Category Archives: INSECT STINGS

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.

Mosquito Bite Allergy

Signs and Symptoms

Although mosquito bites are quite common among the general population, allergies to mosquito bites are luckily rather rare. Most individuals experience localized itching, swelling, and/or redness of the skin at the site of the bite. However, if someone is allergic to the mosquito, they may have more severe skin reactions which can include extremely large areas of swelling and redness, blistering, and/or bruising. In rare cases, some individuals may experience anaphylaxis (a severe life-threatening systemic reaction) after a mosquito bite. Such individuals experience symptoms which may include some or all of the following:

1. Throat closing sensation
2. Hives (Urticaria)
3. Generalized itching of the skin
4. Drop in blood pressure
5. Shortness of breath and/or wheezing
6. Dizziness, lightheadedness, and/or fainting
7. Abdominal cramping, nausea, vomiting, and/or diarrhea
8. Rapid and weak pulse
9. Feeling of warmth

Mosquito Facts

Mosquitoes are flying insects that tend to be more prevalent where there is standing water. They are more active early in the morning and early in the evening. Female mosquitoes lay their eggs in stagnant water. Only the female mosquito bites and feeds on human blood, as they need this blood in order to produce their eggs. Male mosquitoes feed on water and nectar. When a person is bitten, the mosquito injects its saliva into the skin which contains proteins that prevent the human blood from clotting. This allows the blood to be transferred to the mosquito’s mouth. The typical localized itching, swelling, and/or redness of the skin that results from the bite is not directly due to the bite itself, but rather caused by the body’s immune response to the proteins in the mosquito’s saliva. An “allergic reaction” to a mosquito bite is defined when there is a severe immune reaction against the salivary proteins of the mosquito, thus causing the more severe symptoms mentioned above.

Diseases Transmitted by Mosquitoes

In addition to causing allergies in selected individuals, mosquitoes are well known for transmitting many infectious diseases such as dengue fever, malaria, West Nile virus, filariasis (elephantiasis), yellow fever, chikungunya, Eastern equine encephalitis, Western equine encephalitis, Venezuelan equine encephalitis, Japanese encephalitis, St. Louis encephalitis, La Crosse encephalitis, Rift Valley fever, Ross River fever, and Zika fever.

Risk Factors

Mosquitoes are attracted to certain people more than others for a variety of reasons. They are more attracted to individuals with the following characteristics: Type O blood, males, obese or overweight people due to increased carbon dioxide (CO 2) levels, specific body odors that are present because of large numbers of certain bacteria, people wearing dark clothing, individuals that are exercising, and increased body heat.

Diagnosis, Prevention, and Treatment

The diagnosis of mosquito allergy can be done via a blood or skin test and is only done in individuals that have had severe reactions that can be ascertained after a thorough history from the patient. Prevention, however, is the key to treatment. One should avoid areas with standing water such as swamps or fresh water reservoirs. Wear light colored long sleeved clothing and hats. Consider wearing permethrin-treated clothing. Use citronella-scented candles when at outdoor events. Use a bed net if sleeping outdoors. Stay in screened in or air conditioned rooms. Apply insect repellent that preferably contains a 10-25% concentration of DEET (N,N-diethyl-3-methyl-benzamide or N,N- diethyl-meta-toluamide). One can alternatively use insect repellents containing either picaridin or oil of lemon eucalyptus.

Besides prevention, the treatment of mosquito bites is aimed at treating the symptoms of the bite. Since most mosquito bites cause only a local reaction, various topical medications can be used which can include calamine lotion, corticosteroid creams, anti-itch creams, and/or topical antihistamines. It may also be advantageous to apply ice or a cold pack to the site of the local reaction. Oral antihistamines may offer more relief in certain individuals. In the cases where anaphylaxis occurs, the individual should use a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick), call 911, and go immediately to the closest emergency room. Fortunately, anaphylaxis is quite rare when it comes to mosquito bite allergies, however, it is a possibility and anyone who has symptoms of mosquito bite allergy should see a board certified allergist.

The board certified allergists at Black & Kletz Allergy have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 5 decades and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA with on-site parking. The Washington, DC and McLean, VA office locations are also Metro accessible. Please call us for an appointment or alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day. Black & Kletz Allergy prides itself in providing quality allergy care to both adults and children in a friendly professional environment.

Insect Sting Reactions

As we enter into warmer months, insect sting reactions are one of the major concerns in our greater Washington, DC metro area. Most people who are stung by insects experience swelling, redness, and pain at the site of the sting. These symptoms usually resolve within a few days. However, some of us are “allergic” to the insect venoms and the stings can lead to severe life-threatening reactions. In fact, about one-half a million people seek emergency room care every year in United States for insect sting reactions and about 50 deaths are reported every year from these reactions. If we are predisposed to develop allergic reactions, our immune systems make IgE antibodies to the venom after an initial sting. steam cloud . If we are stung by the same insect again, the antibodies interact with the venom and cause the release of certain chemicals into the bloodstream which causes the serious reactions.

Though many insects cause local reactions, almost all the severe generalized reactions commonly found in northern Virginia, Washington DC, Maryland, and the surrounding areas are caused only by four types of insects. These four types include Honey bees (live in colonies or “honeycombs” in hollow trees or cavities of buildings), Yellow Jackets (usually nest underground and rarely in woodpiles or cracks in masonry), Hornets (grey or brown football shaped nests above ground in the branches of trees or in shrubbery) and Wasps (nests are made up of paper-like material under eaves, behind shutters, or in shrubs).

In order to reduce your chance of being stung, it is advisable that you take a few precautions like avoidance of walking outdoors with exposed skin. It is also recommended to avoid wearing dark colored clothing and to also avoid wearing strong perfumes and deodorants. If one has a systemic reaction following an insect sting, he or she has a 60% chance of a similar or more severe reaction in the case of a subsequent sting by the same insect. Another important tidbit of information to know is that if a honey bee stings you, it will leave it’s stinger in your skin at the site of the sting. You should never pull out the stinger, instead, you should scrape off the stinger with your fingernail or credit card. Pulling out the stinger actually causes the bee’s venom sac to pump more venom into you which can make your reaction to its venom more severe. Luckily, there is a highly efficacious treatment option called Venom Immunotherapy, (also known as Venom shots or Venom injections), which has proved to be 97% effective in preventing life-threatening reactions in people who are sensitized to the insect venoms. Allergy shots for indoor and outdoor allergies are different, but also highly effective.

Over the past five decades, the board certified allergists at Black and Kletz Allergy practice have helped hundreds of patients sensitized to insect venoms in Virginia, Washington, DC, and Maryland to lead a normal life. Through education, training in self-injectable epinephrine, and most importantly, by desensitization, our patients have been able to live without the fear of a having a serious reaction from insect stings and are able to enjoy being outside in the warm months.