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Category Archives: ASTHMA

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

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

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

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

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

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

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

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

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

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

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.

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.