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Category Archives: ASTHMA

Allergy Shots – A Brief Overview

Allergy shots are synonymous with other terms such as allergy immunotherapy, allergy injections, allergy desensitization, and allergy hyposensitization. The allergy shots Gainesville, VA residents rely upon are the same allergy shots that have been given in the U.S. for over 100 years. They have been an important method of preventing and/or diminishing allergy symptoms in tens of millions of individuals over the last century.

Allergy shots can be given to almost any person and are given to any individual over the age of 2. Usually, however, most children do not begin allergy injections earlier than 4 years of age. They can be given to children, teenagers, adults, and the elderly. They can be continued in a pregnant individual as well as in a person who is nursing, as long as it is confirmed by the patient’s obstetrician and/or pediatrician of the nursing baby.

Allergy injections are given to patients with allergic rhinitis (i.e., hay fever)allergic conjunctivitisasthma, and venom hypersensitivity (i.e., allergy to stings of bees, wasps, hornets, yellow jackets, and/or bites from fire ants). The idea behind them is to get to the root of the problem, as opposed to treating the symptoms of allergic rhinitis, allergic conjunctivitis, and asthma. By receiving allergy injections, one’s body develops antibodies that help prevent the allergen (e.g., dust mites, molds, pollens, pets, cockroaches, venom) from causing the unwanted allergy and/or asthma symptoms.

Allergy immunotherapy is useful and may be considered when one is allergic to substances that cannot be avoided. They are also used in individuals that have failed over the counter therapy and/or prescription medications. There are other individuals that do not want to take medications on a daily basis. Others have very severe symptoms and develop secondary problems (e.g., sinus infections, ear infections, bronchitis, asthma) from untreated or sub-par treatment from medications. Many people cannot deal with the side effects of many of the allergy medications. Still others would like to treat the cause of the allergy rather than just treat the symptoms of allergy and/or asthma.

During allergy immunotherapy, very small doses of the allergens that the individual is allergic to are administered subcutaneously (i.e., just under the skin into the fat) of the arm(s) either once a week or twice a week, depending on the patient’s choice. Obviously, if the individual receives the injections more frequently (i.e., twice a week vs. once a week), he or she will get through the build-up process twice as fast. Each dose is increased in strength over the build-up period which at Black & Kletz Allergy is usually 18 doses. Therefore, the maintenance dose (i.e., top dose) is reached in 9 or 18 weeks depending if the individual gets his or her build-up shots twice a week or once a week respectively. Once the maintenance dose is reached, the individual can spread out the frequency of the injections to up to every 4 weeks. Note that many people get their shots more frequently throughout the year depending on their “bad” seasons, such as Spring and Fall which in the Washington, DC, Northern Virginia, and Maryland metropolitan area is very common. Others need their injections more frequently throughout the year since they have perennial symptoms which may require them to get the injections more frequently, depending on their severity of allergy and/or asthma symptoms. The average length of time someone is on the allergy shots Gainesville, VA residents receive from Black & Kletz Allergy ranges between 3-5 years. It is important to note that allergy shots to venoms have a different build-up and maintenance schedule.

The effectiveness of allergy injections is excellent. They have been shown work in 80-85% of individuals taking them. Venom immunotherapy is effective in over 90% of patients receiving them. Allergy injections may also prevent the development of asthma in children with allergic rhinitis. They help to prevent the inflammation that occurs in a typical allergic encounter. Normally when an individual is exposed to a known allergen, many chemicals such as histamine and leukotrienes are released into the bloodstream of the patient. These chemicals are responsible for producing the miserable symptoms of allergies, and in addition, cause inflammation to occur. The allergy shots Gainesville, VA patients receive help the body naturally produce antibodies that will help prevent this process from occurring and thus the individual suffers much less or not at all and has much less or no development of allergic inflammation.

There are essentially no side effects of allergy shots, however there are two risks. The first being the chance of having a local reaction at the site of the injection which may include localized itchiness, redness and/or swelling. The second risk is that of a systemic reaction such as developing generalized itching, hives, swelling, wheezing, abdominal cramps, drop in blood pressure, which potentially can be serious. For that reason, although very rare to occur, it is important to wait 30 minutes in our office after an allergy injection, so that we could treat you with epinephrine and/or Benadryl if necessary. Despite the rarity of a systemic reaction, it can occur and it is necessary to wait the 30 minutes after an injection. A longer wait time is needed for individuals receiving venom immunotherapy.

In summary, allergy shots are a very effective treatment modality for individuals with allergic rhinitis, allergic conjunctivitis, asthma, and/or venom hypersensitivity. As mentioned above, they have been given in the U.S. for over a century and can be given to all ages from young children to the elderly. The board certified allergists at Black & Kletz Allergy have been administering allergy shots for over 50 years. We have one office location in Washington, DC and 2 offices in Northern Virginia with one office in McLean, VA (Tysons Corner, VA) and another in Manassas, VA. We have on-site parking at all 3 office locations and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line. If you suffer from allergies, asthma, sinus problems, hives, swelling episodes, and/or immunological conditions, please call our office to schedule an appointment or you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides ourselves in providing high quality allergy and asthma care in a professional, inviting, and friendly environment.

Hay Fever in the Fall

September may be the month to consult an allergy specialist Centreville VA patients turn to, as ragweed pollen counts peak and wreak havoc in allergic individuals in the Washington, DC, Northern Virginia, and Maryland metropolitan area including the following cities in Northern Virginia: McLean, VA, Tysons Corner, VA, Vienna, VA, Fairfax, VA, Arlington, VA, Great Falls, VA, Falls Church, VA, Annandale, VA, Alexandria, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Gainesville, VA, Haymarket, VA, Warrenton, VA, Springfield, VA, Dumfries, VA, Culpeper, VA, Ashburn, VA, Leesburg, VA, Purcellville, VA. Ragweed also affects the surrounding Maryland cities such as Bethesda, MD, Chevy Chase, MD, Potomac, MD, Great Falls, MD, Gaithersburg, MD, Rockville, MD, Darnestown, MD, Germantown, MD, Olney, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Annapolis, MD, Columbia, MD, and Baltimore, MD. In the DC metropolitan area, ragweed begins to pollinate in mid-September and ends at the first frost which is usually at the end of October.

What is Ragweed?
As an allergy specialist Centreville, VA has to offer might attest, ragweed is a tough and hardy soft-stemmed weed that can grow well along roadsides, riverbanks, vacant lots, and fields. It belongs to a genus called Ambrosia and there are 17 different species of ragweed. The height of the plants generally range from about 3 inches to 12 feet.

The plants mature in mid-Summer and produce small flowers. Warmth, decreased humidity, and active breezes after sunrise help create the ideal environment for ragweed flowers to release their pollen. Each individual plant can release up to one billion pollen grains. Though most of the released pollen stays in the general area, some grains can travel as many as 500 miles in dry and windy conditions. This helps explain why pollen counts are usually lowest on rainy days and cool mornings. Individual plants pollinate only for one season but the seeds survive in the soil from year to year producing fresh crops each year. Over the past decade, the EPA has noticed a prolonged ragweed season in the Washington, DC area. Climate changes and increased carbon dioxide levels in the atmosphere may play a role in this prolongation of the ragweed season.

How Does it Cause Allergies?
Though ragweed pollen is generally harmless, in a genetically susceptible individual, the immune system can mistake it as potentially dangerous invader and mount a defensive attack. This process triggers antigen (ragweed) vs. antibody (immunoglobulin) reactions on exposure, resulting in the release of chemical mediators like histamine which are responsible for the classic annoying hay fever and/or asthma symptoms. An estimated 15% of all Americans are sensitive to ragweed. As an allergy specialist in Centreville VA may explain, the risk of developing sensitivity is higher in people with other types of allergic disorders like eczema (i.e., atopic dermatitis) and asthma and in those with a family history of similar disorders.

What are the Symptoms?

  • Itchy nose, eyes, throat, and ears
  • Watery and/or red eyes
  • Runny nose, nasal congestion, and/or post-nasal drip
  • Sneezing
  • Post nasal drip and/or throat irritation
  • Cough, chest tightness, wheezing, and/or shortness of breath
  • Sinus pressure and/or headaches
  • Fatigue
  • Snoring
  • Clogging and/or popping of the ears

Though “hay fever” is the term commonly in vogue, “seasonal allergic rhinitis” is a more accurate description of the condition.

Oral allergy syndrome (i.e., Pollen-food allergy syndrome) is a condition where one experiences itching of the lips, mouth, and/or throat after eating fresh fruits and/or vegetables. The cause of the phenomenon is a cross-reactivity between similar proteins in the pollen and the fruits and/or vegetables. Ragweed pollen typically cross-reacts with melons, bananas, cucumbers, avocados, kiwi, and zucchini.

How is it Diagnosed?
An allergy specialist Centreville, VA residents turn to for help will take a thorough history and physical examination. A simple allergy skin test can be performed by applying the diluted allergen (ragweed) to the surface of the skin. A raised, itchy, red bump after 15 to 20 minutes at the site of application confirms sensitivity to the allergen. Alternatively, a blood test can also be done.

What Can Be Done to Minimize the Symptoms?

  • Keeping track of pollen counts and avoiding outdoor activities to the possible extent on high pollen days.
  • Keeping the windows closed in homes and automobiles and running air-conditioning.
  • Changing clothes and showering before going to bed.

If the symptoms are bothersome in spite of environmental control, several medications like antihistamines, nasal sprays, eye drops, and inhalers may be needed. Keep in mind that most medications only mask the symptoms without treating the underlying cause and can cause undesirable side effects. Many individuals also become tolerant to an antihistamine and what had helped initially becomes ineffective.

Allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) is a process of increasing tolerance to the allergens by exposing the immune system to gradually increasing the concentrations of the antigen at regular intervals. This process has the potential to offer long-term benefit to many people who experience bothersome symptoms every year. Allergy shots are effective in 80-85% of individuals and have been used in the U.S. for over 100 years.

A Centreville, VA allergy specialist at Black & Kletz Allergy can treat both adults and children with ragweed allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA that all offer on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle between the McLean, VA office and the Springhill metro station on the silver line. Please call us for an appointment or alternatively you can click Request an Appointment and we will respond within 24 hours by the next business day. We can also answer your questions and concerns about other allergic and immunologic disorders, since we have been providing allergy, asthma, and immunology care to the local community for over 50 years. If you’re looking for an allergy specialist Centreville, VA patients recommend, turn to a board certified allergist at Black & Kletz Allergy.

Fall Allergies are Quickly Approaching

As the Summer draws closer to an end in Gainesville, VA, Tysons Corner, VA, Falls Church, VA, and the rest of the Washington, DC metropolitan area, you may be searching for an allergist in Arlington, VA as certain allergens become more prevalent which tend to cause an increase in allergy symptoms in certain allergic individuals. In the Washington, DC, Northern, VA, and Maryland metro area, mid-August marks the time of the year when ragweed begins to pollinate. The ragweed pollen levels will steadily increase and generally peak in late September, and then gradually decrease and usually vanish upon the first frost in late October. In addition, mold spores are important allergens in the Fall in the DC area, which is why many seek an allergist in Arlington, VA during this time of year. Since Washington, DC was built on a swamp, there is always mold in the Washington, DC metro area environment, however, the mold levels increase during the rains in the Spring, during the hot humid Summers, and during the Fall, especially when the leaves on the trees fall to the ground. When the leaves fall onto the ground and become damp, the leaves decay producing an increase in the amount of leaf mold. When people rake these leaves in the Fall, it stirs up the leaves which subsequently increases the mold exposure to an individual which can give rise to an increase in their allergic rhinitis (hay fever)allergic conjunctivitis, or asthma symptoms.

Turn to an allergist in Arlington, VA if you have these symptoms:
The typical symptoms that one may experience may include: sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, puffy eyes, redness of the eyes, sinus pressure, sinus pain, fatigue, snoring, itchy throat, wheezing, coughing, chest tightness, and/or shortness of breath. Many people develop sinus infections during this period as well. If you are experiencing any of these symptoms, it may be time to consult an allergist in Arlington, VA that the community trusts. The diagnosis of Fall allergies can be made by seeing a board certified allergist in Arlington, VA, such as the ones at Black & Kletz Allergy. The allergy doctors will take a thorough history and perform a physical examination. Allergy testing either by blood or skin testing can be done in order to find out if and what the offending allergens may be. Environmental prevention measures are discussed with patients and medications are usually prescribed in the form of tablets, capsules, syrups, powders, nasal sprays, eye drops, and/or lung inhalers. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) is a very effective treatment modality to treat and prevent unwanted annoying allergy and/or asthma symptoms. They are effective in 80-85% of patients on them and they have been around for over 100 years. They are used in all ages from little children through the elderly. The average length of time that patients are on allergy immunotherapy is between 3-5 years, however, some individuals are on allergy shots longer.

Contact an Allergist in Arlington, VA Today
The allergy specialists at Black & Kletz Allergy specialize in both adults and children and have been taking care of the allergy, asthma, sinus, and immunology needs of the DC metro area for over 50 years. Tysons Corner, VA, Gainesville, VA, Falls Church, VA residents as well as people from the rest of the Washington, DC metropolitan area see us at one of our 3 offices with locations in Washington, DC, McLean, VA, (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each office and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean office and the Springhill metro station on the silver line. Please call one of our offices to make an appointment to see one of our highly qualified board certified allergists in Arlington, VA or you can click Request an Appointment and we will respond back to you within 24 hours of the next business day. If you are in need of an allergist in Arlington, VA, turn to Black & Kletz Allergy for a professional and caring environment with high quality innovative allergy, asthma, and immunology care.

Asthma and Aspirin

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

The 3 components of the disease are:

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

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

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

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

What causes it?

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

How is it treated?

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

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

Respiratory Infections and Asthma

As we enter into the “cold and flu” season, children and adults with a history of asthma may experience an increase in the frequency and severity of their asthma symptoms triggered by these infections.

Most of us have to contend with a few upper respiratory infections (e.g., cold, flu, sinusitis) each year. Viruses are the usual culprits and the rhinovirus is the most common virus causing upper respiratoryinfections in all age groups.  Respiratory syncytial virus (RSV) usually affects the upper and lowerrespiratory tracts in infants and young children.

Upper respiratory tract infections are usually mild self-limited illnesses in otherwise healthy children and adults.  The common symptoms of nasal congestion, runny nose, post-nasal drip, sneezing, sore throat, achiness, and an occasional dry cough may last for about a week.  However, in individuals with a history of asthma, these infections can trigger a flare-up of their asthma by causing wheezing, coughing, chest tightness, and/or shortness of breath.  Once the asthma symptoms are triggered, they can linger for several days to weeks, even after recovery from the infection.

Viral infections also can predispose one to secondary bacterial infections which can lead to complications like sinus infections causing discolored nasal discharge, facial (sinus) pressure and pain, persistent mucus drainage into throat, and coughing.  Fever, chills, night sweats, fatigue, coughing up discolored sputum, and/or soreness in the chest while breathing, may be indicative of pneumonia. A few precautions may help prevent or alleviate respiratory infections and reduce the risk of asthma exacerbations:

  1. Viruses causing respiratory infections are highly contagious.  Avoid contact with others with active infections can minimize the risk of contracting the illness.
  2. Wash hands frequently with soap and water.  This will eliminate most germs causing infections. Hand sanitizers are useful while traveling.
  3. Refrain from touching one’s eyes, nose, and mouth which can minimize the germs from entering into the body.
  4. An annual influenza vaccine (i.e., flu shot) is highly recommended in all children (above 6 months of age) and adults with asthma.  FluMist (the flu nasal spray vaccine) is not indicated in asthmatics and only approved for use in persons 2 through 49 years of age.
  5. Many children and adults also benefit immensely from a pneumonia vaccine to prevent bacterial infections from pneumococcus, a type of bacteria that causes respiratory tract infections.  The two most common vaccines available are Prevnar 13 and Pneumovax.  It is important to check with your primary care physician to check for documentation of what type of pneumonia shot you may have had and when it was administered.  Depending on this information, your physician will recommend which type of pneumonia vaccine may be needed and when it should be given.  The age of the patient, underlying diseases, and history of previous vaccinations all will play a role in determining what, when, and if the vaccine is needed.
  6. Rest, drinking plenty of fluids, and the use of certain over the counter medications may alleviate some of the symptoms.
  7. Prescription antiviral medications [i.e., Tamiflu (oseltamivir), Relenza (zanamivir), Rapivab (peramivir)] can reduce the duration of the flu and they may also decrease the risk of an increase in asthma symptoms.
  8. Monitoring peak flows is helpful in predicting asthma exacerbations.
  9. If the infection ends up triggering asthma symptoms, one should begin using a rescue inhaler or nebulized medications at regular intervals for symptom relief.
  10. Either initiating the preventative controller medications or increasing their doses at the onset of cold or flu symptoms, (as directed by the physician), may be useful in preventing or reducing the severity of asthma flare-ups triggered by viral infections.

The board certified allergists of Black & Kletz Allergy have been treating adult and pediatric patients with asthma for over 5 decades.  We are very familiar with upper respiratory tract infections as well as other triggers that cause asthma exacerbations.  In addition, we also treat all kinds of upper respiratory infections.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have convenient offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our offices in Washington, DC and McLean, VA are Metro accessible with free shuttle service between the Spring Hill metro station and our McLean office.  All 3 locations offer on-site parking.  To make an appointment, please call us, or alternatively you can click Request an Appointment and we will respond within 24 hours on the next business day.  The allergy doctors at Black & Kletz Allergy strive to manage your asthma to your utmost satisfaction in a professional caring environment.

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

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

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

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

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

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

Asthma in the Winter

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

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

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

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

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

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

Mold Allergies

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

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

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

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

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

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

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

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

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

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

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