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Cold Weather Allergies

Cold Weather Allergies Now that it is turning cold in the Washington, DC, Northern Virginia, and Maryland metropolitan area, some allergic individuals are happy because they have a respite from their pollen (e.g., trees, grasses, weeds) allergies which tend to bother them in the Spring, Summer, and/or Fall. Others however, are not as happy, as they either continue to have their allergy symptoms or develop their allergy symptoms only in the colder weather. These individuals are allergic to other allergens such as dust mites, molds, pets, or cockroaches, to name a few.

Dust mites, molds, pets, and cockroaches are allergens that are generally considered “indoor” allergens; however, molds are found both indoors and outdoors. Molds are particularly a problem in the Washington, DC metro area as Washington, DC was built on a swamp and the mold counts tend to be high in the area throughout the year. The 2 most common conditions caused by these allergens are allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies). The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus headaches, and/or snoring. The typical symptoms of allergic conjunctivitis may include itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Another common malady that can arise from these allergens is asthma. Asthmatics typically complain of wheezing, chest tightness, coughing, and/or shortness of breath. Reducing one’s exposure to dust mites, molds, pets, and/or cockroaches is generally the first step in managing allergic rhinitis, allergic conjunctivitis, or asthma in most individuals. It should be noted that exposure to cockroaches is a fairly common cause of asthma exacerbations in inner city asthmatic children. Medications are also frequently utilized in order to better control the unwanted allergy or asthma symptoms. Allergy immunotherapy (allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a staple in the treatment of all 3 conditions. Allergy immunotherapy has been around for more than 100 years and it is effective in 80-85% of individuals who take allergy shots.

There is a subset of individuals who are bothered just by the cold air and not the allergens associated with the Winter. These patients have vasomotor rhinitis and may experience hay fever-like symptoms (i.e., runny nose, nasal, congestion, post-nasal drip) with just the exposure to cold air. Vasomotor rhinitis is a nonallergic condition that is caused by irritants such as cold air, strong scents, chemicals, pollutants, etc. In addition to these hay fever-like symptoms, the cold air may contribute to nose bleeds (i.e., epistaxis), watery eyes, and redness of the eyes.

The cold air does not only affect the eyes, nose and lungs when it comes to allergic and nonallergic conditions that are diagnosed and treated by board certified allergists like the ones at Black & Kletz Allergy. The skin is affected by the cold quite often and can be extremely annoying and even serious for some individuals. There are 4 cold-related conditions that fall under a similar category that affect the skin. These diseases are similar, but differ mainly by their severity. These 4 disorders include cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis. In cold-induced pruritus, the cold air will cause an individual to have itchy skin. A person with cold-induced urticaria will develop hives with cold exposure. People with cold-induced angioedema will develop swelling episodes when exposed to the cold. Lastly and most seriously, some individuals may develop life-threatening anaphylaxis when they are exposed to the cold. It is important that a patient be prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) for patients with cold-induced angioedema and/or cold-induced anaphylaxis. It is also important to note that any individual who needs to use a self-injectable epinephrine device should go immediately to the closest emergency room after using the device.

In addition to the 4 cold-related conditions mentioned above that affect the skin, some individuals may experience a change in the color of their skin with associated coldness, numbness, and stinging sensation. The color change is typically a whitish or bluish color. These individuals may have either Raynaud’s disease (i.e., primary Raynaud’s) or Raynaud’s phenomenon (i.e., secondary Raynaud’s) depending on whether there is an underlying medical problem. Raynaud’s disease is not associated with an underlying medical disorder and is more common than Raynaud’s phenomenon, which is associated with an underlying medical condition. The medical conditions most commonly associated with Raynaud’s phenomenon include connective tissue diseases (e.g., systemic lupus erythematosus, Sjögren’s syndrome, scleroderma, rheumatoid arthritis), smoking, injuries to the hands and/or feet, carpal tunnel syndrome, atherosclerosis, and certain medications (e.g., beta blockers, ADHD medications, migraine headache medications).

The board certified allergy doctors at Black & Kletz Allergy will promptly respond to any questions regarding cold-induced disorders and any other allergic or immunologic disorders. We have been treating cold-indued disorders for over 50 years and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We treat both adult and pediatric patients. All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you are concerned that you may have a cold-induced condition or any other allergy, asthma, sinus, skin, or immunology problem, please call us to schedule an appointment. You may also click Request an Appointment and we will reply within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and welcoming setting.

Egg Allergy

Egg allergy is second only to milk allergy in prevalence among infants and young children. It affects about 1 to 2 % of young children overall. It is also the most common food allergy in children with eczema.

Proteins found in egg whites are generally responsible for causing allergic reactions in egg-allergic individuals. Although the ovalbumin is the most abundant protein in egg white, it is the protein ovomucoid that is generally responsible for egg allergy in most children. Ovalbumin is heat labile. The heating process denatures the protein ovalbumin and as a result of heating, the new heated protein is structurally different. Since the heated proteins are structurally different, the majority of egg-allergic children will not react to baked egg products that have been heated during the baking process. This suggests that children who have specific IgE antibodies primarily to ovalbumin are likely to tolerate heated forms of egg. On the other hand, the protein ovomucoid, which is also found in egg white, is not altered by extensive heating and thus is responsible for most of the egg allergies in children.

Clinical Manifestations:

Immediate hypersensitivity (Type I or IgE antibody mediated) reactions are the most common type of allergic reaction that occurs in egg-allergic individuals. Symptoms usually begin within minutes of egg exposure. Skin manifestations such as itching, rashes, hives, and/or soft tissue swellings are the most common symptoms. Respiratory symptoms such as chest tightness, coughing, wheezing and/or shortness of breath can rapidly progress in severity. Allergic reactions to eggs can also result in gastrointestinal symptoms such as abdominal pain, abdominal bloating, nausea, vomiting, and/or diarrhea.
Egg allergy most commonly manifests itself in the second half of infancy.
Egg allergy can be potentially life-threatening (e.g., vocal cord swelling can rapidly lead to difficulty in breathing and loss of consciousness)
Food-dependent, exercise-induced anaphylaxis with egg as the trigger has been reported. In other words, an individual can eat an egg and then exercise within a certain period of time (i.e., usually within 2 hours) and then develop anaphylaxis as a result of the combination of egg plus exercise. It is interesting to note that this individual may be fine just eating an egg or just exercising, but when done sequentially, anaphylaxis may occur.
Bird-egg syndrome is a condition where the primary sensitization is to airborne bird allergens and there is secondary sensitization or cross reactivity with the protein albumin in egg yolk. These patients experience respiratory symptoms (i.e., runny nose, nasal congestion, post-nasal drip, sneezing, itchy eyes, watery eyes, puffy eyes, redness of the eyes, chest tightness, coughing, wheezing, shortness of breath) with bird exposure and allergic symptoms with egg ingestion.
Egg allergy can present as infantile atopic dermatitis (i.e., eczema). Children with eczema and asthma are at increased risk for more severe reactions.
Egg allergy is one of the common triggers of symptoms in certain gastrointestinal disorders such as eosinophilic esophagitis (EoE) and food protein induced enterocolitis (FPIES).

Diagnosis:

A comprehensive history of one’s exposure to egg products (both cutaneous and oral), time of onset of specific symptoms after exposure, rapidity of progression, duration of the reaction, and resolution of symptoms are all necessary to help make the diagnosis of an egg allergy.
Skin prick tests (SPT) with egg white and egg yolk antigens
Laboratory tests for blood levels of specific IgE antibodies to egg
Oral food challenge (OFC), a gold-standard for the confirmation of the diagnosis of food allergy.

Treatment:

The most straightforward approach in managing any food allergy is the complete avoidance of the culprit food. Eliminating egg white and egg yolk from the diet can be difficult and can pose nutritional as well as quality-of-life concerns.
The evaluation of the allergy followed by an oral food challenge to extensively heated egg is an option since a majority of those with egg allergy will tolerate egg in extensively heated (baked) products, such as a muffin.
Oral immunotherapy (OIT) is a promising treatment method, though not yet FDA-approved.
Epinephrine auto-injectors are prescribed for use in the case of a reaction following inadvertent exposure to egg products. Some of the more common names of epinephrine auto-injectors may include EpiPen, Auvi-Q, and Adrenaclick. It should be noted that if an individual uses their auto-injector, that person should go immediately to the closest emergency room.
Children with egg allergy should be monitored for the resolution of the allergy since most will outgrow the allergy in childhood. Monitoring for resolution includes assessing the history of any accidental exposures and reactions and serial testing for sensitization using laboratory tests, skin prick testing, and/or oral food challenges.

Immunizations:

Children with egg allergy should not receive yellow fever vaccinations due to an increased risk of allergic reactions since the vaccine is produced using chicken embryos.
Egg-allergic children can safely receive the influenza and MMR (mumps, measles, rubella) vaccinations despite the use of egg-based technology since the amount of egg protein is incredibly small. It is recommended however that the vaccination be given in a doctor’s office and observed for 30 minutes after the injection. There are also a couple of influenza vaccines that do not contain any egg protein that are available.

Prevention:

The early introduction of egg can provide protection against egg allergy for at least some children who are at high risk for developing an egg allergy. Children at risk may need to undergo a comprehensive evaluation to see if the early introduction of eggs in the diet is appropriate.

The board certified allergy doctors at Black & Kletz Allergy have been diagnosing egg allergy and other food allergies in both adults and children in patients in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has 3 offices in the Washington, DC metro area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you think or know you have a food allergy, please call us to make an appointment at one of our conveniently located offices. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy are confident that we will be able to help you identify your food allergies and any other allergy you may have. The allergists at Black & Kletz Allergy are dedicated to providing you with the best quality allergy, asthma, and immunology care in a professional and caring environment.

Latex Allergy Update

Natural rubber latex is the milky white sap that comes from the Brazilian rubber tree. The Brazilian rubber tree is scientifically referred to as Hevea brasiliensis. The tree is mainly found in Southeast Asia and Africa. The sap is collected from rubber trees much in the same manner that maple syrup is extracted from maple trees. In order to give latex its elastic characteristic, several chemicals are added to the milky sap during the manufacturing process. The latex is then further refined into rubber for commercial use. This natural rubber should not be confused with synthetic rubber which is made from chemicals. Synthetic rubber products are not made with natural rubber latex and do not cause allergic reactions in individuals who are allergic to natural rubber latex.

Latex allergy is a condition in which a sensitive individual develops an immunological reaction against the allergenic proteins found in natural rubber latex. This allergic reaction usually begins within 30 minutes, but can develop later, and can range in severity from mild to life-threatening. Approximately 1-2% of the U.S. population has a latex allergy. Latex allergies are much more common in certain groups of individuals such as children with spina bifida, rubber industry workers, patients who have had multiple surgeries, patients who have had recurrent catheterizations of their bladder, and health care workers.

Approximately 70% of children with spina bifida have latex allergies because they have not one but 2 risk factors for latex allergies: multiple surgical procedures and the use rubber urinary catheters. Both of these factors make these children more susceptible to latex allergy mainly because they come in contact with natural rubber latex more than most individuals. Since they are exposed to latex more than the average person, they are more likely to develop an allergy to latex.

The allergic reaction that occurs in an individual due to a latex allergy can be different in each person. The allergic reaction can be either an immediate-type (i.e., Type I) hypersensitivity reaction or a delayed-type (i.e., Type IV) hypersensitivity reaction. In addition to a true allergic reaction, a non-allergic irritant contact dermatitis may also occur. In an immediate-type or Type I allergic reaction, the allergic individual usually has allergy symptoms within 30 minutes after exposure to the allergen (i.e., mold, dust mite, pollen, food, bee venom). The allergic reactions to latex usually occur after a number of exposures to latex, however, the severity of the reactions can worsen with repeated exposures. The symptoms of an immediate-type (Type I) allergic reaction due to a latex allergy may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, wheezing, shortness of breath, chest tightness, coughing, generalized itching, hives (i.e., urticaria), abdominal cramping, throat tightening (i.e., angioedema), nausea, dizziness, rapid heart rate, feeling faint, and/or drop in blood pressure. In severe cases, anaphylaxis can occur which can be life-threatening. A self-injectable epinephrine device may be prescribed to an individual with a history of a systemic reaction to latex. If such a device is used, they are to go immediately to the closest emergency room.

Physical contact with latex can also cause soreness and blistering of the skin which usually begins 2 to 3 days of exposure. This type of reaction is a delayed-type (Type IV) reaction and is called allergic contact dermatitis. It is similar to the reaction that is caused by poison ivy, poison oak, and poison sumac. As mentioned above, a non-allergic irritant contact dermatitis may also occur. Patients with this type of reaction may develop itchy, red, dry, flaky, peeling, and/or cracked skin after topical exposure to latex. Blisters may also develop in certain individuals.

The diagnosis of latex allergy is made by a comprehensive history and physical examination. Blood tests can be done to confirm a diagnosis. Allergy skin testing can also be performed in individuals where the blood test is negative but there is a high index of suspicion for latex allergy.

The treatment of latex allergy is to avoid exposure to natural rubber latex. Individuals should avoid all products containing latex, some of which may include: latex gloves, condoms, dental dams, balloons, rubber bands, select toys, tires, erasers, elastic clothing waistbands, nipples used on baby bottles, pacifiers, baby bottles, soles of shoes, athletic shoes, certain fruits and vegetables (see below). Many medical and dental devices (e.g., gloves, stethoscopes, dental dams, catheters, and airway and IV tubing. It should be noted that synthetic rubber products such as house paint are not made with natural latex. Patients who are allergic to latex should wear a medical alert bracelet and carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) and know when to use it. As mentioned above, if the self-injectable epinephrine device is used, the individual should go immediately to the closest emergency room.

It should also be noted that certain fruits and vegetables cross-react with latex as they share similar proteins and should be avoided in individuals who have a latex allergy. Approximately 30-50% of people with latex allergy have reactions to these fruits and vegetables. Some of the more common cross-reacting fruits and vegetables may include apples, avocados, bananas, chestnuts, carrots, celery, kiwi, melons, papayas, potatoes, and tomatoes.

The board certified allergists at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating latex allergies. We treat both pediatric and adult patients. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a warm and pleasant environment.

Influenza Vaccination and Treatment Recommendations for 2022-2023

Influenza Immunization:

A routine annual influenza (i.e., flu) vaccination is recommended for all individuals equal to and greater than months of age. The recommendations below should always be discussed and approved by an individual’s primary care provider before vaccination occurs.

Children:

Children from 6 months through 8 years of age who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 1 dose of the 2022-2023 influenza vaccine.
Children from 6 months through 8 years of age who have not previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 2 doses of the 2022-23 influenza vaccine. These 2 doses should be given at least 4 weeks apart.
Children who are 9 years old or older only need 1 dose.

Adults 65 Years of Age or Older:

Adults 65 years or older should receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).

Pregnancy:

Influenza vaccines, except the quadrivalent live attenuated (LAIV4), can be received in any trimester of pregnancy, if approved by one’s Ob/Gyn doctor.
The quadrivalent live attenuated vaccine (LAIV4) should not be used during pregnancy since it contains a live virus, but it can be used postpartum, if approved by one’s Ob/Gyn doctor.

Chronic Medical Conditions:

The quadrivalent live attenuated vaccine (LAIV4) should not be received in individuals with the following:

History of severe allergic reaction (i.e., anaphylaxis) to any component of the vaccine
Concomitant aspirin or salicylate-containing therapy in children and adolescents
Children between the ages of 2 – 4 years of age who have received a diagnosis of asthma or if a wheezing episode has occurred during the preceding 12 months
Children and adults who are immunocompromised due to any cause
Close contacts and caregivers of severely immunosuppressed individuals who require a protected environment

Egg Allergy:

Individuals who have experienced only hives after exposure to egg may receive any licensed recommended influenza vaccine appropriate for their age.
Individuals reporting symptoms other than hives after exposure to egg [i.e., angioedema (i.e., swelling), respiratory distress, lightheadedness, recurrent vomiting], or who required epinephrine or another emergency medical intervention, may also receive any influenza vaccine that is otherwise appropriate. If a vaccine other than a quadrivalent cell-based influenza vaccine (ccIIV4) such as Flucelvax® or a quadrivalent recombinant influenza vaccine (RIV4) such as Flublok® is selected, it should be administered in an inpatient or outpatient medical setting, supervised by a health care provider who can recognize and manage severe allergic reactions.

Previous Serious Allergic Reaction:

Influenza vaccines are contraindicated for those with a history of a severe allergic reaction to any component of that vaccine.

Travelers:

Travelers who wish to reduce the risk for influenza should consider vaccination, preferably at least 2 weeks before departure.

Vaccination and Influenza Antiviral Medications:

Individuals receiving influenza antiviral medications can take influenza vaccines other than a quadrivalent live attenuated influenza vaccine (LAIV4).

With Other Vaccines:

The quadrivalent inactivated influenza vaccine (IIV4) and the quadrivalent recombinant influenza vaccines (RIV4) may be administered concurrently or sequentially with other live or inactivated vaccines.
Injectable vaccines given simultaneously should be administered at separate anatomic sites.
The quadrivalent live attenuated vaccine (LAIV4) may be administered simultaneously with other inactivated or live vaccines. If not given simultaneously, then at least 4 weeks should pass between the administration of the quadrivalent live attenuated vaccine (LAIV4) and another live vaccine.

Administration of IIV4 and RIV4:

The quadrivalent inactivated influenza vaccines (IIV4) and quadrivalent recombinant influenza vaccines (RIV4) are administered intramuscularly (IM). For adults and older children, the deltoid muscle in the arm is the preferred site. For infants and younger children, the anterolateral thigh is the preferred site.
The quadrivalent recombinant influenza vaccine (RIV4) is licensed for individuals 18 years of age and older and should not be used for children and/or adolescents less than 18 years of age.

Administration of LAIV4:

The quadrivalent live attenuated influenza vaccine (LAIV4) is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 ml. of vaccine.
If the vaccine recipient sneezes immediately after administration, the dose should not be repeated.
If nasal congestion is present which may interfere with the delivery of the vaccine to the nasopharyngeal mucosa, a deferral should be considered, or another age-appropriate vaccine should be administered.

Treatment of Influenza:

The antiviral medications that are used to treat the flu (i.e., influenza) are more efficacious when they are begun within 2 days of the beginning of symptoms.
There are 4 FDA-approved antiviral drugs used in the treatment of influenza:

oseltamivir phosphate (Trade name: Tamiflu®)
zanamivir (Trade name: Relenza®)
peramivir (Trade name: Rapivab®)
baloxavir marboxil (Trade name: Xofluza®)

Oseltamivir (Tamiflu®) is available as a pill or liquid suspension and is FDA-approved for the early treatment of influenza in individuals 14 days of age and older. Zanamivir (Relenza®) is a powder that is inhaled and approved for the early treatment of influenza in individuals 7 years of age and older. Note that zanamivir is administered using an inhaler device and is not recommended for individuals with respiratory problems such as asthma or chronic obstructive pulmonary disease (COPD). Oseltamivir and zanamivir are given twice a day for 5 days. Peramivir (Rapivab®) is given once intravenously by a health care provider and is approved for the early treatment of influenza in individuals 6 months of age and older. Baloxavir (Xofluza®) is a pill given as a single dose by mouth and is approved for the early treatment of influenza in children 5 – 12 years of age who do not have any chronic medical conditions, and for all individuals 12 years of age and older.

The board certified allergists at Black & Kletz Allergy have been advising patients on the treatment and prevention of the flu (i.e., influenza) for many years in both children and adults. Black &Kletz Allergy has 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The allergy specialists of Black & Kletz Allergy are eager to help you with your allergy, asthma, immunological, and vaccination needs. We are dedicated to providing first-rate care to you as we have been doing in the Washington, DC metropolitan area for more than 50 years.

Halloween and Food Allergies

To the average parent, there is generally no association between Halloween and allergies. For some parents however, Halloween can be a “scary” time, but not because of ghosts and goblins. These “frightened” parents are parents that have a child who has food allergies. To the parent of a food-allergic child, the association between Halloween and food allergies is not only real, but can be downright scary and concerning.

Some food allergy statistics are in order at this point in order to shed light on the seriousness of food allergies. Approximately 8% of children in the U.S have food allergies. Food allergies are increasing and have increased by more than 50% in the last few decades. About one-third of children have food allergies to more than one food. Approximately 4 in 10 food-allergic children have had a severe reaction to a food. Peanut, followed by milk are the number one and two causes of food allergies in children. Tree nuts, shellfish, fish, eggs, wheat, and soy make up the next most common food allergies in children. If you are an observant parent, you can see that 6 of the top 8 food allergies are commonly found in many Halloween candies, assuming fish tacos and crab cakes are not common on your neighborhood block. To make matters worse, it is fairly common for miniaturized Halloween candies not to contain the nutritional information and allergen labeling, which is often found on the larger full-sized versions. This makes it even more difficult for a parent to screen for food allergens that may be in each treat. It should be noted that in order to be extra safe, a parent or child should live by the motto: “when in doubt, throw it out.”

Parents of a food-allergic child who are concerned about their child trick-or-treating on Halloween can go to the website of the Food Allergy Research and Education (FARE) organization and look at their program called the “Teal Pumpkin Project.” The Teal Pumpkin Project has been around since 2014 and its main objective is to increase awareness of the severity of food allergies as well as provide support to families who have food-allergic children. In the world of food allergies, the color teal signifies food allergy awareness. People with and without food-allergic children are encouraged to paint their pumpkins teal and display them by their front doors as a sign that their house is aware of food allergies and that they have alternative non-food containing “treats” for food-allergic children. Some non-food treats may include non-food treats may include stickers, toys, money, crayons, necklaces, bracelets, rings, glow sticks, hair accessories, finger puppets, bookmarks, vampire fangs, spider rings, balls, whistles, balls, etc. The houses with the teal pumpkins may also distribute traditional candies, but they will have separate bowls for food items vs. non-food items. FARE’s website provides a detailed “Teal Pumpkin Project Participation Map” so that participating houses can be easily assessed by the parents of food-allergic children.

In addition to the above Teal Pumpkin Project, other precautions should be adhered to with food-allergic individuals. Food-allergic children should be taught to graciously refuse homemade foods such as cupcakes and cookies that may not be safe for them. Young children should not trick-or-treat without parental supervision. Candies and treats without proper nutritional and allergen labeling should not be eaten in order to prevent a life-threatening allergic reaction. It is advised that one should trick-or-treat with an epinephrine self-injectable device such as an EpiPen, Auvi-Q, or Adenaclick. If an epinephrine self-injectable device is ever used, one should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy support the efforts of the Teal Pumpkin Project and hope that our patients join in their efforts in order to try to make Halloween a safer holiday. Black & Kletz Allergy has always had a link to FARE. You will find it in the upper portion of our website under the blue “Resources” tab. Please click “LINKS” and then click “Food Allergy Research and Education.” The allergy specialists at Black & Kletz Allergy see both pediatric and adult patients and have over 5 decades of experience in the field of allergy, asthma, and immunology. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

Alpha-Gal Syndrome (Mammalian Meat Allergy)

Meat allergy is an increasing problem over the last decade. It is generally not that people have developed a typical food allergy to meat in the classic sense, but this increase has rather occurred because of an entity called alpha-gal syndrome. It is often referred to as mammalian meat allergy, red meat allergy, and tick bite meat allergy. More specifically, alpha-gal syndrome is a food allergy to red meat (i.e., mammalian meat) and any other products made from mammals such as gelatin or milk products. The condition was discovered by researchers at the University of Virginia a little more than a decade ago.

The mechanism of why and how the syndrome occurs is quite interesting. Alpha-gal, technically referred to as galactose-alpha-1,3-galactose, is a carbohydrate (i.e., sugar molecule) that is present in most mammals (e.g., cows, pigs, sheep, deer, rabbits, whales). It is not found in humans or non-mammals such as fish, birds, and reptiles. Alpha-gal syndrome is caused by a Lone Star tick bite. After an individual is bitten by a Lone Star tick, the carbohydrate alpha-gal which is present in the tick’s saliva, is transmitted into the person’s blood stream. As a result, the individual will produce IgE antibodies as a defense mechanism against this foreign sugar molecule (i.e., carbohydrate). Because the person now has alpha-gal IgE antibodies present in their blood stream, whenever that individual consumes future mammalian meat which contains alpha-gal, their alpha-gal IgE antibodies will react against the alpha-gal present in the mammalian meat (e.g., beef, pork, lamb, venison, rabbit, whale) causing allergic symptoms.

The symptoms of alpha-gal syndrome or mammalian meat allergy are typically delayed approximately 2-8 hours after the person eats the meat before manifesting. This is in contrast to a “normal” allergic reaction to a food which usually causes symptoms within 30 minutes after ingestion. The symptoms of alpha-gal syndrome can vary in severity from mild to severe and may consist of hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), runny nose, nasal congestion, wheezing, coughing, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, dizziness, drop in blood pressure, and/or anaphylaxis. Obviously, anaphylaxis is life-threatening and individuals who have a history of anaphylaxis should use an injectable epinephrine device such as an EpiPen, Auvi-Q, or Adrenaclick if anaphylactic symptoms occur. They should also go immediately to the closest emergency room if they use their injectable epinephrine device.

The diagnosis of alpha-gal syndrome is made by performing a comprehensive history and physical examination. A history of a recent tick bite makes the diagnosis more likely, but it is not crucial as not all patients may remember if they had a recent tick bite. Since there is a delay between the ingestion of meat and the onset of symptoms with alpha-gal syndrome, the condition is underdiagnosed. Physicians may not see the connection between the ingestion of the meat and the beginning of allergic symptoms because of this time delay which is not characteristic of a normal allergy. As a result, the syndrome is underdiagnosed. Note: It is therefore important to seek out a board certified allergist like the ones at Black & Kletz Allergy in order to make the correct diagnosis. It is also important to note that since the allergic symptoms of alpha-gal syndrome are very common allergy symptoms, an allergist is often needed to differentiate these symptoms from other allergic conditions that are not tick-induced. Blood tests and/or food prick testing is usually necessary to confirm the diagnosis.

The prevention of alpha-gal syndrome is the prevention of tick bites. One should avoid places where ticks live such as in grassy or wooded areas. Wear long-sleeved shirts and pants. Wear hats and gloves. Use insect repellants, especially containing DEET. Check yourself and your pets for ticks after being outdoors in the grass or woods. Taking a shower after you return from outside may remove unattached ticks. If bitten, remove the tick as soon as possible either by yourself or by a physician in an emergency room. Do not squeeze or squash the tick. Let your physician know if you have been bitten by a tick as there are other diseases that can be caused by tick bites. Some of these diseases may include Lyme disease, Rocky Mountain spotted fever, Tularemia, Babesiosis, Ehrlichiosis, Rickettsiosis, Tick-borne encephalitis, Relapsing fever, Q Fever, Anaplasmosis, and Powassan.

The treatment of alpha-gal syndrome is also simply prevention. It is important to avoid the ingestion of mammalian meat and any other products made from mammals such as gelatin or milk products. Furthermore, one should avoid getting bitten again by ticks as it is thought that subsequent Lone Star tick bites may cause more severe disease if exposure to mammalian meat occurs.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating alpha-gal syndrome and food allergies in both adults and children for more many years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have 3 office locations, all of which offer on-site parking. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. For an appointment, please call us at one of our locations or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy have the expertise in alpha-gal syndrome and food allergies. Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless commitment and great pride as we have done for over 50 years.

Climate Change and Allergic Disease

Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate is steadily changing over the past several decades and is likely to continue into near future. This climate change also has the potential to alter the incidence and severity of allergic and respiratory diseases in humans. Although each individual is different, a general trend towards more allergens and more severe allergic disease seems likely if climate change continues in the direction it is going. While it is already known that the prevalence of both allergic rhinitis (i.e., hay fever) and asthma have increased in the last few decades, it seems likely that these numbers will continue to increase in the near future, at least partially as a result of climate change.

Below are a few ways that climate change may impact allergies:

The warming of the climate and higher carbon dioxide levels will likely lead to longer pollen seasons.
More hot summer days will generate more ozone which will probably trigger more flare-ups of breathing difficulties for people with chronic respiratory conditions such as asthma.
Rising sea levels and changes in rainfall patterns are likely to increase the incidence and severity of mold allergies.
The warming conditions caused by global warming may lead to the increased prevalence of biting and stinging insects in new areas.
The effect of fewer cold winter days on respiratory infections from viruses and bacteria is still unpredictable.

We know that having more energy efficient and tighter homes leads to an increase in indoor air pollution. The accumulation of volatile organic compounds (VOC’s), radon gas, smoke particulates, and allergenic proteins will increase the risk of respiratory illnesses. In addition, higher water vapor and moisture levels will increase dust mite and mold growth, leading to an increase in the number of allergy sufferers as well as the severity of allergy symptoms.

“Green” practices such as composting facilities may cause an increase in respiratory diseases through the increased fungal load put into the air by these facilities. Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde. Inhaling particles coated with these chemicals contribute to bronchitis, asthma, and emphysema.

With an increase in temperatures and other features of climate change, ragweed will flower earlier in the season and produce more pollen in urban locations where carbon dioxide concentrations and temperatures are higher. The same effect can be seen on other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures should be noted as a means to help prevent allergy symptoms. Keeping the indoor humidity lower in order to limit dust mite and mold growth is a good thing to do particularly if one is allergic to dust and/or molds. It is also important to use a HEPA filter in one’s house and to change them regularly. Minimizing outdoor activities on high pollen days can also diminish allergic symptoms and reduce the need for allergy medications. One can also take a shower after spending time outdoors so that the pollen is washed off one’s body. Another environmental control measure that helps allergy sufferers is to wash off one’s pet after they spend time outdoors since pet hair attracts pollen.

The allergy doctors at Black & Kletz Allergy are board certified and treat both adult and pediatric patients. We have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are eager to help you with any of your allergy or immunology needs. We diagnose and treat a multitude of allergy and immunological conditions including allergic rhinitis (i.e., hay fever), asthma, sinus problems, hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), food allergies, medication allergies, eczema (i.e., atopic dermatitis), insect sting allergies, poison ivy, poison oak, poison sumac, contact dermatitis, eosinophilic esophagitis, mast cell diseases, and immune disorders. The allergists at Black & Kletz Allergy are knowledgeable about how climate change may affect allergy symptoms and are here to help guide you through these changes. We are dedicated to providing excellent care to you as we have been doing in the Washington, DC metropolitan area for more than 5 decades.

Allergy to Chlorine?

August 9, 2022
Black & Kletz Allergy

The swimming season is in full swing and most public and private swimming pools are attracting swimmers of all ages and of all skill levels. For most individuals, swimming is one of the most pleasurable recreational avenues offered in the summer. For others, swimming offers an effective workout option without putting undue pressure on one’s joints.

Despite the popularity of swimming, a small percentage of individuals may experience adverse reactions while in a pool or after coming out of the pool. Some individuals experience itchy skin and rashes while others notice an increase in upper and lower respiratory symptoms. The question is: Is the chlorine in the water the culprit?

Chlorine is a chemical added to water in swimming pools in order to kill the bacteria that can grow in such water. Chlorine also oxidizes suntan oils, other body oils, cosmetics, leaf mold, bugs, urine, sweat, and other human bodily waste. Chlorine is not an allergen because it does not stimulate the immune system to produce proteins which then cause allergic symptoms. Chlorine is instead considered an irritant. As an irritant, chlorine may cause undesirable side effects on the skin and respiratory system. It is similar to other irritants such as perfumes, colognes, strong scents, pollution, and organic dusts. These irritants may also cause skin and respiratory symptoms that may be confused for allergy symptoms, but when it comes down to it, the symptoms are due to the irritating effect of the chemicals, dusts, or particulates, and not an allergic reaction to them.

In sensitive individuals, chlorine can result in a type of irritant contact dermatitis (ICD), especially if the concentration of chlorine in the pool is high.

Symptoms of irritant contact dermatitis may include:

Excessive dryness of the skin
Redness of the skin
Itching of the skin
Flakiness, fissuring, and/or scaling of the skin
Hives (i.e., urticaria) – Raised blotches or “welts” with clear margins

Treatments of irritant contact dermatitis include:

Washing with fresh water as soon as coming out of the pool
Liberal application of emollients (i.e., moisturizing lotions)
Mild topical corticosteroid creams or ointments
Antihistamines to relieve itching of the skin

Patients with a history of respiratory disorders [i.e., asthma, chronic obstructive pulmonary disease (COPD)] may experience more of a flare-up of both the upper and lower respiratory symptoms listed below when exposed to chlorine in a pool.

Upper Respiratory Symptoms:

Sneezing
Itchy nose
Runny nose
Nasal congestion
Post-nasal drip
Itchy throat
Itchy eyes
Watery eyes
Redness of the eyes
Sinus congestion
Sinus headaches
Coughing

Lower Respiratory Symptoms:

Chest tightness
Coughing
Shortness of breath
Wheezing

Even though the above upper and lower respiratory symptoms may be seen in anyone exposed to chlorine, these symptoms are more common and more prominent in patients with inadequately controlled allergic rhinitis (i.e., hay fever) and/or asthma.

Treatment of Upper Respiratory Symptoms: The treatment of the upper respiratory symptoms caused by chlorine exposure may include oral antihistamines, oral decongestants, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular decongestants, and/or ocular mast cell stabilizers.

Treatment of Lower Respiratory Symptoms: The treatment of the lower respiratory symptoms caused by chlorine exposure may include an inhaled bronchodilator and/or an inhaled corticosteroid. The inhaled corticosteroid is used to prevent and control airway inflammation.

Prevention of Chlorine-Induced Symptoms: Choosing a swimming pool with less of a concentration of chlorine may help prevent or mitigate the severity of symptoms that occur in individuals who are sensitive to the effects of chlorine.

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating chlorine sensitivity as well as all types of irritant reactions. In addition, we also treat all types of allergic, asthmatic, and immunologic conditions. The allergists at Black & Kletz Allergy treat both pediatric and adult allergy and immunology patients and have been practicing 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. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from irritant reactions to chlorine or any other irritant, or have allergies or asthma, we are here to help alleviate or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy, asthma, and immunology care in a compassionate, relaxed, and professional environment.