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How the Cold Weather Affects Allergic Individuals and Asthmatics

• January 17, 2017
• BY BLACK & KLETZ ALLERGY

Now that it is Winter and the temperatures are cold, one may think that they do not have anything to worry about when it comes to allergies and asthma in the Washington, DC metropolitan area like in the cities of McLean, VA (Tysons Corner, VA), and Manassas, VA.  Unfortunately, this is not true, as the cold weather can mimic allergies in many individuals and produce the same symptoms that occur in allergic people.  In addition, during the Winter, there are many allergens that still exist (i.e., dust mites, molds, pet dander and saliva, cockroaches, rodents) which cause allergic and asthmatic symptoms in susceptible individuals.  Furthermore, there are a lot of viruses that are prevalent in the Winter that can also cause symptoms that can be confused with allergies.  These viruses are also responsible for upper respiratory tract infections (URI’s) that are known to exacerbate asthma in many asthmatics.

It is well known that cold air can cause a runny nose and watery eyes.  The runny nose is a result of the vascular constriction caused by the cold air.  Non-allergic individuals that have these symptoms may think they have allergies.  Allergic individuals that have these symptoms may truly be having these symptoms because of the vascular constriction or because they are at increased exposure to allergens found during the Winters such as dust mites, molds, pet dander and saliva, cockroaches, and rodents.  Cold air is also a very well know trigger in many asthmatics and in these patients can cause wheezing, shortness of breath, chest tightness, and/or coughing. Exercising in the cold air is another important trigger for many asthmatics.

During the Winters in the Washington, DC, Northern Virginia, and Maryland metropolitan area, it is common for people to contract a multitude of viruses that cause upper respiratory tract infections.  The most common viruses that are responsible for URI’s include the rhinovirus, influenza virus (i.e., flu), parainfluenza virus, coronavirus, respiratory syncytial virus (i.e., RSV), picornavirus, adenovirus, coxsackievirus, and echovirus.  URI’s cause many symptoms that are the same as allergic rhinitis symptoms such as nasal congestion, runny nose, sneezing, sinus headaches, clogged ears, cough, and fatigue.  In addition, URI’s are known to exacerbate asthma in many asthmatics.

Three other conditions that the cold can cause that can be misconstrued as an allergy include hives (i.e., urticaria), swelling episodes (i.e., angioedema), and generalized itching (i.e., pruritus).  These skin conditions can be caused by exposure to cold air or cold water. There a many factors that can cause hives, swelling episodes, and/or itching; some of which include medication allergies, food allergies, certain infectious diseases, autoimmune disorders, and thyroid abnormalities.  In the Winter in the Washington, DC metro area, one must also think of the cold weather as a cause of these skin conditions.

The board certified allergists at Black & Kletz Allergy have more than 50 years of experience in diagnosing and treating allergies, asthma, hives, swelling episodes, generalized itching, URI’s (including sinus infections and bronchitis) in both adults and children. Whether they are caused by the cold or caused by other factors, Black & Kletz Allergy has the experience and expertise in treating these conditions.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at all locations.  The Washington, DC and McLean, VA offices are Metro accessible and we provide a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is proud to provide high quality allergy care to the Washington, DC, Northern Virginia, and Maryland metropolitan area residents in a friendly and professional setting.

Respiratory Infections

• December 13, 2016
• BY BLACK & KLETZ ALLERGY

The onset of winter in the Washington, DC, Northern Virginia, and Maryland metropolitan area brings with it an increase in the frequency of respiratory infections. In comparison to individuals without an underlying long-term health condition, people with a history of allergies, asthma, diabetes, as well as individuals with suppressed immune systems are more susceptible to respiratory tract infections.

Some common respiratory infections during the Winter include:

Sinus infections (acute rhinosinusitis):
According to Centers for Disease Control and Prevention, about 1 in 8 adults are diagnosed with sinus infections yearly, resulting in more than 30 million diagnoses in the U.S. More than 90% of these cases are viral. Antibiotics are not guaranteed to be of any benefit, even when they are caused by bacteria.

Bacterial cause is more likely when the symptoms are:

1. Severe, such as fever of more than 102°F and discolored nasal secretions or facial pain lasting for more than 3 to 4 days.
2. Persistent nasal discharge or daytime cough lasting longer than 10 days.
3. Worsening fever, cough, or nasal discharge after initial improvement of a viral upper respiratory infection lasting for 5 to 6 days.
4. Sinus X-rays and CT scans are not routinely recommended.

Management:

1. Watchful waiting is appropriate for uncomplicated cases.
2. Amoxicillin or Augmentin is the preferred first-line antibiotic choice.
3. The macrolide class of antibiotics [(e.g., azithromycin (Z-Pak)] is not recommended as up to 40% of the bacteria causing sinus infections are not sensitive to them.
4. For patients are who are allergic to penicillin, doxycycline or the quinolone class of antibiotics are suitable alternatives.

Bronchitis:

Inflammation of the lining of the bronchial tubes that carry air in and out of the lungs causes a cough lasting several days or weeks.

1. Fever of more than 102°F, rapid heart-beat, rapid breathing, and abnormal lung examination findings may suggest pneumonia.
2. Discolored sputum does not always indicate bacterial infection.
3. Chest X-rays are not needed in most instances.

Medications for relief of symptoms may include:

1. Cough suppressants (e.g., codeine, dextromethorphan)
2. First generation antihistamines (e.g., diphenhydramine)
3. Decongestants (e.g., pseudoephedrine, phenylephrine)
4. Bronchodilators (e.g., albuterol)

Non-specific upper respiratory tract infections (URI’s):

Most adults experience two to four URI’s (e.g., “colds”) each year. More than 200 different types of viruses are known to cause the common cold.

Prominent “cold” symptoms consist of nasal congestion, clear runny nose, post-nasal drip, sore throat, cough, fever, headache, and/or body aches.

Treatment is mostly geared towards relieving symptoms, as the condition usually resolves spontaneously after a few days to one week and antibiotics are not needed.

Decongestants combined with first-generation antihistamines may provide short-term relief of nasal symptoms and cough. Anti-inflammatory medications (e.g., ibuprofen, naproxen) can relieve fever and aches. Nasal saline irrigation can sometimes be helpful.

Pharyngitis (throat inflammation):

About 90% of throat infections are caused by viruses. Only about 5 to 10% of cases are due to bacteria which are commonly referred to as “Strep throat.”

Rapid Antigen Detection Test (RADT), also known as a “strep-test” may be necessary to distinguish between viral and bacterial pharyngitis, as the clinical features are similar in both conditions.

Antibiotics are not recommended for patients with a negative RADT result. For those with a positive RADT result, amoxicillin or penicillin VK are the drugs of choice as they are very effective against streptococcal bacteria. For penicillin-allergic patients, antibiotics in the macrolide class, as well as clindamycin, may be utilized. The duration of treatment for bacterial pharyngitis is typically 10 days.

The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metro area and are very experienced in managing various respiratory infections. They are experts in checking the immune systems in individuals that develop frequent and/or unusual infections, since they are also immunologists. Black & Kletz treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA 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 our office to make an appointment. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, DC, Northern Virginia, and Maryland metro area for more than a half a century and pride ourselves in providing excellent quality allergy, immunology, and asthma care in a professional and friendly setting.

How to Manage Fall and Winter Allergies

• December 9, 2016
• BY BLACK & KLETZ ALLERGY

As we enter the Winter season, while many people see an improvement in their allergy symptoms because of the lack of pollen in the air, many other individuals experience a worsening of their allergy symptoms due to the increase in the amount of perennial allergens that are present during this time of the year.  Specifically, people with sensitivities to dust mites, molds, pets, and cockroaches tend to do worse in the Fall and Winter months.  Despite the fact that all of these allergens are omnipresent in the Washington, DC, Northern Virginia, and Maryland metropolitan area, and are present year-long, during the colder months, individuals tend to “close up” their homes and workplaces more than in the Spring and Summer months.  During the Fall and Winter, people generally keep the windows shut, turn on the heat, and go outdoors less often.  These factors all play a role in increasing the exposure to more quantities of dust mite, mold, pet dander, and cockroach allergens. Hence, individuals may be bothered more in the Fall and Winter.

It is noteworthy to mention that all of the above allergens are found only indoors, except molds and occasionally pets.  When the leaves fall from the trees in the Fall and get wet, molds will grow on the decaying leaves.  In the Washington, DC metro area, the leaf mold is a major allergen that causes a great deal of suffering for many allergy patients.  When the leaves are disturbed by either raking them, rainfall, or via the wind, the mold spores are more likely to become airborne, thus increasing the likelihood of them causing allergy symptoms in individuals with mold sensitivities.  It is therefore recommended that a person with mold allergies should avoid exposure to leaves, particularly if they are or have been wet.  They should also keep the humidity of their homes below 35%, if possible as there is direct correlation with increased humidity and the amount of mold growth.  In the home, mold growth tends to be more abundant in basements, bathrooms, and kitchens due to the increased moisture found in these places.

The main culprits of dust allergy are the dust mites prevalent in the Washington, DC metropolitan area.  There are 2 very common species of dust mites in the Washington, DC, Northern Virgina, and Maryland metro area.  They are known as Dermatophagoides fariniae (i.e., American dust mite) and Dermatophagoides pteronyssinus (i.e., European dust mite).  Both species are highly allergenic and tend to live indoors in places like carpeting, upholstered furniture, pillows, mattresses, box springs, and bedding.  It is technically the fecal particles and exoskeleton that are the allergenic components of the dust mites.  The dust mites are microscopic and look similar to a cockroach, however, they cannot be seen with the naked eye.  They are about 0.25 mm. in length.  They survive by eating dead skin that regularly sloughs off of humans each night.  The dust mites thrive in warm moist climates and when the humidity is high.  They do not survive if the temperature is over 130° F or when the altitude is greater than 1 mile (5,280 feet).  Dust mites are known to be a cause of allergic rhinitis and asthma in many individuals.  There are products that can be put on carpeting that act to kill dust mites, but these products have been shown not to very effective.  Encasing one’s pillows, mattresses, and box springs in allergy-proof encasings are a fairly effective way to minimize exposure to dust mites.

When the home is “closed up,” pet allergens from the dander and saliva tend to be worse.  Usually, however, pet allergy tends to be very similar for most individuals despite the time off the year.  Likewise cockroach allergy is common particularly in major cities such as Washington, DC.  Many homes, apartments, condos, restaurants, and public buildings in urban settings are infested with cockroaches, even though they may not be visible during the day to most people.  It is important to make sure that traces of food are not left on counters, floors, etc., as this attracts cockroaches.  There is a common strong association between cockroach allergy and childhood asthma in inner city populations.  Cockroaches are potent allergens allergy sufferers of all ages and cause both allergic rhinitis and asthma symptoms.

Other than avoidance, which is always preferable, there are numerous medications that can be used by allergists to treat dust mite, mold, pet, and cockroach allergies.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective tool that board certified allergists use to treat individuals with these allergies, as well as pollen allergies.  They work in 80-85% of people and allergy injections have been used in the U.S. for over 100 years.  The average length of treatment is 3-5 years.

The board certified allergists at Black & 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 have convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Each office has on-site parking.  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 for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy prides itself in providing quality allergy and asthma care to the Washington, DC, Northern Virginia, and Maryland metropolitan area community.

Aspirin Allergy and Its Relationship to Allergies and Asthma

• November 21, 2016
• BY BLACK & KLETZ ALLERGY

Aspirin-Exacerbated Respiratory Disease (AERD) is an acquired condition in which the sensitivity to aspirin and/or related drugs (e.g., nonsteroidal anti-inflammatory drugs or NSAID’s) is associated with long term inflammation of the upper and lower airways.

How common is AERD?
Approximately 8% of the adults in the U.S. are asthmatics and 9% of those individuals have AERD. About 13% of U.S. adults have chronic nasal and/or sinus disease and 15% of those have AERD.

AERD is a clinical syndrome consisting of:
1. Growth of polyps inside the nose
2. Chronic sinus inflammation and/or recurrent sinus infections
3. Persistent asthma, which is often difficult to control
4. Allergic sensitization to aspirin and/or other nonsteroidal anti-inflammatory drugs (NSAID’s)

What causes AERD?
Although the exact cause remains unknown, a disorder in the metabolism or breakdown of a chemical called arachidonic acid is at the root of the condition. Aspirin is not the cause of the disorder, but in sensitive individuals, ingestion of aspirin will aggravate the underlying respiratory symptoms, probably by increasing the levels of inflammatory chemical mediators called leukotrienes. This process also leads to the accumulation of excessive numbers of eosinophils (i.e., “the allergy white blood cell”) in the respiratory tract.

Clinical Features:
1. Severe nasal congestion
2. Overgrowth of polyps in the nose, which typically recur after surgical removal
3. Decreased sense of taste and/or smell
4. Facial pressure and pain
5. Frequent headaches
6. Moderate to severe asthma causing wheezing, coughing, chest tightness and/or shortness of breath
7. Fatigue caused by sleep deprivation
8. Significant opacification of the sinuses seen in X-rays and CT scans of the sinuses

Diagnosis:
The diagnosis is suspected when there is a history of an exacerbation of one’s asthma following ingestion of aspirin and/or NSAID’s. The diagnosis is confirmed if the symptoms are induced or aggravated during an oral aspirin challenge, where incremental doses of aspirin are administered by mouth under the close monitoring by a board certified allergist.

Treatment Options:
Complete avoidance of aspirin and other salicylates (e.g.,diflunisal (Dolobid); salsalate (Disalcid), as well as other related NSAID medications called COX-1 inhibitors (e.g., all NSAID’s except celecoxib) will help some patients attain better control of their symptoms. For some individuals, however, these medications can be substituted for other similar NSAID pain relievers called COX-2 inhibitors [e.g., celecoxib (Celebrex)] without adverse effects. Note that Celebrex (celecoxib) is currently the only approved COX-2 inhibitor NSAID in the U.S. Some, but not all, of the common available NSAID’s which are COX-1 inhibitors include [e.g., ibuprofen (Motrin, Advil); naproxen (Aleve, Anaprox); fenoprofen (Nalfon); flurbiprofen (Ansaid); ketorolac (Toradol); diclofenac (Voltaren, Arthrotec); etodolac (Lodine); sulindac (Clinoril); oxaprozin (Daypro); indomethacin (Indocin); tolmetin (Tolectin); nabumetone (Relafen); piroxicam (Feldene); meloxicam (Mobic)]. Avoidance of aspirin is not always possible due to the need for aspirin in the management of heart, blood vessel, and joint diseases. In addition, even with the avoidance of aspirin and NSAID’s, AERD patients usually experience progressive airways disease, despite aggressive surgical intervention and/or topical or systemic anti-inflammatory treatment with corticosteroids and leukotriene antagonists like montelukast (Singulair), zafirlukast (Accolate), and zileutin (Zyflo).

For these individuals that need to be treated with aspirin, aspirin desensitization followed by regular long term intake of aspirin is an alternative option. Multiple studies have shown that desensitization and daily treatment with aspirin can significantly improve overall symptoms and quality of life, decrease formation of nasal polyps and sinus infections, reduce the need for oral corticosteroids and sinus surgery, and improve nasal and asthma scores in patient with AERD. Significant clinical improvement is seen in as little as 4 weeks after treatment.

The procedure for aspirin desensitization involves administering aspirin by mouth in gradually increasing doses at regular intervals, while closely monitoring for adverse effects in a controlled setting such as an allergy office. The process can take 1 to 2 days.
There is a potential for adverse reactions during the procedure like nasal congestion, generalized itching (pruritus), hives (urticaria), swelling of the soft tissues (angioedema), wheezing, breathing difficulty, drop of blood pressure, and/or anaphylaxis. In case of a minor adverse reaction, they may be treated with medications. After observation for about 3 hours, the last dose can be repeated. Many individuals will be able to successfully finish the procedure in spite of some untoward reactions. Pre-treatment with leukotriene antagonists (e.g., montelukast) play a role in minimizing the risk of reactions during the desensitization procedure.

Aspirin desensitization reduces nasal congestion and nasal polyp formation, improves respiratory symptoms, reduces the need for surgery, and decreases the need for ongoing medications. The board certified allergists at Black & Kletz Allergy have had over 50 years of experience with patients who have aspirin sensitivity. Desensitization in patients who are sensitive to aspirin can be done in any of our 3 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 offer on-site parking at all of our offices and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that transports patients between our McLean, VA office and the Spring Hill metro station on the silver line. For 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. Black & Kletz Allergy treats both adults and children suffering from all types of allergies (i.e., hay fever, food, medication, insect stings), asthma, sinus problems, hives, swelling episodes, eczema, and immunologic disorders. We strive to provide exceptional quality allergy and asthma care to the Washington, DC metro community in a friendly and professional setting.