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The “Cold” of Winter Has Effect on Allergy and Asthma Patients

The onset of winter in the Washington DC metro area has brought two cold-related health problems to the forefront.

The first one concerns many people with respiratory disorders like asthma and COPD (Chronic Obstructive Pulmonary Disease). Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of respiratory symptoms like coughing, wheezing, and shortness of breath. In addition, respiratory infections, especially caused by viruses, are more prevalent during the winter months. Influenza (the “flu”) is just one of the many viral infections which are notorious in aggravating asthma and pulmonary-related conditions.

Avoiding exposure to the cold air, in addition to minimizing the chance of developing a viral upper respiratory tract infection by frequent hand washing and covering one’s sneezes and coughs, can help prevent flare-ups in people with breathing difficulties such as asthma and COPD. People with persistent asthma (defined by any asthma symptom which occurs more often than twice a week during the daytime and/or more often than twice a month during the nighttime) need to use their controller medications on a daily basis as prescribed, in order to reduce the chances of exacerbating their asthma. Controller medications may include inhaled corticosteroids, long-acting beta agonists, leukotriene antagonists, and/or theophylline. In more severe asthmatics that meet certain criteria, a humanized antibody called Xolair (omalizumab), may also be prescribed in order to help prevent asthma exacerbations.

The second issue concerns people with a history of a specific type of “hives” called “cold-induced urticaria.” Though there are usually multiple triggers for hives (urticaria), exposure to colder temperatures can result in giant hives over exposed skin in susceptible individuals. The condition can be very serious in selected patients and is usually diagnosed in our office by an “ice cube test,” where an ice cube is placed on the forearm of the patient for 10 to 15 minutes and then removed. When the skin re-warms in a few minutes, an elevated red wheal or hive in the shape of the ice cube confirms this disorder. In rare instances, this condition is also associated with some systemic diseases and blood tests for cold agglutinins and cryoglobulins may be appropriate. Treatment begins with avoiding the cold when possible. In addition, various medications can be used to help prevent the hives and/or anaphylaxis that can occur in people with this condition.

The board certified allergists at Black and Kletz Allergy are experts in cold-related respiratory and skin disorders. Please call any one of our 3 office locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA if you need further information or are in need of an evaluation and advice regarding any of the cold-related disorders above or other cold-related disorder not mentioned above.

Asthma in the Winter

With the onset of cold weather, some children and adults with a history of asthma are experiencing flare-up of their symptoms. Breathing in cold, dry air can irritate and inflame the lungs, causing acute exacerbations of one’s asthma. The other common triggers of asthma symptoms are viral infections, which are usually more common in winter months.

The viral infections usually begin as “cold-like” symptoms with sneezing, followed by copious amounts of clear mucus in one’s nasal secretions and usually are associated with nasal congestion. Some of us also can have a skin rash, low-grade fever, sore throat, and/or frequent cough. Many children and adults recover spontaneously from these infections after a few days. However, they can result in aggravation of asthma, causing the typical symptoms of wheezing, chest tightness, coughing and/or difficulty in breathing.

A few precautions during the coming season may ward off flare-ups of asthma, the suffering, and the loss of productive time:

Avoid exposure to the cold air to the extent possible. Wearing a face mask while walking outdoors during the height of winter can be helpful.
The air can be very dry indoors and can irritate the respiratory passages. A room humidifier will help in hydration of the air we breathe.
General hygiene, frequent hand-washing, avoidance of sharing utensils, etc. may prevent certain infections.
Staying home when sick and covering the sneezes and coughs can keep the infections from spreading.
Plenty of fluids, rest, and eating well will help in a faster recovery.
Antibiotics usually have no role in viral illness, except in rare secondary bacterial infections.
Receiving the influenza vaccination (flu shot) as soon as possible in the season.
Pneumococcal vaccine, as per indications.

Children and adults with a history of frequent flare-ups of asthma during the late fall or early winter should begin taking the daily controller medications on a regular basis starting early in the season. At times, one also may need to increase the doses of preventive maintenance medications.

The board certified allergists and staff at Black and Kletz Allergy practice are always available to answer questions and address the concerns of people in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area who may be dealing with above conditions. Feel free to contact us by phone or via our “Request an Appointment” page on our main website to make an appointment.

SINUS INFECTION vs. “COLD” vs. WINTER ALLERGIES vs. FLU

As Winter approaches, people with dust, mold, and pet allergies tend to suffer more than those with pollen allergies. Pollen levels in the mid-Atlantic region (Washington, DC, Virginia, Maryland, etc.) become immeasurable once the first frost occurs. The first frost usually occurs by November in our region of the country. Therefore, when people experience the typical allergy symptoms during the late Fall and Winter months, dust mites and/or molds are generally the culprits. Keep in mind that there are other causes of these symptoms, namely the common cold, flu (influenza), or other upper respiratory tract infection (i.e., sinus infection, bronchitis). How does one know the difference between winter allergies, a “cold,” the “flu” or other type of upper respiratory tract infection?

WHAT ARE THE SYMPTOMS?

Winter Allergies – the same symptoms as seasonal allergies and can include all or some of the following: runny nose, nasal congestion, post-nasal drip, sore throat, cough, sneezing, itchy nose, itchy eyes, watery eyes, red eyes, itchy throat, fatigue, sinus headaches, wheezing, and shortness of breath.

Common Cold – can include all or some of the above symptoms, but in addition may contain achiness, fever, and chills, although discolored nasal discharge and a fever do not occur in most cases of the common cold.

“Flu” (also referred to as influenza) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there is usually severe achiness and/or headache, and a fever is almost always present.

Note: For the flu season of 2014-2015, one must be cognizant of the recent Ebola epidemic in Western Africa. If a person develops “flu-like” symptoms and has traveled to Western Africa and/or if they have been in contact with someone infected with the Ebola virus in the last 21 days, he or she must assume that they could have Ebola and should contact the CDC (Centers for Disease Control) and local county and state health agencies for guidance about seeking medical care at an appropriate hospital. If one cannot get in touch with the CDC or local health agency, they should go immediately to closest emergency room.

Sinus Infection (also referred to as sinusitis) – can include all or some of the symptoms of the common cold, but unlike a “cold,” there usually is discolored nasal discharge, sinus pain and/or pain that radiates to the teeth.

WHAT ARE THE CAUSES?

Winter Allergies – Dust mites; Molds: Pets; Cockroaches

Common Cold – Viruses [Rhinoviruses, Coronaviruses, Parainfluenza viruses, and Respiratory syncytial virus (RSV) are the most common ones]; Note that there are many more viruses that cause the common cold. “Flu” – Viruses (Influenza virus types A, B, and/or C)

Sinus Infection – Viruses, Bacteria, and/or Fungi (Most are caused by viruses)

HOW ARE THESE CONDITIONS DIAGNOSED? Besides a thorough history of your symptoms and a physical examination, the following also help our physicians distinguish between the 4 common conditions below:

Winter Allergies – An experienced allergist can perform blood and/or skin tests to evaluate if you have a true allergy to one of the many allergens that can cause winter allergy symptoms. When symptoms last longer than 1-2 weeks or there is a history of recurring symptoms every Winter or perennial (year-round) symptoms, allergies should be a top concern.

Common Cold – Typically the symptoms last less than 1 week in duration and resolve on their own.

“Flu” – A fever is the hallmark of this condition. The flu can be very serious particularly in the elderly. There are rapid influenza diagnostic tests that can identify the flu in about 30 minutes. These require that the physician to wipe the inside of the back of one’s throat or nose with a swab and then send it for testing. They are not 100% accurate however.

Sinus Infection – The symptoms may begin as a result of an individual being exposed to an allergen, virus, and/or bacteria. A thorough history together with a complete examination of the ears, nose, mouth, and throat can usually identify a sinus infection in the majority of patients. Further diagnostic studies such as a CT scan of the sinuses may be necessary in some individuals. When there is recurrent sinus infections, the diagnosis of chronic sinusitis and/or an immunologic disorder should be investigated by an experienced allergist.

WHAT ARE THE TREATMENTS?

Winter Allergies – There are many allergy medications that can be used which include tablets, syrups, nasal sprays, and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays.

“Flu” – Usually self-limited and generally does not require treatment except to help relieve symptoms with medications and nasal sprays. Occasionally a severe case or a case in the elderly may need hospital care of complications from the flu which can include dehydration, pneumonia, and other more severe complications. Antiviral flu medications can be taken to reduce the duration and severity of the flu. These medications work best if they are taken within the first 48 hours of the beginning of symptoms, however they can still be effective if taken later.

Sinus Infection – May need to be treated with antibiotics if it persists or is recurrent. Other medications may also be used if needed to help alleviate the symptoms with tablets, syrups, and/or nasal sprays.

WHAT CAN BE DONE TO PREVENT THESE CONDITIONS?

Winter Allergies – Avoidance of dust mites, molds, and pet exposure. Allergy medications and/or allergy shots (allergy immunotherapy or allergy injections).

Common Cold – Washing of hands; good hygiene; avoidance of crowded areas.

“Flu” – Flu vaccination (unless one has a reason not to take it such as egg allergy, previous reaction to the flu vaccine or the preservative used in the flu vaccine, etc.). In addition, one should avoid exposure to people with the flu. They should also practice good hygiene, avoid crowded areas during the flu season, wash their hands, etc.

Sinus Infection – Control allergies; washing of hands, good hygiene; avoidance of crowded areas.

As one can see from the information above, it may not be so easy for the average person to distinguish the difference between Winter allergies, the common cold, the flu, and a sinus infection. Many of the symptoms are the same, similar, and/or overlap. The board certified allergists at Black & Kletz Allergy have the expertise to help diagnose the correct ailment and more importantly, treat your problem. We have 3 office locations in the Washington, DC metro and Virginia areas and we will be happy to schedule a visit for you at your earliest convenience.

Pet Allergy: What You Should Know

October 9, 2014
BY BLACK & KLETZ ALLERGY

The two most common pet allergies in the United States are cats (20% of the population) and dogs (10% of the population). Dogs, however, are the most common pet, followed by cats. There has been an upward trend in the U.S. in the number of household pets with almost 70% of households having at least one pet. Of course, besides dogs and cats, other common pets include birds, rodents (i.e., hamsters, guinea pigs, gerbils, chinchillas, mice, etc.) reptiles (i.e., lizards, snakes, turtles, etc.), rabbits, ferrets, horses, hermit crabs, spiders, and fish. Horses, unlike the other pets mentioned above, do not live in people’s homes, but can be quite allergenic.

One can be allergic to any animal, but clearly the most common indoor pet allergies are cats and dogs. For the purpose of this blog, we will talk exclusively about cats and dogs. If you would like to see more information about allergies to other types of pets, please visit our website, www.bkallergy.com , click “SERVICES,” and then click the 4th bullet which is a link entitled “Pet Allergies.”

When an individual is “allergic” to a pet, they are in fact “allergic” to particular proteins that are produced by that animal. For example, the proteins that cause most of the misery suffered by people who are allergic to cats are designated “Fel d 1” and “Fel d 4.” Likewise, in individuals that are allergic to dogs, the major protein involved is called “Can f 1.” Most proteins that cause allergies in any household pet tend to be concentrated in the pet’s dander, urine, saliva, and/or feces.

The dander (from the skin of an animal) tends to be a big problem with most pets. In cats, the dander tends to “stick” to things such as clothing, walls, carpeting, bedding, etc. and therefore can and is “transported” from the home to other places that people go to, such as their workplace. If Fel d 1 protein is measured on a cat owner’s clothing or their upholstered chair at work, it is likely to be found. In addition, since the proteins stick to the walls of the cat owner’s home, it takes months for the proteins responsible for causing an allergic reaction to diminish to non-detectible levels, despite a thorough cleaning of the home. Since the protein is also found in urine, cat litter boxes are a rich source of the proteins. In dogs, luckily the protein Can f 1 is not as “sticky” as the cat proteins, but still can stick to clothing, bedding, etc.

As a general rule, it is advisable not to have a pet if one is allergic to it. However, despite common sense, most people still opt to either acquire a pet or to keep an existing pet that they have had even if they cause bothersome allergy symptoms. Even though this is not advised, it is understandable since a pet can cause great joy in one’s life and becomes a member of the family!

One major misconception is that there are “hypoallergenic” cats and dogs. While some people feel that

they do better around short-haired cats or around dogs that do not shed like poodles, most scientific studies do not support this phenomena.

One can take some measures to reduce their exposure to the allergens that cause pet allergies. Brushing your cat or dog frequently and bathing your cat or dog often will help reduce the levels of cat and proteins. It is also advisable to prevent the cat or dog from entering your bedroom.

The symptoms of pet allergies are similar to any other type of environmental allergy. The symptoms can include any or all of the following: sneezing, runny nose, stuffy nose, itchy/watery/red puffy/eyes,

post-nasal drip, itchy skin, hives, wheezing, chest tightness, coughing, and/or shortness of breath.

The board certified allergists at Black and Kletz Allergy can help you diagnose whether you have a pet allergy by simple tests which involve a thorough history and physical examination as well as skin tests and/or blood tests. In addition to avoidance measures, there a number of medications that can be tried to try to alleviate your symptoms of pet allergies. These medications can be in the forms of tablets, nasal sprays, eye drops, creams, inhalers, and/or injections. Since pet allergies are a perennial (year-round) problem, many patients find allergy shots (allergy immunotherapy) extremely effective in preventing and/or diminishing their pet allergy symptoms. Allergy shots can be administered to children, pregnant women, and adults and have been used for over a century.

If you would like to have a consultation with us regarding your pet allergies (or other type of allergies), please call us or use our website to “Request An Appointment” and we will get back to you by the next work day. Black and Kletz Allergy has been serving the Washington, DC metropolitan area including Maryland and Northern Virginia for more than 50 years.

Mold Allergies

October 6, 2014
BY BLACK & KLETZ ALLERGY

As the temperatures are dropping and the leaves are starting to “fall”, the ragweed and other weed pollen counts are also gradually decreasing, but the mold spores will be a significant trigger of asthma and allergy symptoms in the coming few months for sensitized individuals.

Mold is a fungus which can cause bothersome symptoms in a few different ways:

Allergic Reaction: Though all of us are exposed to molds, only some of us develop “sensitivity” to them determined by our genetic composition. When a genetically predisposed individual inhales spores from molds, his/her immune system considers them as foreign invaders and manufactures antibodies in an attempt to fight them. These antibodies memorize the particular spores and “attack” them when they are exposed to them again. This reaction causes certain chemicals like histamine to be released into the tissues which cause the typical symptoms of sneezing, stuffy/runny nose, itchy/watery eyes, etc. (Note: If your vision is seriously impaired, it may be a sign on something more severe, and you may wish to consult with a LASIK surgeon in Washington DC.)
Irritant Reaction: Molds can release substances called volatile organic compounds (VOC’s) which can irritate skin and mucus membranes inside the mouth, nose and eyes resulting in burning sensation, watery eyes, runny nose, scratchy throat and cough.
Toxic Reaction: Mycotoxins, produced by certain types of molds, in addition to causing irritant symptoms can also lead to flu-like symptoms, fatigue, headache, dizziness, and shortness of breath.
Infection: Though skin lesions are the most common infectious manifestation, different types of molds also can cause respiratory, gastrointestinal, and neurological disorders.

Molds are found in both indoor and outdoor environments and thrive in high humidity. Moist and decaying leaves on the ground, which tend to peak in the Fall, form a substrate for the mold growth. Damp basements, leaky faucets, wet shower curtains, and wet bathroom tiles also encourage proliferation of molds. Though many mold overgrowths are visible, their spores are microscopic and are air-borne. The most common types of molds that cause human suffering are alternaria, hormodendrum, cladosporium and penicillium.

Most people sensitive to mold spores only exhibit “hay fever”- like symptoms involving the eyes, nose, mouth, and throat. Less commonly, molds also play a role in more serious conditions like:

Allergic Asthma: In sensitized individuals with a history of asthma, mold spores can induce sudden and severe flare-ups of asthma symptoms which may require emergency treatments and/or cause an increase in the number or dose of controller medications.
Allergic Bronchopulmonary Aspergillosis (ABPA): It is a hypersensitive reaction to a particular type of mold called aspergillus in the lungs of patients with persistent asthma or cystic fibrosis.
Allergic Fungal Sinusitis: A chronic inflammatory response of the membranes and tissues inside the sinus cavities can be caused by certain types of molds in susceptible people.

Diagnosis: Mold allergies can be detected either by skin testing or by measuring the amount of specific IgE antibodies in a blood sample by a clinical laboratory. Skin testing is a more sensitive test and is the preferred method used by allergists. A detailed history of the symptoms and their possible triggers in the environment followed by a focused physical examination will help the allergist in determining the type of testing needed to confirm the diagnosis.

Treatment: The first principle in the management of any allergic disorder is to identify the possible triggering and aggravating factors in the environment and to avoid exposure to them to the extent possible. To reduce exposure to the mold spores, the following measures can be quite useful:

As dampness encourages mold growth, indoor humidity levels should be kept below 50 percent. Avoiding water leaks and running a dehumidifier in damp and musty areas of the house can also inhibit mold proliferation.
Installing HEPA filters in HVAC systems and changing them periodically will reduce indoor spore counts by trapping them before fresh air is circulated.
Adequate ventilation of the bathrooms either by running the exhaust fan or opening the windows will reduce mold growth. Keep in mind that by opening the windows, outdoor molds may enter one’s home which can be counterintuitive.
Proper care of indoor plants such as removing the dead leaves and avoiding standing water can be helpful.
Wearing a face mask to cover the nose and the mouth before raking leaves and cutting grass will reduce exposure to molds substantially.
Mold spore counts are usually higher at nights when the atmosphere is cool and damp. Closing the windows will keep the outdoor molds from entering inside one’s home.

Medications like ocular, nasal, and oral antihistamines as well as nasal and inhaled anti-inflammatory drugs can relieve the misery of symptoms to a certain extent. When environmental control measures and medications do not help enough or when the side effects of the drugs are bothersome, a desensitization process (i.e, allergy shots or allergy immunotherapy), which induces tolerance to the offending allergens, can be a long term solution which is highly efficacious.

The board certified physicians and staff at Black & Kletz Allergy have the training, expertise, and decades of experience in the diagnosis and treatment of adults and children with mold and other allergies in a professional, caring, and patient-friendly environment in the Washington, DC, Maryland, and Northern Virginia area.

Ragweed Allergies – What Are They and Do You Have Them?

As summer draws to a close and schools reopen across our region, most of us look forward to cooler days and fall colors. But if you are one of several million Americans who suffer from “Hay Fever” (“seasonal allergic rhinitis,” as it is more accurately named) to ragweed, the rising levels of pollen from ragweed are sure to increase your misery due to your allergic reaction to these pollen grains.

Though many weeds like Pigweed, Mugwort/Sagebrush, Cocklebur, and Russian thistle pollinate in the fall, Ragweed (species Ambrosia) is the most common and predominant allergen in our geographical area. Each plant can produce up to one billion pollen grains per season, and these can remain airborne for several days and travel hundreds of miles from the site of origin. In the Washington, DC metropolitan area, the ragweed pollen usually starts appearing in the air in mid-August. The pollen counts gradually increase and peak in early September and subside after the first frost which is usually in late October. Many scientists believe that rising temperatures and an increase in atmospheric carbon dioxide (CO2) levels may prolong the ragweed season.

When a person who has been previously sensitized to a particular pollen is exposed to that pollen in the air, the proteins trigger specialized cells in the immune system to release excessive levels of histamine and other chemical mediators which are responsible for various allergic symptoms, some of which are listed below:

Excessive sneezing
Itchy, red, puffy, watery eyes
Persistent runny nose
Nasal stuffiness, blockage, or congestion
Itchy throat and post-nasal drip leading to a dry cough
In asthmatic individuals, the pollen can also induce flare-ups of wheezing, chest tightness, cough and/or breathing difficulty.

In ragweed sensitive people, eating fresh fruits and vegetables like melons (cantaloupe, honeydew, watermelon, etc.), cucumber, zucchini, kiwi, and bananas may cause itching and tingling of mouth, tongue, and throat. This condition is called “pollen-food allergy syndrome” or “oral allergy syndrome” and is due to cross-reacting proteins in the pollen and fresh fruits.

A few avoidance measures can reduce the exposure to pollen and the suffering:

Minimize outdoor activities in the early morning hours when the pollen counts tend to be the highest.
Keep the windows at home and in automobiles closed and use air-conditioning.
Shower to remove pollen from the skin and hair after coming indoors and wash clothing.
Nasal irrigation can wash the pollen and irritants from nasal passages.

If the symptoms are bothersome, several medications like antihistamines (available in pills, liquid, nose sprays and eye drops), decongestants (pills and liquid), and corticosteroids (nasal sprays, pills, liquid), either alone or in combination may offer considerable relief. To be optimally effective, the medicines are best started a few days before the onset of the active season. For many people with moderate to severe sensitivity, allergy immunotherapy (also referred to as “allergy shots,” will cause a desensitization to that pollen, which in this case is ragweed pollen) will offer the most effective long-term relief from the symptoms and can reduce or eliminate the need for medications.

The physicians and Washington, DC allergy doctors at Black and Kletz Allergy practice in DC and northern Virginia have several decades of experience and expertise in managing ragweed sensitive patients and are committed to provide the most up to date and evidence based treatment options in a patient-friendly environment.

Food Allergy vs. Food Sensitivity (Food Intolerance) vs. Food Poisoning

August 28, 2014
BY BLACK & KLETZ ALLERGY

Many people are convinced that they have food allergies. For some, this is a correct assumption. For others, they may actually have a food sensitivity or food intolerance, but not a true food allergy. Still others, may have an episode of food poisoning. In order for it to be a true food allergy, there must be a specific immune response to a particular food protein involving the immunoglobulin E (IgE) antibody (also known as the “allergy” antibody). This type of reaction is called a Type I, IgE-mediated immunologic reaction. The symptoms of a food allergy usually occur within seconds to a couple of hours after exposure to a food.

FOOD SENSITIVITY or FOOD INTOLERANCE:

A food sensitivity or food intolerance, on the other hand, is a non-immune toxic reaction against a food. Unlike food allergies, the reaction usually occurs in a delayed fashion and typically develops between 1 hour and 3 days after eating the food. It carries a much lower risk and is not as serious. The food can affect different people in different ways. Any organ system can be affected. Since it can take days to develop symptoms, people with food sensitivities are difficult to diagnose and may go undiagnosed for many years. One of the best ways to determine if someone has a food sensitivity is to do a food elimination diet and then add one food at a time back for several days to see if their symptoms re-occur. If it does, then the individual should remove that food from their diet. Some examples of food sensitivities and their cause are as follows:

Gluten Intolerance – Inability to digest gluten (wheat, rye, and/or barley) or more recent research suggests that it may be the inability to digest FODMAP’s (Fermentable Oligo-, Di-, Mono-saccharides and Polyols) rather than gluten.
Lactose Intolerance – Deficiency of the enzyme “lactase” which normally breaks down the sugar lactose found in milk products.
Favism (Glucose-6-phosphate dehydrogenase deficiency or G6PD deficiency) – Genetic deficiency in the enzyme G6PD causes anemia, fatigue, abdominal pain, headache, fever, etc. when these individuals eat fava beans or take certain medications (i.e., sulfonamides, certain anti-malarial drugs, aspirin, nitrofurantoin, dapsone, isoniazid).
Adverse Reactions to Preservatives and/or Food Dyes – Some examples include sulfites, tartrazine, sodium benzoate, nitrates, nitrites, parabens, monosodium glutamate (MSG), aspartame, and butylated hydroxytoluene (BHT).
Pharmacologic Effect of Food – Some examples of chemicals found in a variety of foods include caffeine, tyramine, and histamine.

FOOD POISONING:

Food poisoning can mimic the symptoms of food allergies or food sensitivities. Typically these symptoms of food poisoning can include diarrhea, abdominal pain, nausea, and/or vomiting. Other symptoms more consistent with food poisoning than that of either food allergies or food sensitivities include fever, bloody diarrhea, blood in vomit, and/or general weakness. The symptoms of food poisoning generally begin from a few hours to a few days after eating the affected food. They typically last hours to a few days, but can last longer. Often, other individuals eating the same food will exhibit similar symptoms which make the diagnosis of food poisoning more likely. The causes of food poisoning most often include contamination with various bacteria, viruses, or parasites. Other causes can include natural toxins (found naturally in many plants and some fish, etc.), other toxins that can arise from certain bacteria and fungi, and prions. It is always highly recommended to wash one’s hands thoroughly before eating and avoid eating undercooked or raw meat, poultry, fish, shellfish, sprouts, or eggs however, many cases of food poisoning are caused by poor sanitary conditions, spoilage, and/or improper food processing and/or storage of the food. Travelers should also be extremely careful. When in other countries, particularly third world countries, it is highly recommended to drink sealed bottled water, avoid ice and any food that has been washed or mixed with the local water (unless boiled and filtered), and avoid unpasteurized foods. Dehydration is one of the most serious complications from a case of food poisoning. It does not take long for a patient who has severe vomiting and/or diarrhea to become dehydrated. It is therefore important to drink plenty of fluids in cases of food poisoning. If symptoms last 2-3 days, one should seek medical care, so that the physician can obtain an appropriate history and perform a thorough physical examination. The physician will order the appropriate blood work and obtain stool samples and cultures. Treatment may include intravenous fluid and electrolyte replacement as well as antibiotics or anti-parasitic medication, if needed.

Note: There is a food poisoning that can mimic an allergic reaction called “Scrombroid poisoning.” The symptoms of this illness can include flushing and rash, rapid heart rate, lightheadedness/dizziness, headache, nausea, abdominal pain, and/or diarrhea. In severe cases, one may experience shortness of breath, wheezing, swelling of the throat or tongue, and/or decreased blood pressure which can be life-threatening. These symptoms all are typical of an allergic reaction, however, in scrombroid poisoning, there is no allergy and there is no contamination with bacteria, viruses, or parasites. The cause of this condition is a chemical called histadine that is naturally occurring in some fish (i.e., tuna, bluefish, mahi mahi, mackerel, sardines, herring, anchovies). When the fish is not properly stored, the fish spoils and certain bacteria grow and cause the histadine to convert to histamine. It is the histamine (which is one of the main culprits in causing allergic reactions), that is the cause for the allergic symptoms found in scrombroid poisoning. Treatment of mild symptoms can be treated with antihistamines, however, if symptoms become more severe or they become prolonged, one should go to the closest emergency room for treatment.

FOOD ALLERGIES:

Symptoms:

The symptoms of food allergies can be diverse. Some of the more common symptoms found with food allergies include: generalized itching (pruritus), itchy mouth and/or throat, hives (urticaria), other rashes, abdominal pain, diarrhea, vomiting, wheezing, shortness of breath, swelling (angioedema) , throat tightening, and/or anaphylaxis. As mentioned above, the symptoms usually occur within seconds to a couple of hours after exposure to the food. They can be very mild or very severe and life threatening. The most common foods associated with life-threatening reactions from foods include: peanuts, tree nuts, fish, and/or shellfish.

Most Common Food Allergies:

The most common food allergies in infants and children are milk, egg, soy, wheat, peanuts, and tree nuts. In adults, the most common food allergies are fish, shellfish, peanuts, and tree nuts. It should be noted that anyone can be allergic to any food. That food can cause symptoms ranging from very mild to very severe life-threating reactions.

Food protein-induced enterocolitis syndrome (FPIES):

Food protein-induced enterocolitis syndrome is a type of food allergy which usually affects infants and babies. The cause of the syndrome is usually due to a food, most commonly cow’s milk formula and soy-based formula. Breast milk may also contain food proteins that can cause this condition, however, this is rare. Other foods commonly associated with this syndrome can include oats, rice, sweet potatoes, squash, chicken, turkey, peas, green beans, and fish. Symptoms include vomiting and diarrhea (occasionally with blood), dehydration, weight loss, and failure to thrive. It is typical, however, for the symptoms to begin several hours after the food is consumed. This delay in symptoms makes it more difficult for this condition to be diagnosed. The diagnosis is further complicated by the fact that usual skin and blood testing done for food allergies usually are not be positive. Once the diagnosis is established, the food should be eliminated from the infant’s diet and alternative foods should be consumed. It is usually necessary to see a board certified allergist to diagnose this often “difficult to diagnose” problem.

Diagnosis and Treatment:

If one suspects food allergies, one should seek a board certified allergist. The allergists at Black & Kletz Allergy have had over 50 years of experience in diagnosing and managing food allergies and sensitivities in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Food allergies can be diagnosed by a thorough history and physical examination along with prick skin testing and/or blood testing. The management varies but in most instances, avoidance of the food is the recommended treatment. If you feel that you may e an issue with food allergies or sensitivities, we would be happy to see you in one of our 3 convenient locations with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Please feel free to call our office or alternatively, you may click Request an Appointment and we will respond within 24 hours on the next business day. Black & Kletz Allergy is proud to provide quality allergy and immunology care in a relaxed caring environment.

Allergies and Asthma in the Washington, DC Area

July 28, 2014
BY BLACK & KLETZ ALLERGY

A very common question that has been raised by many patients and especially parents of children with environmental and food allergies is: Why are we experiencing more and more allergies and asthma in the DC area now compared to a generation ago?

While it is possible that we are now able to detect and recognize allergic disorders more effectively than before, there is data to support the view that the actual incidence (the number of newly diagnosed cases) and the prevalence (the number of cases existing in the population) is increasing for the past several years. While the exact cause for this phenomenon is yet to be determined, there are some theories that try to explain the reasons behind it.

1. Genetics/Epigenetics:

Children born to parents who already have allergies are at higher risk for developing allergies. If one parent has allergies, the risk for the child is doubled and if both the parents have allergies, the risk is tripled. This increased likelihood to develop allergic disease because of their genes is called atopy. The genes can be “turned on and off” by some factors in our environment that we are exposed to. The role of viral infections in turning the allergic genes on and off is a subject of intense ongoing research.

2. Hygiene Hypothesis:

Several studies in Scandinavian countries revealed that children who grew up on farms exposed to farm animals have lower incidence of allergic diseases compared to children who grew up in cities in a “cleaner” environment. This indicates that the immune system needs to be exposed to micro-organisms like viruses and bacteria while at a developing stage in infancy, in order to respond appropriately later in life. Compared to our parents and grandparents, most of us are now living in a more “sterile“ environment due to better hygiene, immunizations, and antibiotics. While these helped us defeat many life-threatening infections, the inadequate exposure of our immune system to micro-organisms early-on may have resulted in a tendency to fight harmless substances like mites, pollen, and foods resulting in allergic diseases.

3. Diet:

We are now eating more processed foods and fewer vegetables and fruits than our forefathers did. Our diets also contain less omega-3 fatty acids and anti-oxidants. Vitamin D plays an important role in the modulation of immune function, and more and more people are currently being diagnosed as having a deficiency of Vitamin D, probably due to inadequate exposure to sunlight. The precise role of these factors in increased incidence of allergic disorders is being studied worldwide, though no conclusions have yet been reached.
Although no conclusions have been reached regarding the cause of why the incidence and prevalence of allergies and asthma in Manassas, VA and the DC area have increased over recent years, it is clear that these conditions are very problematic for allergy sufferers. We, at Black and Kletz Allergy, strive to help alleviate your allergy and asthma symptoms in McLean, Virginia and the Washington, DC area, so that you can enjoy a high quality of life.