Category Archives: BLOG

It’s an Early Spring – What Can You Do Now?

People in the Washington, DC, Northern Virginia, and Maryland metropolitan area as  well as in the Northeast are experiencing record warm temperatures this Winter.  This warm weather seems to have confused the trees into releasing their pollen much earlier this year than in previous normal years.  In February of this year, tree pollen counts hit “high” levels a few times, when normally they are at the most a “low” level by the end of February.  In addition to Washington, DC, the tree pollen counts has been much higher than normal this February in the following Northern Virginia cities:  Tysons Corner, VA, Vienna, VA, McLean, VA, Great Falls, VA, Arlington, VA, Fairfax, VA, Falls Church, VA, Alexandria, VA, Annandale, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Bristow, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Haymarket, VA, Gainesville, VA, Warrenton, VA, Springfield, VA, Ashburn, VA, Dumfries, VA, Culpeper, VA, Leesburg, VA, and Purcellville, VA.  In Maryland, the tree pollen counts have also been “high” this February in the following cities:  Potomac, MD, North Potomac, MD, Rockville, MD, Gaithersburg, MD, Germantown, MD, Olney, MD, Darnestown, MD, Bethesda, MD, North Bethesda, MD, Chevy Chase, MD, Great Falls, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Temple Hills, MD, Columbia, MD, Annapolis, MD, and Baltimore, MD.

Tree pollen usually begins to pollinate in late February and generally stops pollinating in May, however this year, tree pollen was seen in January.  Along with tree pollen comes misery for millions of allergic individuals who are sensitive to tree pollen.  The symptoms that allergic individuals typically experience may include sneezing, runny nose, nasal congestion, itchy nose, post-nasal drip, itchy throat, sinus congestion, sinus headaches, itchy eyes, puffy eyes, watery eyes, fatigue, snoring, and/or asthma (e.g., wheezing, shortness of breath, chest tightness, coughing).  Many people with hay fever (i.e., allergic rhinitis) are more prone to developing sinus infections (i.e., sinusitis) as well.

In order to try to ward off allergy and asthma symptoms at the beginning of the season, several things can be done by the allergy sufferer before the symptoms begin or certainly before the symptoms get bad.  Some of these things that can be done in order to help prevent allergy symptoms include:

  1. If doing yardwork or exercising outdoors, wash and change your clothes and take a shower after come inside.
  2. If you must do yardwork, wear a mask, preferably a respirator mask with a HEPA filter.
  3. Keep the windows and/or sunroof closed in your cars.
  4. Wash your pet if he/she has been outdoors for a prolonged period of time as the fur/hair collects pollen.
  5. If you need to do outdoor activities, try to do them in the late afternoon or after it rains, when the pollen levels are lower. Pollen counts are higher in the mornings.
  6. Watch the pollen count. You can check it daily on our website.  Click Today’s Pollen Count.
  7. If you need to go outdoors, try to avoid going out in hot, windy, dry days as the pollen counts tend to be higher on these days.
  8. Make sure you clean and/or change your filters in both your home and car.
  9. Make sure the setting on your car’s air conditioning system is set on recycle in order to avoid fresh air from the outside from entering your vehicle.
  10. Begin your allergy medications at the beginning of the season or even a few days before the season begins, only if suggested by your allergist.
  11. If you are on allergy shots (I.e., allergy immunotherapy, allergy injections, allergy desensitization), increase the frequency of the injections at the start of the season and continue that increased frequency throughout the season.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating allergic rhinitis and asthma in both adults and children for more than 50 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 doctors at Black & Kletz Allergy have the expertise in order to take outstanding care of your allergy, asthma, sinus, skin-related disorders, and immunological needs.  Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless dedication and great pride as we have done for many years.

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.

Alcohol Allergy and Intolerance

As allergy specialists Centreville, VA patients trust may attest, while it is possible to be allergic to alcoholic beverages, an alcohol allergy is relatively rare.  Most of the time, it is an intolerance and not an allergy to the alcohol that is bothersome to an individual.  An intolerance is basically an unwanted side effect of the alcohol.

True alcohol allergies can occur and generally are not an allergic reaction to the alcohol itself, but more likely an allergic reaction to an ingredient in the alcoholic beverage.  Some of the ingredients that may cause a true food allergy include barley, rye, wheat, corn, hops, grapes, egg, and yeast.  Symptoms can range from mild to life-threatening and can be the same symptoms that one experiences with alcohol intolerance (discussed below), which is why contacting an allergy specialist Centreville, VA has to offer may be crucial.

Most individuals that have reactions from drinking alcohol, however, have alcohol intolerance.  Some of the symptoms commonly associated with alcohol intolerance may include facial flushing, increased heart rate, nausea, vomiting, diarrhea, abdominal pain, headaches, nasal congestion, runny nose, sneezing, wheezing, shortness of breath, generalized itching (pruritus)hives (urticaria)swelling (angioedema), decreased blood pressure, and/or anaphylaxis.

If you speak to an allergy specialist in Centreville, VA, they might mention some of the following causes of alcohol intolerance which include:

  1. Sulfites:  Sulfites are put into most bottles of wine to act as a preservative. Note that one can buy sulfite-free wine, but the supply is much more limited than wines that contain sulfites.  Sulfites are found in many other foods, medications, and vaccines.  Many individuals are sensitive to sulfites and this preservative can cause hives, swelling, and even anaphylaxis in very sensitive individuals.  An estimated 5-10% of asthmatics have the propensity for sulfites to exacerbate their asthma.  Sulfites may be labeled as sodium metabisulfite, sodium bisulfite, sodium sulfite, potassium metabisulfite, potassium bisulfite, or sulfur dioxide (which technically is not a sulfite, but is a close relative).
  2. Inactivated Aldehyde Dehydrogenase:  Aldehyde dehydrogenase is an enzyme that breaks down alcohol to acetic acid (i.e., vinegar).  Some individuals have a genetic mutation that inactivates this enzyme which results in a flushed face and body during the consumption of alcohol.  They may also experience rapid heart rate, nausea, and/or headache.  In these people, alcohol is not broken down into acetic acid, and as a consequence, there is a build-up of acetaldehyde which is the cause of the flushing.  This mutation is more common in individuals of Asian descent as approximately 35% of East Asians have this condition and thus is sometimes referred to as “Asian flush syndrome.”  The gene change responsible for this mutation is thought to be linked with the domestication of rice, several hundreds of years ago in southern China.  The flushing syndrome is associated with a lower rate of alcoholism, probably due to the adverse effects when drinking alcohol, as well as an increase risk to esophageal cancer in those individuals who drink.
  3. Histamine:  Top allergy specialists Centreville, VA residents turn to should know that alcoholic drinks contain the chemical histamine, which is generated by the fermenting of yeast.  Histamine is released into the bloodstream in a normal allergic reaction and is attributable for many of the symptoms found in hay fever (allergic rhinitis).  Histamine found in alcoholic beverages are primarily responsible for the nasal congestion that one notices while drinking alcohol.
  4. An Underlying Medical Condition:  Hives and/or swelling can be exacerbated in patients with chronic hives (chronic urticaria) and/or swelling (angioedema).  Likewise, patients with Hodgkin’s lymphoma and other cancers are more likely to have alcohol-induced pain.  Individuals using medications such as Antabuse (i.e., disulfiram), Flagyl (i.e., metronidazole), and tinidazole (i.e., Tindamax, Fasigyn, Simplotan). Antabuse inhibits the enzyme, aldehyde dehydrogenase, thus causing the same flushing, increased heart rate, nausea, vomiting, and/or headaches found in the flushing syndrome mentioned above. Flagyl and Tindamax both are anti-parasitic medications and Flagyl is also used as an antibiotic.  Both of these medications interfere with the breakdown of alcohol and cause symptoms such as flushing, nausea, vomiting, abdominal pain, headaches, sweating, increased heart rate, decreased blood pressure, and liver damage.  Keep in mind that small amounts of alcohol (e.g., 1 tablespoon) are all that is needed to cause reactions when mixed with these medications.  Many over the counter oral and topical products contain alcohol such as colognes, aftershaves, cough syrups, mouthwashes, etc. and should be avoided while taking Flagyl and/or Tindamax.  There may also be other medications that should not be taken together with alcohol. As experienced allergy specialists Centreville, VA patients recommend highly, it is important to read the warnings on all prescription bottles from the pharmacy to ensure one’s safety.

Contact a Top Centreville, VA Allergy Specialist Today
If you have had an untoward reaction or side effect from consuming alcohol, please call the board certified allergists at Black & Kletz Allergy to schedule an appointment.  Food testing can be done to rule out an actual food allergy that is present in all alcoholic drinks.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 locations offer on-site parking.  In  addition, the Washington, DC and McLean, VA offices are Metro accessible with a free shuttle available that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been providing high quality allergy and asthma care to the DC metro community for more than a half century. If you have experienced alcohol allergies or intolerance, turn to allergy specialists Centreville, VA is proud to have in its community.

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.

Rashes from Plants

The Allergists McLean VA Trust for Plant Rash Treatment
With the advent of summer, many people in Gainesville, VA, Falls Church, VA, Tysons Corner, VA, as well as the rest of the Washington, DC metropolitan area, are experiencing various types of rashes after outdoor activities.

“Irritant contact dermatitis” develops in individuals with very sensitive skin when they handle plants with prickles or barbs.  Some other type of plants cause skin reactions only in people who are previously sensitized to them.  This is called “allergic contact dermatitis.”  Physical contact of the skin with oil from these plants, called urushiol, is usually the culprit in these instances.

Poison ivy, poison oak, and poison sumac are the common plants that produce urushiol and trigger inflammation of the skin.  They grow as shrubs in open fields, wooded areas, on the roadside, as well as in backyards and parks throughout Falls Church, VA, Gainesville, VA, and Tysons Corner, VA.

The offending oils can be found on the leaves, stems, flowers, and roots of these plants. Exposure to even a small amount of urushiol can result in a severe rash in susceptible people. Touching the plants directly or indirect contact through pets, tools, and/or clothing can lead to the rash.  Airborne exposure can also occur especially when the plants are burned.

The symptoms can start anywhere from a few hours to a few days after the contact and usually presents itself as redness, swelling, itching, and/or burning of the exposed areas of the skin.  The rash may get more severe over the next few days and form blisters of various sizes.  They are usually distributed in a linear or streaky pattern depending on the type of contact.  The fluid that oozes from the blisters does not contain urushiol and therefore is not contagious.

The diagnosis is established after a detailed history and physical examination.  No blood tests or X-rays are needed.  The characteristic appearance of the lesions and their distribution pattern provide useful clues.

Thoroughly rinsing the exposed area with large amounts of warm water as soon as possible after known contact with plants may help remove the offending oily resins to some extent. After the rash appears, some helpful treatments consist of the following:

  1. Cool compresses to the affected skin.
  2. Local application of soothing agents such as calamine lotion and/or oatmeal baths.
  3. Antihistamines like Benadryl (i.e., diphenhydramine) by mouth to help relieve itching.
  4. If the affected area is limited and the rash and itching are intense, a topical medium to high potency steroid cream may be prescribed by an allergist in McLean, VA or the DC area.
  5. In more severe cases, an oral corticosteroid course may be needed to reduce the inflammation and prevent progression.
  6. In case of secondary bacterial infection, antibiotics are sometimes required.

One to three weeks is the usual duration of the condition.  Future episodes can be prevented by the following:

  1. Familiarizing with the appearance of the plants in order to recognize and avoid exposure.
  2. Wearing protective clothing including long sleeves, pants, boots, and gloves before outdoor activities.
  3. Applying commercially available OTC barrier creams to the skin in order to reduce or prevent contact with the toxic oils.
  4. Thoroughly washing clothes and bathing pets with protective gloves after coming into contact with the plants.

The board certified allergists at Black & Kletz Allergy in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA have had many years of experience in treating poison ivy, poison oak, and poison sumac and will readily answer your questions and address your concerns at any time.  In addition to treating poison ivy, poison oak, and poison sumac, we also diagnose and treat both adults and children with hay fever (i.e., allergic rhinitis), asthma, food allergies, medication allergies, sinus disease, immune disorders,  eczema (i.e., atopic dermatitis), hives (i.e., urticaria), swelling episodes (i.e., angioedema), and other types of skin rashes.  The 3 offices of Black & Kletz all have 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 suffer from allergies, please call our office to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  The allergist McLean VA patients trust at Black & Kletz Allergy have been serving the allergy and asthma needs of the Washington, DC metro area for more than 50 years and we take pride in providing quality care in a friendly and professional environment.

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.

Epinephrine Auto-Injectors

The Allergy Doctor Centreville, VA Relies On Explains Epinephrine Auto-Injectors
Severe sensitivity to certain foods, insect venoms, and certain medications can lead to a life- threatening reaction called anaphylaxis.  The symptoms usually begin within a few minutes after exposure and can progress very rapidly.  Anxiety is often the initial symptom and the other usual manifestations include generalized itching, redness, hives, swelling of the eyelids, lips, tongue, and/or throat (i.e., angioedema) leading to difficulty in swallowing and breathing. Other signs can include excessive sweating, rapid pulse, and a sudden drop in blood pressure.

Epinephrine (adrenaline) is a self-injectable medication and is the first line treatment option for anaphylaxis.  It can stall the progress of the reaction and can be life-saving by reversing the deleterious effects of anaphylaxis.  To be maximally effective, epinephrine needs to be administered as soon as possible after the onset of the first symptom.  In fact, delayed use of epinephrine is the leading cause of mortality in anaphylaxis.  It is therefore imperative for all people susceptible to severe allergic reactions to have a self-injectable epinephrine immediately available at all times.

The foods most likely to cause anaphylaxis include peanuts, tree nuts, fish, and shellfish.  In children and adults who are severely sensitized, other foods like milk and eggs can also cause severe adverse reactions.  The insect stings that are known to cause anaphylaxis belong to the Hymenoptera family and include honeybees, yellow jackets, hornets, wasps, and fire ants.  Penicillin and related antibiotics are the most common drugs that are associated with a tendency to cause life-threatening reactions.

Epinephrine auto-injectors are available by prescription only and are covered by most insurances.  One of the products marketed under the trade name Auvi-Q was voluntarily recalled by the manufacturer in October 2015 and two other products Epipen and Adrenaclick are currently available.  A generic version of an epinephrine auto-injector is also offered by certain pharmacies. Note that there are generally 2 doses (0.15 cc. and 0.3 cc.) of each epinephrine auto-injector.  The dose depends on the weight of the individual, such that the 0.3 cc. dose is the dose usually given individuals weighing greater than or equal to 66 lbs.  The 0.15 cc. dose (e.g., EpiPen Jr.) is generally given to children weighing 33-66 lbs.

Although the medication is identical, different brands have different administration methods and it is crucial that the patient receive adequate training and practice with a training device to get familiarized with the specific technique. The medicine is usually injected intramuscularly (IM) into the outer part of the thigh, even through clothing, and the device is kept in place for about 10 seconds.  It is recommended that two doses be carried at all times, as the second dose may be needed if the symptoms persist about 10-15 minutes after the first dose.

The most common side effects of epinephrine include palpitations, tremors, and restlessness. However the benefits of epinephrine almost always outweigh the risks.  After using the epinephrine, it is important to go to the nearest emergency department to be monitored.  In some individuals with anaphylaxis, a late phase reaction can occur anywhere from 4 to 72 hours (4-8 hours is more typical) after the initial anaphylactic reaction.  Patients and/or parents should also contact the allergist for reevaluation and for replenishment of epinephrine auto-injectors.  The devices should be stored at room temperature and should never be frozen or exposed to high temperatures or direct sunlight.

The board certified allergists and the staff at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area are trained and experienced in evaluating the need for, prescribing, and teaching the technique for epinephrine auto-injectors.  We have 3 offices in the DC metro area with offices 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 offices are Metro accessible.  We offer free shuttle service between our McLean office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been providing quality care allergy, asthma, and immunology services to the Washington, DC , Northern Virginia, and Maryland metro area community  for more than a half century.