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Allergies and Asthma in the Washington, DC Area

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

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:

  1. 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)
  2. 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.
  3. OTC pain medications like acetaminophen and ibuprofen to relieve headache, achiness, and/or fever.
  4. Gargling with warm salt water and using throat lozenges to soothe the throat irritation.
  5. 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

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.”

Also read: What Is Hay Fever?

Another important allergen that affects many individuals in the Washington, DC area is mold.  People are exposed to mold spores and become sensitized to them, the same way that pollen causes sensitization in allergic patients.  Washington, DC was built on a swamp and therefore tends to always have mold in the air.  Mold tends to like damp and humid climates such as the DC area, however, some molds can exist and flourish in dry climates, even the desert.  Of course, molds are both an outdoor and indoor allergen and is found indoors primarily in basements, kitchens, and bathrooms which tend to be more damp.  The symptoms of hay fever may include nasal congestion, runny nose, sneezing, itchy nose, throat and/or eyes, watery eyes, red eyes, post nasal drip, sinus headaches, and/or fatigue. These symptoms are most bothersome after outdoor activities and many people feel that they are forced to isolate themselves indoors for several weeks when the weather is nice, resulting in a significant negative impact on their quality of life.  Many patients with asthma also experience cough, wheezing, chest tightness, and/or breathing difficulty on exposure to pollen.  These flare-ups can also cause sleep disturbances, unscheduled emergency visits to health care providers, and loss of work and school days.

Pollen counts are the highest on warm, dry, and windy days and are directly proportional to the “misery index” of the people who have been previously sensitized to the pollen. They also tend to be higher in the mornings and decrease temporarily after it rains.  Individuals that are sensitized to pollens have specific antibodies (called IgE antibodies) which interact with the antigen in the pollen, causing histamine and other chemicals to be released.  It is these chemicals that cause the symptoms of hay fever.  To alleviate hay fever symptoms, a few common sense precautions can help reduce the amount of exposure to pollen.  These precautions include closing the windows in homes and automobiles, keeping the sunroof closed in automobiles, minimizing outdoor activities on warm and windy days, and taking a shower after being outdoors.  Over the counter antihistamine medications can offer some relief from symptoms in mildly sensitized individuals but are not very helpful in people who have long term severe sensitivities to these pollens.  For people who continue to be symptomatic, however, more effective treatment options like prescription medications and/or allergy desensitization (immunotherapy) procedures offer long term relief, greatly improving the quality of life and increasing productivity.

Board certified allergists are physicians who have received advanced training in treating hay fever, asthma, and sinus conditions.  Black and Kletz Allergy practice has over five decades of experience in evaluating and treating hay fever in the DC area.  Feel free to contact us to schedule an appointment if you are experiencing hay fever or any other allergic or immunologic symptoms.

Asthma Symptoms and Goals for Treatment

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

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

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.

What Is Hay Fever? Allergic Rhinitis: Symptoms & Treatment Options

What is hay fever?  It’s a common term in vogue to refer to the symptoms of sneezing, runny noses, stuffy noses, and itchy red, watery eyes, triggered by exposure to pollen.  However, these are not usually caused by hay and not associated with fever!  “Allergic Rhinitis” is a more accurate term as it describes the true cause of hay fever, which is inflammation of the lining and other tissues inside the nose.

Also read: Hay Fever in the Washington, DC Area

All of us are exposed to dust mites, mold spores, and pollen very frequently and a majority of us do not have any symptoms as these substances are inherently harmless.   However, some of us are “sensitized” to them, usually determined by our genetic make-up.   In sensitive people, the immune system considers them harmful and forms antibodies to fight them off.   These antibodies (Immunoglobulin E or IgE) are specific to particular substances and memorize their triggers.  When we are sensitized and exposed to the indoor or outdoor allergens, they bind to their specific antibodies and cause chemicals like histamine to be released from different cells, resulting in the classical symptoms.

More than 40 million Americans suffer from Allergic Rhinitis and Allergic Conjunctivitis (inflammation of the membrane covering the eyeball and insides of the eyelids) and the severity can range from mild to debilitating.   In more severe cases the symptoms of hay fever like nasal blockage, post nasal drip, cough, and sleep disturbances can have a substantial impact on the quality of life and many lost work and school days. Indoor allergens like dust mites, pets, and some molds cause year round symptoms whereas outdoor allergens like tree, grass, and weed pollen cause misery in certain seasons.  When over the counter remedies are not relieving the symptoms adequately, physicians specially trained in the treatment of these conditions (board certified allergists) can offer substantial help.

The allergist starts by taking a detailed history of symptoms and environmental triggers and follows up with a focused physical examination.  Simple exams like skin tests are extremely helpful in identifying the specific hay fever triggers which may vary from person to person.  This will enable us to institute some environmental controls in order to reduce exposure to the offending substances and to consider desensitization protocols to enhance the “tolerance” of the immune system so that it does not overreact when it encounters the allergens.  Several well designed clinical studies have proved that this process is very effective in relieving the symptoms of hay fever and reduce the need for medications in 80 to 85% of people over the long term.

What is hay fever?  Now that you can identify it, you can confide in the physicians and staff at Black & Kletz Allergy practice who have had decades of experience and expertise in the diagnosis and treatment of this common condition. Allergic Rhinitis (hay fever) in the Washington, DC area and Allergic Conjunctivitis are our specialty and we are committed to offer these services in a professional and caring atmosphere.  Our focus is not only to thoroughly evaluate and treat patients, but also to educate them so that they become empowered to take active control of their allergies.

Asthma Treatment Warrenton, VA

Black & Kletz Allergy offers physician services specializing in asthma treatment Warrenton, VA residents trust. There are 2 board certified physicians specializing in allergy and immunology that provide state-of-the-art allergy, immunology, and asthma treatment Warrenton, VA inhabitants rely on. Our allergy doctors begin with performing a comprehensive history followed by a detailed and focused physical examination. This will be followed by targeted tests to evaluate the possible triggers and/or aggravating factors for the patient’s symptoms. These steps are essential for formulating a suitable plan of asthma treatment Warrenton, VA residents deserve.

Asthma is a chronic inflammatory disease of the airways. The symptoms of asthma may include coughing, wheezing, chest tightness, and/or shortness of breath. The symptoms can be adequately controlled with properly planned asthma treatment Warrenton, VA inhabitants expect. Without good management, the patient can experience life-threatening flare-ups, which for the most part can be prevented by asthma treatment Warrenton, VA deserve.

There are many different types of medications that are utilized to control the bothersome symptoms that are part of asthma treatment Warrenton, VA residents trust. These medications may include oral medications, inhaled medications, and/or injectable medications. Oral medications may include leukotriene antagonists [e.g., Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileutin)] Beta-agonists (e.g., albuterol), and/or theophylline. Inhaled medications can be daily maintenance medications or they can be as needed quick-relief “rescue” medications. There are also injectable (i.e., biological) medications which can effectively control the condition. All of these medication options may be a part of asthma treatment Warrenton, VA inhabitants are entitled to. The treatment regimen is customized for each patient based on their specific needs.
After explaining the various options in detail to the patient, our specialist physician will formulate a specific asthma treatment Warrenton, VA residents trust. After the asthma treatment Warrenton, VA patients expect is initiated, our allergists will reevaluate the patient’s condition on a regular basis. Depending on the response, the asthma treatment Warrenton, VA residents get may need to be modified in order to suit the requirements of the patient. Sometimes potential side effects and/or adverse reactions to medications may create the need to modify the asthma treatment Warrenton, VA inhabitants deserve.

Another method that plays a major role in asthma treatment Warrenton, VA residents expect are allergy shots. Allergy shots are also referred to as allergy injections, allergy immunotherapy, allergy desensitization, or allergy hyposensitization. Allergy shots or allergy immunotherapy is a procedure which can desensitize individuals to the allergens that they have previously been sensitized to. After the successful integration of this modality in the asthma treatment Warrenton, VA residents expect, patients undergoing allergy shots will be able to tolerate exposure to offending allergens and they will no longer trigger acute or chronic allergy or asthma symptoms. Allergy shots are effective in 80-85% of the individuals who take them. Most individuals are on allergy shots for 3-5 years. Allergy shots are effective for the treatment of asthma, hay fever (i.e., allergic rhinitis), and eye allergies (i.e., allergic conjunctivitis).

The board certified allergy doctors at Black & Kletz Allergy have expertise in diagnosing and treating asthma as well as hay fever, eye allergies, eczema (i.e., atopic dermatitis), hives (i.e., urticaria), generalized itching (i.e., pruritus), sinus problems, food allergies, insect sting allergies, eosinophilic esophagitis, medication allergies, and immune deficiencies. We are board certified to treat both pediatric and adult patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. Please call our office directly to schedule an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from asthma or any other allergic condition, we are here to help alleviate or hopefully end these unwelcome symptoms that have been so bothersome, so that you can enjoy a better quality of life. The allergy specialists at Black & Kletz Allergy consistently use their combined experience of over 5 decades to deliver evidence-based allergy, immunology, and asthma treatment Warrenton, VA residents trust and deserve. We are dedicated to providing the highest quality allergy care in a welcoming and professional environment.