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Asthma and Aspirin

Providers of Asthma Treatment Gainesville VA Patients Trust: Dr. Kletz & Dr. Gondi
Any provider of asthma treatment in Gainesville can tell you that about 10% of all adults with asthma may have a condition called Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad, or Aspirin-Sensitive Asthma.

The 3 components of the disease are:

  1. Persistent asthma
  2. Chronic inflammation in the nose and sinuses with polyp formation
  3. Allergic sensitivity to aspirin and other non-steroidal anti-inflammatory drugs NSAID’s

The asthma associated with AERD tends to be more severe and poorly responsive to the usual treatments.  When providing the treatment for allergies and asthma Gainesville VA residents need, we see that most patients also suffer from recurrent sinus infections and often experience a reduced sense of smell and/or taste.

The adverse reactions on exposure to aspirin and/or NSAID’s can include:

  1. Flushing, rash, and/or itching
  2. Increased nasal congestion
  3. Facial pain and headache over the forehead region
  4. Coughing, wheezing, and/or heaviness in the chest
  5. Abdominal cramps and/or nausea
  6. Dizziness

What causes it?

AERD is not a genetic or inherited condition.  The exact cause of the disorder is not known at this time, although a lot of research is being done in order to try to find a cause.  The patients have higher than normal levels of eosinophils (i.e., a type of white blood cell that tends to be high in allergic individuals) in their blood and in the sinuses, and these cells usually play a role in causing chronic allergic inflammation.  They also have high levels of substances called leukotrienes which also cause inflammation.  Ingestion of aspirin and/or NSAID’s leads to a further increase in these leukotrienes resulting in a flare-up of asthma symptoms.

How is it treated?

  1. Patients who are diagnosed with AERD and who have not been desensitized to aspirin should always avoid taking aspirin and other NSAID’s like ibuprofen (e.g., Motrin, Advil) naproxen (e.g., Naprosyn, Aleve), diclofenac (e.g., Voltaren, Arthrotec), indomethacin (e.g., Indocin), meloxicam (e.g., Mobic), piroxicam (e.g., Feldene), nabumatone (e.g., Relafen), sulindac (e.g., Clinoril), ketorolac (e.g., Toradol), oxaprozin (e.g., Daypro), etc.  Acetaminophen (e.g., Tylenol) is a suitable alternative medication for relief of pain. Certain related non-steroidal anti-inflammatory drugs called COX-2 inhibitors like celecoxib (Celebrex) may be safer alternatives to aspirin in some individuals.
  2. In spite of avoiding these drugs, many patients will continue to experience frequent asthma symptoms, repeated sinus problems, and growth of nasal polyps.  They may need daily inhaled corticosteroid medications into their lungs to control asthma and daily corticosteroid nasal sprays and saline irrigations into their nostrils to control nasal congestion and polyps.
  3. Medications that inhibit leukotrienes like zileuton (Zyflo), which reduce the production of leukotrienes, or montelukast (Singulair) and zafirlukast (Accolate), which block the effects of leukotrienes on tissues can be helpful in certain patients to reduce the exacerbation of symptoms.
  4. Many patients also need sinus surgery and removal of nasal polyps, often more than once, as polyps tend to regrow after the surgery.  Regular use of intranasal corticosteroids and oral leukotriene modifiers after the surgery can help some patients in slowing the progression of their disease.
  5. Aspirin desensitization (i.e., the administration of gradually increasing doses of aspirin under close monitoring in a hospital or clinic, followed by daily intake of a standard maintenance dose of aspirin by mouth) has been shown to reduce the need for medications and the number of surgeries in some patients with AERD who were unresponsive to other standard treatments.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults andchildren with asthma, AERD, sinus disease, nasal polyps, other allergic and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also 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 or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to administer high quality allergy and asthma care in a caring professional environment.

Allergist Gainesville VA: Can Allergies Cause Dental Problems?

Dr. Kletz & Dr. Gondi, Trusted Gainesville Allergists, Discuss Dental Problems and Allergies
As allergists that Gainesville, VA calls upon, we know that when one thinks about allergies and allergy symptoms, dental problems usually do not come to mind.  In fact, most people tend to separate dental and medical problems into two distinct categories.  Medical diseases can and do influence your dental health.  Most people know that certain heart defects and murmurs may require premedication with antibiotics in order to prevent subacute bacterial endocarditis.  Patients with GERD (gastroesophageal reflux disease), Sjögren’s syndrome, anorexia, and bulimia are more prone to cavities of the teeth.  There are many more medical conditions which can have profound implications on the health of one’s teeth which will not be discussed.

What about allergies?  Can they cause dental problems?  The simple answer to this question is:  Yes

Many children with hay fever (allergic rhinitis) have nasal congestion as a major feature of their disease.  The nasal congestion frequently causes these children to become “mouth breathers,” since they are unable to breathe through their noses.  As the children grow, they develop a narrow high upper arched palate in their mouths which results in malocclusion (i.e., poor bite) of their teeth.  The teeth grow in crooked usually resulting in the need for costly braces by an Orthodontist.  Seeing a board certified allergist like the ones at Black & Kletz Allergy in the Gainesville, VA, Falls Church, VA , and Tysons Corner, VA areas can prevent this type of dental problem in children if addressed early on.  The allergists at Black & Kletz Allergy would perform a comprehensive history and physical examination and likely do allergy testing to find out if and what the child is allergic to in the environment.  Allergies to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, and cockroaches are very common allergens that can cause chronic nasal congestion.  There are other nasal conditions, such as nasal polyps, which are usually due to an underlying allergy that can also cause chronic nasal congestion.  After fully evaluating the child, a treatment plan would be discussed with the parent(s) which may include measures to avoid the offending allergen, use medications in the forms of syrups, powders, tablets, capsules, nasal sprays, eye drops, and/or begin a course of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization).  Allergy immunotherapy or allergy shots are very effective as they work in 80-85% of the individuals taking them.  They are given to people ranging in age from young children through the elderly.  They have been given in the U.S. for over 100 years.  Treating the hay fever early in its course is very effective in preventing the dental malocclusion that occurs too often in untreated individuals with this condition.

Another problem that people face when it comes to allergies and dentistry is the common “I am allergic to Novocain” response that dentists hear over and over again from patients.  We, as allergists near Gainesville, VA, also hear this common complaint.  Dentists frequently have to use a “numbing medicine” before they can do certain dental procedures such as root canals, pulling teeth, dental implants, putting in crowns, etc. in order to prevent pain from occurring in their patients.  Many times the “allergy” symptoms described are really a side effect of the Epinephrine (adrenaline) that is frequently mixed in with the “numbing medicine” rather than a true allergy to the “numbing medicine” itself.  Epinephrine is usually mixed in with the “numbing medicine” as a way to constrict the small blood vessels in the mouth which helps prevent excessive bleeding.  The most common “numbing medicines” or local anesthetics used are categorized as “Caine drugs.”  (See “Medication Allergies”).  Some examples of “Caine drugs” include Novacain (procaine), Xylocaine (lidocaine), Carbocaine (mepivacaine), Marcaine (bupivacaine), and Pontocaine (tetracaine).  Some individuals are truly allergic to the local anesthetic and some are even allergic to the preservatives found in the local anesthetic.  It turns out, however, that most individuals who think they are allergic to a “Caine drug” usually are not when skin tested by an allergist.  It is important, however, to see a board certified allergist and have skin testing performed to rule out a “Caine drug” allergy, as such an allergy can be very serious and potentially life-threatening.  The allergy doctors in the Gainesville, VA, Falls Church, VA, and Tysons Corner, VA areas at Black & Kletz Allergy routinely see patients with this potential allergy and skin test them to a specific local anesthetic in the “Caine drug” class at one of our 3 office locations in theWashington, DC, Northern Virginia, and Maryland metropolitan area.  If the skin testing to a specific “Caine drug” is negative, then the allergist will let your dentist know that is fine to use that particular medication.  Note that it is possible to be allergic to one specific “Caine drug” but not another specific “Caine drug.” (Example: One can be allergic to Novacain but not Xylocaine).

The board certified allergists at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning local anesthetic allergy testing as well as other medication allergy testing such as penicillin testing.  Black & Kletz Allergy has locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at each location and the Washington, DC and McLean offices are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergist, 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 has been providing quality allergy care to the DC metro area for more than a half century.

Epinephrine Auto-Injectors

The Allergy Doctor Centreville, VA Relies On Explains Epinephrine Auto-Injectors
Severe sensitivity to certain foods, insect venoms, and certain medications can lead to a life- threatening reaction called anaphylaxis.  The symptoms usually begin within a few minutes after exposure and can progress very rapidly.  Anxiety is often the initial symptom and the other usual manifestations include generalized itching, redness, hives, swelling of the eyelids, lips, tongue, and/or throat (i.e., angioedema) leading to difficulty in swallowing and breathing. Other signs can include excessive sweating, rapid pulse, and a sudden drop in blood pressure.

Epinephrine (adrenaline) is a self-injectable medication and is the first line treatment option for anaphylaxis.  It can stall the progress of the reaction and can be life-saving by reversing the deleterious effects of anaphylaxis.  To be maximally effective, epinephrine needs to be administered as soon as possible after the onset of the first symptom.  In fact, delayed use of epinephrine is the leading cause of mortality in anaphylaxis.  It is therefore imperative for all people susceptible to severe allergic reactions to have a self-injectable epinephrine immediately available at all times.

The foods most likely to cause anaphylaxis include peanuts, tree nuts, fish, and shellfish.  In children and adults who are severely sensitized, other foods like milk and eggs can also cause severe adverse reactions.  The insect stings that are known to cause anaphylaxis belong to the Hymenoptera family and include honeybees, yellow jackets, hornets, wasps, and fire ants.  Penicillin and related antibiotics are the most common drugs that are associated with a tendency to cause life-threatening reactions.

Epinephrine auto-injectors are available by prescription only and are covered by most insurances.  One of the products marketed under the trade name Auvi-Q was voluntarily recalled by the manufacturer in October 2015 and two other products Epipen and Adrenaclick are currently available.  A generic version of an epinephrine auto-injector is also offered by certain pharmacies. Note that there are generally 2 doses (0.15 cc. and 0.3 cc.) of each epinephrine auto-injector.  The dose depends on the weight of the individual, such that the 0.3 cc. dose is the dose usually given individuals weighing greater than or equal to 66 lbs.  The 0.15 cc. dose (e.g., EpiPen Jr.) is generally given to children weighing 33-66 lbs.

Although the medication is identical, different brands have different administration methods and it is crucial that the patient receive adequate training and practice with a training device to get familiarized with the specific technique. The medicine is usually injected intramuscularly (IM) into the outer part of the thigh, even through clothing, and the device is kept in place for about 10 seconds.  It is recommended that two doses be carried at all times, as the second dose may be needed if the symptoms persist about 10-15 minutes after the first dose.

The most common side effects of epinephrine include palpitations, tremors, and restlessness. However the benefits of epinephrine almost always outweigh the risks.  After using the epinephrine, it is important to go to the nearest emergency department to be monitored.  In some individuals with anaphylaxis, a late phase reaction can occur anywhere from 4 to 72 hours (4-8 hours is more typical) after the initial anaphylactic reaction.  Patients and/or parents should also contact the allergist for reevaluation and for replenishment of epinephrine auto-injectors.  The devices should be stored at room temperature and should never be frozen or exposed to high temperatures or direct sunlight.

The board certified allergists and the staff at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area are trained and experienced in evaluating the need for, prescribing, and teaching the technique for epinephrine auto-injectors.  We have 3 offices in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible.  We offer free shuttle service between our McLean office and the Spring Hill metro station on the silver line.  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.  Black & Kletz Allergy has been providing quality care allergy, asthma, and immunology services to the Washington, DC , Northern Virginia, and Maryland metro area community  for more than a half century.

Can Sleep Disorders be Due to Allergies?

A top allergist Arlington, VA trusts examines the correlation between allergies and sleep disorders
Sleep disorders affect about 30% of the population.  Several sleep disorders have been linked to allergies.  People who suffer from hay fever (allergic rhinitis) are more than twice as likely to have insomnia as those individuals who do not have hay fever.  They are also more than twice as likely to have problems falling asleep.  A little more than one-third of individuals with hay fever complain of insomnia.  Almost two-thirds of these same allergic people complain that they do not get enough sleep.  For comparison, only one-sixth of individuals without allergies say they have insomnia and one-quarter of individuals without allergies say that do not get enough sleep.  The severity of the sleep disorders also increased as the severity of the allergies increased, showing a direct proportional relationship.  Sleep disorders are linked to sleepiness during the day, fatigue, depression, decreased ability to learn, decreased memory, decreased productivity at school and/or work, and a decreased quality of life.  Interestingly, allergic rhinitis has been linked to many of the same symptoms.  The combination of allergic rhinitis and a sleep disorder can have deleterious effects on these individuals.

Obstructive sleep apnea is a sleep disorder that is caused by repeated interrupted breathing which does not allow an individual to get enough “deep” sleep that is required to rejuvenate the body.  As a result, excessive daytime sleepiness or falling asleep at inappropriate times is the hallmark of this condition.  It is often caused by one’s tongue sliding back in the throat, in combination with a relaxed airway which changes shape to a more oval (rather than round) shape which gives way to less “room” for air to be able to get to the lungs from the nose or mouth.  This combination of things often causes the individual to snore.  People with obstructive sleep apnea are unable to breathe in air due the blockage caused by a tongue that is blocking the airway on top of an already relaxed smaller diameter airway.  These individuals literally stop breathing for typically 20 to 60 seconds.  When this occurs, there is an “emergency” sensor called the carotid body near the carotid arteries in one’s neck, that detects the lowering of the oxygen and rise in carbon dioxide in the blood.  This triggers the awakening center in one’s brain and the individual awakens for a few seconds allowing them to unknowingly move their tongue and re-form their throat shape to the normal awakened state.  Breathing is then reestablished.  This cycle in people with obstructive sleep apnea occurs many times per hour.  It can occur greater than 50 times per hour, resulting in a lack of restful sleep.  Obstructive sleep apnea has been linked to allergic rhinitis.  People with allergic rhinitis often have nasal congestion which causes the upper airway to narrow.  Individuals with hay fever also are more prone to sinus infections.  Most people with sinus infections also have nasal congestion as part of their symptoms.  The upper airway narrowing that occurs due to nasal congestion increases the likelihood of snoring and obstructive sleep apnea.  Obstructive sleep apnea should not be taken lightly as some of the complications of obstructive sleep apnea include heart disease, stroke, increased risk for motor vehicle accidents, and sexual dysfunction.

If you snore, experience insomnia, have difficulty falling asleep, and/or have daytime sleepiness, the board certified allergists at Black & Kletz Allergy can order a sleep study as well as diagnose and treat you for allergic rhinitis, if applicable.  We treat both adults and children and have 3 offices 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.  All our offices have on-site parking and our offices in Washington, DC and McLean are Metro accessible.  We offer a free shuttle between our McLean office and the Spring Hill metro station.  If you have a sleep disorder and/or hay fever symptoms, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy strives to provide quality allergy, asthma, sinus disease, hives, and immunologic care to the Washington, DC metro area community in a caring and professional manner as we have done for more than 50 years.

7 Things You Can Do To Get Ready for the Tree Pollen in the Spring

Well it is the middle of March in Arlington, VA, Centreville, VA, and Vienna, VA as well as the rest of the Washington, DC, northern Virginia, and Maryland metropolitan area, and Spring is around the corner.  Pretty soon the cars will be covered in yellow pollen, the cherry trees will be in full blossom, and many allergy sufferers will be complaining of hay fever (i.e., allergic rhinitis) symptoms.  As the temperature climbs, the buds will appear on various trees in the Washington, DC area.  This coincides with the release of tree pollen from numerous trees in the area.  Some of the more prevalent trees to cause allergy symptoms in the Arlington, Centreville, and Vienna areas of northern Virginia include, but are not limited to, the following trees:  alder, ash, beech birch, box elder, cedar, cottonwood, elm, hazelnut, hickory, maple, mulberry, oak, pecan, pine, poplar, sycamore, walnut, and willow.  Currently, the tree pollen counts are elevated after a relatively recent mild winter this year.  The pollen counts tend to increase as the Spring progresses, usually peaking in late April – early May.  The tree pollen counts tend to peak at about 1,200 grains of tree pollen per cubic meter of air.  For reference, in the Washington, DC area, a tree pollen count of 80 or more is considered “high.”

As Vienna allergists, we see that the manifestations that allergy sufferers experience vary in both the type and severity of the symptoms.  Some of the classic symptoms of Spring hay fever may include sneezing, runny nose, itchy nose, nasal congestion, post-nasal drip, itchy roof of the mouth, itchy ears, itchy eyes, watery eyes, redness of the eyes, puffy eyes, dark circles under the eyes, sinus congestion, sinus headaches, sinus pain, fatigue, and, snoring.  If the allergies effect the lungs, they can cause or exacerbate asthma symptoms such as wheezing, shortness of breath, chest tightness, and/or coughing.

Given the above, there are 7 simple ways to get ready for the tree pollen in the Spring which are as follows:

1.)  Check the pollen count, so you know when the counts are high, so you can avoid being outdoors, if possible.  (You can check the pollen count by clicking Today’s Pollen Count or clicking it at the top right of our website daily.)

2.)  Try to minimize your exposure to the tree pollen by closing the windows in your home and car and turning on the air conditioner and setting it to “re-circulate” so it will not bring in outside air that is high in tree pollen.

3.)  Be proactive and begin using prescribed or over the counter nasal sprays a few days prior to when you normally begin to feel the symptoms of tree pollen allergies.

4.)  If you go outdoors or enjoy exercising outside, try to avoid exercise early in the morning as the pollen count tends to be highest at these times.

5.)  If outdoors for a prolonged period of time during the tree pollen season, shower and change your clothes as soon as you re-enter your home.

6.)  Minimize your contact with pets and individuals who have spent a lot of time outdoors as they will bring the pollen to you.

7.)  Wear sunglasses to prevent the tree pollen from directly entering your eyes.

In addition to the above 7 ways to help prevent the tree pollen from aggravating your allergies, there a multitude of medications that can be taken in order to help reduce allergy symptoms you can get from your Vienna allergist.  The medications come in the forms of tablets, capsules, powders, syrups, nasal sprays, and inhalers.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are an extremely effective treatment for hay fever and asthma.  They are effective in 80-85% of patients that take allergy shots.  They take about 4-6 months to become effective and the average person is on allergy shots for 3-5 years.

The board certified allergists of Black & Kletz Allergy have been diagnosing and treating both adults and children in the Washington, DC, northern VA, and Maryland metropolitan area for over 50 years.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at all of the offices.  The Washington, DC and McLean, VA office locations are Metro accessible and there is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  The Vienna allergy doctors of Black & Kletz Allergy specialize in all types of allergic conditions including hay fever, asthma, sinus disease, hives, eczema, swelling problems, food and medication allergies, and immunological disorders.  If you would like to schedule an appointment, please call us or alternatively you can click Request an Appointment and we will respond back to you within 24 hours on the next business day.

New Tests for Food Allergies

It is estimated that about 3 million children and adolescents in the U.S. have food allergies. As an allergy doctor serving Mclean VA, I see many food allergy cases. For reasons that are not entirely clear, the incidence (newly reported and diagnosed cases) has been increasing steadily over the past several years.

Milk, wheat, egg, peanuts, tree nuts, and shellfish account for a vast majority of food allergies. Among these, peanuts and tree nuts (e.g., almonds, Brazil nuts, cashews, hazelnuts, pecans, walnuts) are more likely to cause serious life threatening allergic reactions.  They are also less likely to be “outgrown” than other food allergies.

The diagnosis of peanut and tree nut allergies from an allergy doctor in Mclean VA is based on a detailed history of the nature of reaction and the specific food trigger along with the results of prick skin tests and/or blood tests to estimate the level of an antibody called a specific IgE.  An elevated specific IgE level indicates a higher likelihood of a reaction upon exposure to the specific food.  Elimination of any exposure to the involved food and carrying a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q) are the only treatment options at this time.

Many children diagnosed with peanut and tree nut allergies and their parents experience considerable anxiety about accidental ingestion and the potential for a serious reaction.  A few newly available tests may ease their fears to some extent.

Both prick skin tests and blood tests, while extremely useful in detecting sensitivity, can also be falsely positive in a significant percentage of patients (especially in children with eczema) and can overestimate the risk of a reaction upon exposure.  Peanuts and tree nuts contain more than 10 types of proteins which trigger an allergic reaction, and some of them are more dangerous than others.

Until recently, the available tests for peanut allergy only measure the total quantities of all peanut specific antibodies.  A new “component” blood test can measure the levels of individual peanut protein antibodies, helping us better delineate the actual risk of a reaction.  The five major peanut proteins are as follows:  Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9.  An elevated Ara h 1, Ara h 2, or Ara h 3 level predicts a higher likelihood of a reaction than an elevated Ara h 8 or Ara h 9 protein level.

Children with elevated Ara h 2 levels should strictly avoid all exposure to all peanut products at all times.  Ara h 8 resembles the protein found in birch pollen, which is one of the tree pollens that is responsible for hay fever (i.e., allergic rhinitis) in the Spring in the Washington, DC metropolitan area.  Higher levels of Ara h 8 in the absence of Ara h 1, Ara h 2, and/or Ara h 3 can predict less severe reactions with symptoms limited to an itchy mouth, throat, and/or lips [i.e., Pollen-food syndrome (formally known as oral allergy syndrome)].  These children can undergo oral food challenges to peanuts under controlled conditions in the presence of a board certified allergist.

Oral food challenges to peanuts involve consumption of tiny quantities of peanut-containing foods while closely monitoring for adverse reactions.  Small incremental doses are given at regular intervals.  If the usual daily dose is tolerated, peanut can then be integrated in the regular diet of the patient.  It goes a long way in reassuring the family and alleviating the anxiety.  Similar tests are also available for certain tree nut specific component proteins.

The board certified allergists at Black & Kletz Allergy treats both adults and children and will gladly answer any questions you have concerning food component testing and related food allergy issues.  Black & Kletz Allergy has 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 on-site parking at each location and the Washington, DC and McLean offices are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergy doctor Mclean VA, 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 has been providing quality allergy, asthma, sinus, and immunological services to the DC metro area for more than 50 years.

New Treatments For Asthma

More than 22 million people in the U.S. suffer from asthma. As Centreville allergists, we know there are many options for treating your
allergies. Though several effective medications are available, many asthmatics frequently experience severe flare-ups of their asthma causing shortness of breath, wheezing, and/or cough.  About 400, 000 people end up getting hospitalized every year in the U.S. for management of their acute exacerbations.

As asthma is a chronic inflammatory condition involving the lungs, most currently available preventive maintenance medications are in the form of anti-inflammatory drugs inhaled directly into the lungs.  A few oral medications are also frequently employed, though they are usually less effective.

A third class of medications consists of injectable agents given every few weeks on a regular basis.  These are called monoclonal antibodies which target and reduce the numbers of certain specific mediators which contribute to the severity of asthma.

One of them, Xolair (omalizumab), has been available for the past several years.  It reduces the numbers of IgE antibodies which play a crucial role in causing exacerbations of asthma.  In selective patients who meet certain criteria, it has been found to be very useful in reducing the frequency of asthma symptoms and the need for emergency treatments.

A second drug in this class, called Nucala (mepolizumab), was recently approved by the FDA for the treatment of severe asthma.  It is a monoclonal antibody produced by recombinant DNA technology which targets and blocks a protein mediator called IL-5 (interleukin 5).  IL-5 causes an increase in the number of a particular type of white blood cell called an eosinophil which contributes to tissue damage in the lungs.  Since Nucala blocks the effect of IL-5, the resulting number of eosinophils decreases which reduces the tissue damage in the lungs of asthmatics.

In clinical trials, Nucala has shown to decrease the numbers of asthma exacerbations, emergency room visits and hospitalizations compared to a placebo.  It has been approved to treat severe and persistent asthma in adolescents above 12 years of age and adults who are still symptomatic despite the regular use of other controller medications.

While the dose and the frequency of administration of Xolair is determined by the weight of the patient and the serum IgE level, Nucala is given in a standard dose of 100 mg. every 4 weeks.  It can be injected under the skin in the arms, thighs, or abdomen.  The only criterion for the use of Nucala is a blood eosinophil count of more than 150 cells/mcL (which can be measured in a routine CBC) in patients with uncontrolled asthma.  The most common side effects of Nucala include headache, injection site reactions (pain, redness, swelling, itching, and/or a burning feeling at the injection site), back pain, and/or fatigue.

This new medication is a welcome addition to our armamentarium in our battle with uncontrolled asthma. It has the potential to greatly benefit certain selective patients whose asthma is predominantly mediated by harmful eosinophils. Being allergists in Centerville, we are happy to see additional alternative therapeutic options for the treatment of asthma.

In addition to the above treatment modalities for asthma, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective in the treatment of asthma.  It should be noted that Xolair as well as Nucala can be given in combination with allergy shots.

The board certified allergists at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about this new treatment modality. Dr. Michael Kletz and Dr. Appaji Gondi, Centreville allergists at Black and Kletz Allergy, have been treating both adults and children with hay fever, with hay fever, asthma, sinus problems, insect sting allergies, eczema, hives, swelling episodes, food and medication allergies, and  immunological problems for more than 50 years.  We have an office in Washington, DC and 2 offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA.  All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  For an immediate appointment, please call us or you may click Request an Appointment and we will respond within 24 hours by the next business day.

Allergies and Sinus Infections

People who have allergies are more prone to developing acute, chronic, and recurrent sinus infections (i.e., acute sinusitis, chronic sinusitis, recurrent sinusitis).  Allergic rhinitis (hay fever) is a condition in which allergens such as dust mites, molds, pollens, cats, dogs, and/or cockroaches will cause classic allergy symptoms in individuals that are sensitized to these allergens.  Some of the typical symptoms may include:  runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, snoring, sinus pressure, and/or sinus headaches.  The allergens cause inflammation and swelling in the nasal passages and sinus cavities.  These allergies can also lead to the development of nasal polys which further aggravate nasal congestion.  In the month of February, in the areas surrounding our Washington, DC, Manassas and McLean allergist offices, like Arlington, Centreville and Vienna, the allergens primarily responsible for causing allergic rhinitis symptoms include:  dust mites, molds, cats, dogs, cockroaches, and tree pollens.  The trees in the Washington, DC area usually begin to pollinate in mid to late February.  If the month is on the warmer side, the trees pollinate earlier.

When an allergic individual is exposed to an allergen to which they are sensitized, they exhibit the symptoms as mentioned above.  This predisposes the allergic person to develop sinus infections.  When someone develops nasal congestion or has nasal polyps due to allergies, the capability for the sinuses to drain properly diminishes.  As a result, the mucus becomes stagnant in the nasal passages and accumulates in the sinuses.  When the mucus “sits” in the sinuses, it is more likely to become infected with bacteria.  The dark, moist, stagnant environment in the sinuses is a perfect breeding ground for bacteria; much like a stagnant pond is much more likely to develop algae than a free flowing river.  Hence, if allergies are treated or prevented, then one is less likely to develop a sinus infection.

Allergic rhinitis can be treated with a multitude of medications which may include antihistamines, decongestants, expectorants, nasal sprays, saline irrigation of the nose, and/or leukotriene antagonists.  Allergic rhinitis symptoms can be prevented by avoiding the offending allergen, although this is difficult to accomplish in many cases.  Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy injections) are another way to minimize or prevent allergic rhinitis symptoms from occurring.  They are 80 – 85% effective and have been used in the U.S. for over 100 years.  Patients on allergy shots often realize a decrease in both the number and the severity of sinus infections.

Note that in addition to allergies, February is a time of the year that has other nonallergic factors which increase the likelihood of developing sinus infections.  In the Winter, there tends to be more “colds,” (which are due to viruses), as well as other viruses in circulation that cause upper respiratory tract infections.  Notwithstanding, people tend to stay indoors more often during the Winter, resulting in individuals being in closer contact with each other than at other times of the year.  This further increases the chance of spreading these viral upper respiratory tract infections.  In addition, the flu season occurs during the Winter which affects the nose and sinuses in most individuals.  The flu, which is caused by the influenza virus, also predisposes individuals to sinus infections.

Sinus infections can also exacerbate both allergy-induced and nonallergy-induced asthma.  When an asthmatic develops an upper respiratory tract infection such as a sinus infection, it also commonly aggravates their asthma symptoms which generally include wheezing, shortness of breath, coughing, and/or chest tightness.  This can be very serious and the asthmatic should see their allergist so their sinus infection can be treated effectively and without delay.  In addition to the asthma symptoms, acute sinus infections typically present with sinus headaches, nasal congestion, post-nasal drip, purulent discolored nasal discharge, and possibly a low grade fever.  Recurrent sinus infections may indicate an additional immunological defect and an immune system evaluation should be performed by the allergist.  Chronic sinus infections usually indicate that antibiotic therapy needs to be given to the patient for a much longer course than the typical 10-14 days given with acute sinus infections.  Another interesting fact about chronic sinus infections is that they can cause exacerbations of someone’s asthma without any sinus-related symptoms present.  Patients with chronic sinusitis may not have any symptoms at all.

If you suffer from allergies and/or sinus infections, please call Black & Kletz Allergy to schedule an appointment with one of our board certified allergists.  We treat both adults and children, and have 3 offices in the Washington, DC, Northern VA, and Maryland metro area.  Our offices are located 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, VA offices are Metro accessible, with a free shuttle between the McLean office and the Spring Hill metro station on the silver line.  Black & Kletz Allergy has been providing high quality allergy, asthma, and immunology care to the DC metro area for over 50 years.  Please call us for an appointment today or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.