication approved for treatment of moderate to severe atopic dermatitis not adequately controlled by topical therapies in patients 18 years of age and above. It is a monoclonal antibody which blocks the receptor of a common inflammatory mediator called IL-4 (i.e., interleukin-4).  The initial dose is two injections (given subcutaneously under the skin) of 300 mg. each at different sites, followed by 300 mg. every other week.  It can be used along with or without topical steroids preparations.

Black & Kletz Allergy has board certified allergy and immunology specialists as well as a trained staff experienced in both the diagnosis and treatment of atopic dermatitis of varying degrees of severity.  We treat both children and adults and have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and the Washington, DC and McLean offices are Metro accessible.  There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us if you, a family member, a friend, or a colleague suffers from eczema or atopic dermatitis and want to be evaluated and treated.  In addition to conventional therapy, we also have expertise in the newer treatment options for the treatment of eczematous dermatitis or any other allergic or immunologic disorder.  You may also click Request an Appointment and we will respond within 24 hours of the next business day.  The allergists at Black & Kletz Allergy strive to keep up with the newest allergy and asthma treatment modalities so that cutting edge medicine is always available to our greater Washington, DC community.

Shortage of Venom Extracts

Most insect bites cause “local reactions” resulting in redness and/or swelling at the site of the bite which usually subsides in a few days.  However, stings by 5 different types of insects (honey bee, yellow jacket, yellow-faced hornet, white-faced hornet, and wasp) belonging to the Hymenoptera species, can cause a life-threatening “systemic reaction” (i.e., anaphylaxis) in sensitized individuals.  Approximately 5% of the population has had systemic reactions to stinging insects.

The more common symptoms of anaphylaxis may include:

  • Swelling of the lips, face, throat, and/or tongue (i.e., angioedema)
  • Difficulty breathing, wheezing, chest tightness, and/or coughing
  • Dizziness or lightheadedness which could signify a drop in one’s blood pressure
  • Abdominal cramping and/or diarrhea
  • Nausea and/or vomiting
  • Generalized itchiness (i.e. pruritus) and/or hives (i.e., urticaria)

Avoidance of stings by insects is not always possible and the reactions tend to get progressively more severe with each sting.  In fact, many fatalities are reported in the U.Ss every year from insect stings.

A highly effective form of treatment called venom immunotherapy (i.e., allergy shots for venoms) significantly reduces the risk of severe reactions in sensitized people.  The process involves building up tolerance by injecting gradually increasing doses of commercially made “extracts” from the insect venoms at regular intervals.  Venom immunotherapy has been credited with saving a number of lives and helps people live without fear of a serious reaction from insect stings.  Venom immunotherapy is effective in preventing a systemic reaction to further insect stings in approximately 95% of individuals that go on such treatment.

In the U.S., there are only two companies (i.e., ALK and HollisterStier) which manufacture insect venom extracts which are utilized as antigens during venom immunotherapy.  Unfortunately, since October 2016, ALK Laboratories has notified that it is unable to fill orders for Hymenoptera venom extracts due to manufacturing difficulties.  It is not known how long it will take to restore normal production and distribution.

HollisterStier has indicated that it is doing everything possible to equitably distribute the available venom and to ramp up production of the venoms to help deal with the shortage. However, it is expected that increased production will take time to reach the market.

As the demand now exceeds supply, there is a need to judiciously manage the reduced availability of commercial extracts.  The American Academy of Allergy, Asthma, and Immunology came up with guidance for allergy/immunology practices all over the country regarding the measures that are needed to mitigate the venom shortage that likely will exist for some period of time.

There are 4 strategies to be considered until the shortage eases up:

  • Increasing the maintenance interval
  • Decreasing the maintenance dose
  • Suspending or restricting treatment in patients with the lowest risk of severe reaction to stings
  • Scrupulous avoidance of wastage of extracts in mixing and administration

In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the board certified allergists at Black & Kletz Allergy are striving to increase the supply of venom extracts by following the recommendations of the American Academy of Allergy, Asthma, and Immunology in order to make available the extracts to our patients according to their risk profiles.  Black & Kletz Allergy treats both adults and children for venom sensitivities and we have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

We encourage all our patients to call us and discuss their concerns over the venom shortage situation and we would be happy to answer any questions that may arise.  If you would like to make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.