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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.

Summertime Sickness: Sinus Infection vs. the Common Cold

July 21, 2014
BY BLACK & KLETZ ALLERGY

As the tree and grass pollen season is winding down in the Washington DC area, “summer colds” are playing a bigger role in symptoms that include stuffy nose, runny nose, eye irritation, sore throat, and cough in many people.

Also read: Sinus Infection vs. Cold: Symptoms & Treatment Options

The common cold is caused by a viral infection of the upper respiratory tract passages. Different strains of viruses are responsible for these infections in different seasons. Whereas rhinoviruses cause most of the colds in the winter, enteroviruses are more prevalent in summer.

The symptoms usually begin as sneezing spells followed by nasal congestion, runny nose, and a redness and burning sensation of the eyes. More serious eye problems, may be better handled by a Washington DC ophthalmologist. They are usually followed by a sore throat, occasional dry cough, and fatigue. Many individuals also experience headaches and a mild fever. The illness may last for 5 to 7 days and usually resolves by itself.

Though, no medication is needed to eradicate the infection, the symptoms can be relieved and the person can be made to feel more comfortable by taking some of the following steps:

Irrigating the nasal cavity with a saline spray and over-the-counter (OTC) oral decongestants to unclog the nostrils and help breathe easier. (Note that individuals with high blood pressure, heart problems, prostate conditions, and other various diseases should not use decongestants)
Though the OTC nasal decongestant sprays can give quicker relief, if they are used more than 3 days continuously, they can cause “rebound” congestion when their effect wears off. This can lead to a habituation and dependency and is called “rhinitis medicamentosa.” Therefore, never use an OTC nasal decongestant such as Afrin (oxymetazoline) or Neosynephrine (phenylephrine) more than 3 days.
OTC pain medications like acetaminophen and ibuprofen to relieve headache, achiness, and/or fever.
Gargling with warm salt water and using throat lozenges to soothe the throat irritation.
Get rest and drink plenty of oral fluids while the immune system is fighting the virus.

However, in some instances the upper respiratory infections can also progress to involve the linings inside the sinuses. (Sinuses are air-filled cavities within the facial bones and are present behind the forehead, around the eyes, and behind the cheek bones). This complication can not only prolong the duration of the illness, but can also result in additional symptoms such as fever, facial pain/tenderness, persistent thick and discolored nasal secretions, post-nasal drip, and/or frequent productive coughing, which are symptoms consistent with a sinus infection. People with a history of asthma may also experience aggravation of their breathing problems and the more frequent need for their rescue medications.

If the symptoms are persisting in spite of the OTC medications and comfort measures (especially if the symptoms last more than 1 week), it is time to consult your Manassas, VA sinus problem doctor for evaluation and treatment. Black & Kletz Allergy’s Washington, DC specialists will help you beat your summer allergies for good.

Hay Fever in the Washington, DC Area

June 4, 2014
BY BLACK & KLETZ ALLERGY

Hay Fever in the DC area is manifested by tree and grass pollens in the Spring and ragweed pollen in the Fall. More specifically, the tree pollen usually begins to pollinate towards the end of February each year and continue pollinating into May or even early June. Grass pollen usually begins to pollinate in May and the peak of it is usually over by early July, but it still is present into August. Ragweed pollinates usually beginning in mid-August and ends with the first frost which is usually in late October. There are other weeds that cause hay fever in the DC area which are present throughout the Spring, Summer, and Fall. The medical name for hay fever is “allergic rhinitis.”

Asthma Symptoms and Goals for Treatment

May 15, 2014
BY BLACK & KLETZ ALLERGY

Asthma is one of the most common chronic diseases afflicting both adults and children. Over 20 million Americans suffer from this condition and more than 6 million of them are children.

There are three main features of asthma. Chronic inflammation of the airways in the lung causes swelling of the tissues around these airways and is the most important abnormality in asthma. In addition to this chronic inflammation, the muscles around the walls of the airways will spasm which results in the narrowing of the lumen (inside of the airway or breathing tubes) which restricts the amount of air that flows in and out of the lungs during breathing. As this is not bad enough, the third factor that occurs in patients with asthma is that there is excess mucous production. This increase in mucous will cause a further blockage of the airways as it sits inside the lumens of the breathing tubes. So not only does an asthmatic feel like he or she is breathing from a straw, but now the straw is partially clogged with mucous. These three factors together, lead to the feeling of chest tightness/heaviness, cough, shortness of breath and/or wheezing (a high pitched whistling noise caused
by passage of air through narrowed tubes).

These bothersome symptoms impact the quality of life of an asthmatic. Many experience lost work and/or school days. Sudden flare-ups of asthma can be triggered by exposure to allergens (dust mites, molds, pollens, pets, etc.), strong scents (perfumes, colognes, cleaning fluids, etc.), upper respiratory infections, exercise, cold air, increased humidity, cigarette smoke, medications (certain blood pressure medications, etc.), as well as other factors. Asthma can be life-threatening. However, there are effective treatments available which can control the inflammation, preserve the lung function, and prevent the symptoms and exacerbations of asthma.

The goals of treatment of asthma are to use the least amount of medications that can achieve the above objectives, taking precautions to minimize the side effects. This calls for identification of the specific triggers (which can vary from person to person) and their avoidance, choosing the correct medication (whether is be inhaled, taken by mouth, or injected such as allergy shots) at an appropriate dosage, and close monitoring of symptoms and lung capacity to enable either stepping-up or stepping-down the treatments at regular intervals.

The board certified allergists at Black & Kletz Allergy practice have received advanced training in the management of asthma and constantly keep themselves abreast of the latest developments in evidence based medicine. They are committed to utilize their expertise and years of experience in treating asthma in children and adults to thoroughly educate their patients and offer individualized treatment plans following national guidelines and practice parameters.

Insect Sting Reactions

May 2, 2014
BY BLACK & KLETZ ALLERGY

As we enter into warmer months, insect sting reactions are one of the major concerns in our greater Washington, DC metro area. Most people who are stung by insects experience swelling, redness, and pain at the site of the sting. These symptoms usually resolve within a few days. However, some of us are “allergic” to the insect venoms and the stings can lead to severe life-threatening reactions. In fact, about one-half a million people seek emergency room care every year in United States for insect sting reactions and about 50 deaths are reported every year from these reactions. If we are predisposed to develop allergic reactions, our immune systems make IgE antibodies to the venom after an initial sting. steam cloud . If we are stung by the same insect again, the antibodies interact with the venom and cause the release of certain chemicals into the bloodstream which causes the serious reactions.

Though many insects cause local reactions, almost all the severe generalized reactions commonly found in northern Virginia, Washington DC, Maryland, and the surrounding areas are caused only by four types of insects. These four types include Honey bees (live in colonies or “honeycombs” in hollow trees or cavities of buildings), Yellow Jackets (usually nest underground and rarely in woodpiles or cracks in masonry), Hornets (grey or brown football shaped nests above ground in the branches of trees or in shrubbery) and Wasps (nests are made up of paper-like material under eaves, behind shutters, or in shrubs).

In order to reduce your chance of being stung, it is advisable that you take a few precautions like avoidance of walking outdoors with exposed skin. It is also recommended to avoid wearing dark colored clothing and to also avoid wearing strong perfumes and deodorants. If one has a systemic reaction following an insect sting, he or she has a 60% chance of a similar or more severe reaction in the case of a subsequent sting by the same insect. Another important tidbit of information to know is that if a honey bee stings you, it will leave it’s stinger in your skin at the site of the sting. You should never pull out the stinger, instead, you should scrape off the stinger with your fingernail or credit card. Pulling out the stinger actually causes the bee’s venom sac to pump more venom into you which can make your reaction to its venom more severe. Luckily, there is a highly efficacious treatment option called Venom Immunotherapy, (also known as Venom shots or Venom injections), which has proved to be 97% effective in preventing life-threatening reactions in people who are sensitized to the insect venoms. Allergy shots for indoor and outdoor allergies are different, but also highly effective.

Over the past five decades, the board certified allergists at Black and Kletz Allergy practice have helped hundreds of patients sensitized to insect venoms in Virginia, Washington, DC, and Maryland to lead a normal life. Through education, training in self-injectable epinephrine, and most importantly, by desensitization, our patients have been able to live without the fear of a having a serious reaction from insect stings and are able to enjoy being outside in the warm months.

Sinus Infection vs. Cold: Symptoms & Treatment Options

April 1, 2014
BY BLACK & KLETZ ALLERGY

When we have frequent nasal congestion, runny noses, sneezing fits, and itchy, red, watery eyes, the common dilemma arises: Is it a sinus infection vs. a cold? How do I treat either?

Sinus Infection vs. Cold: Differences
The “common cold” refers to an infection caused by germs like viruses affecting the upper respiratory passages. It causes inflammation of the tissues inside the nose and surrounding areas (Infectious Rhinitis). It usually begins with nasal congestion, runny nose, and sneezing. The nasal secretions are usually clear to start with but can turn into light yellow after a few days. One can also have a sore throat, cough, and mild fever. Most symptoms usually subside after about a week without any treatment, though the cough can linger for a few weeks. This condition is more frequent in winter months and common in children who attend daycare and preschool, due to repeated exposure to viruses. Adults usually get less frequent “colds” because their more mature immune systems can resist and fight more effectively.

“Allergic Rhinitis,” on the other hand, is the inflammation of the nose and eyes (conjunctivitis) caused by exposure to allergens like dust mites, animal dander, mold spores and various pollens in a susceptible individual. The symptoms of a sinus infection are somewhat similar to “common colds,” but itching can be more prominent and fever is usually not present. One important differentiating feature is that the symptoms usually do not remit after a few days but can persist either throughout a particular season or throughout the year depending on the specific triggering agents. In more severe cases, the condition can have a substantial impact on the quality of life and productivity. Allergic sensitivity can also play a role in the causation of repeated ear infections and contribute to lower airway disorders like asthma.

Sinus Infection vs. Cold: Similarities
Both Infectious and Allergic rhinitis can also lead to a “sinus infection or sinusitis” where the lining and tissues inside the sinuses (hollow cavities inside the facial bones) are inflamed. This can result in facial pressure and/or pain, headache, fatigue, fever, discolored secretions, persistent post nasal drip or drainage, sore throat, and cough. The condition can be caused either by viruses (which do not need antibiotics) or less frequently by bacteria, especially if the symptoms last for several weeks.

Allergic Rhinitis and Allergic Conjunctivitis, not relieved by simple over the counter (OTC) remedies, require thorough evaluation and management by qualified allergists, who can offer long lasting symptom relief, prevent complications, and improve the quality of life in these individuals. If you have any additional sinus infection vs. cold questions, please contact the allergists at Black & Kletz Allergy.