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Infusion Therapies in Allergy and Immunology

There are disease states where medications taken by mouth do not offer enough benefit in either relieving symptoms, stopping the progression of a condition, or preventing complications of a disease. In these instances, medications may need to be administered by means of the parenteral route, such as using a needle or catheter to infuse the medication.

The 2 ways that the administration of medications via the parenteral route can be accomplished include:

1. Intravenous route: A needle or catheter is inserted into a vein and the medication is infused. A peripheral vein in the arms or legs is most commonly used. Rarely a “central” deeply situated vein may need to be catheterized for long-term medication administration.

2. Subcutaneous route: A needle or catheter is inserted just under the skin and the medication is infused. The liquid medication is gradually absorbed into the blood stream from the surrounding “subcutaneous” space.

One of the most common medications used by allergists/immunologists like the one’s at Black & Kletz Allergy are immunoglobulins (i.e., antibodies) which are given by infusion therapy to treat diseases where one’s own immune system is unable to manufacture antibodies to fight infections. These diseases are called primary immunodeficiency diseases (PIDD). Untreated, the patient experiences frequent, severe, and sometimes life-threatening infections. These infections can be prevented by replenishing the body with “outside” antibodies (i.e., antibodies collected from healthy donors) through either intravenous or subcutaneous infusions. In some instances, the therapy is begun as intravenous therapy and then it may be transitioned to the subcutaneous route.

SOURCE:

The immunoglobulins that are used to treat these conditions are extracted from the plasma of healthy blood donors. They are usually pooled from thousands of donors, concentrated, and purified. They are treated to prevent transmission of blood borne diseases and then packaged in sterile conditions.

DURATION:

Intravenous infusions generally take approximately 3 to 4 hours each time to infuse. Subcutaneous infusions, on the other hand, can take up to 6 hours to get to the desired place because the solution is gradually absorbed from the site.

FREQUENCY:

Intravenous infusions are usually given once every 4 weeks, whereas the interval between subcutaneous infusions can vary between 1 and 4 weeks depending on the specific product.

Intravenous infusions usually involve 1 needle stick in order to insert a catheter into the vein, whereas subcutaneous infusions may need 2 to 4 different sites (over the abdomen, thighs, etc.) depending on the volume of the solution that needs to be injected.

LOCATIONS:

Patients can be trained to infuse the medications at home by using electric infusion pumps. The infusions are not usually painful. In complex situations, the treatments are given either in doctor’s offices or in infusion centers located in hospitals or free-standing infusion centers.

SIDE EFFECTS:

Intravenous infusions rarely cause systemic side effects. Headache is a commonly reported side effect. Some patients also experience chills and sweating during infusions. These side effects can often be mitigated by slowing down the rate of infusions. After the infusion is completed, some patients may experience fatigue and achiness for a day or two. These side effects can sometimes be prevented or minimized by being premedicated prior to the infusions.

Subcutaneous infusions usually cause fewer systemic side effects than intravenous infusions but they still may cause local reactions such as redness, swelling, and/or pain at the site of administration.

MONITORING:

The doses of immunoglobulin infusions are adjusted based on the “trough” or lowest levels (i.e., immediately before the next dose) for IgG antibodies. The goal is to constantly maintain these IgG levels in the normal range.

The frequency and severity of the infections are also closely monitored to assess the effectiveness of the antibody replacement therapy.

OTHER MEDICATIONS AND CONDITIONS:

In addition to immunoglobulins, other therapeutic agents such as antibiotics, corticosteroids, and biologicals can also be administered either intravenously or subcutaneously for conditions treated by allergists/immunologists. There are a multitude of biologicals on the market and more are becoming available to treat a slew of allergic or immunological conditions such as asthma, eczema (i.e., atopic dermatitis), chronic hives (i.e., urticaria), and chronic rhinitis with nasal polyps. The treatment of food allergies may be another allergic condition in which biologicals may be used in the future depending on the results from ongoing research.

The board certified allergists at Black & Kletz Allergy have treated numerous patients with conditions requiring treatment by the intravenous and subcutaneous routes in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We treat both children and adults and we have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 offices of Black & Kletz Allergy 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 would like to be seen for any allergy or immunology condition, please call us to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours of the next business day. Black & Kletz Allergy is proud to continue to provide high quality allergy, asthma, and immunology care to the Washington, DC metropolitan area.

When Hay Fever Symptoms Are Not Allergies?

Hay fever is the common name for allergic rhinitis. The classic symptoms of hay fever or allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, sinus pressure, sinus headaches, itchy throat, itchy eyes, watery eyes, and/or redness of the eyes. In some individuals, respiratory symptoms such as wheezing, chest tightness, coughing, and/or shortness of breath can develop. These individuals are then said to have allergic asthma. The cause of hay fever and/or asthma in allergic individuals is due to an allergic response to a foreign allergen such as pollens, molds, dust mites, pets, cockroaches, etc. Our immune system mistakes these allergens as potentially detrimental, and as a result mounts a defensive attack on these allergens when it encounters them.  Biologically, there is a release of chemical substances (e.g., histamine, leukotrienes, prostaglandins) into the tissues inside the nose, eyes and lungs which is responsible for the allergy symptoms.

The diagnosis of hay fever relies on a comprehensive history and physical examination by a board certified allergist in conjunction with allergy testing by either allergy skin testing or allergy blood testing. This is done in order to identify allergies to specific allergens for each individual.

The treatment of hay fever involves avoiding the offending allergens if at all possible. Most of the time however, it is impossible to avoid the exposure to things like dust mites, molds, and pollens. When avoidance is either impossible or unhelpful, allergy medications are usually utilized in order to alleviate the annoying allergy symptoms. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are often implemented as a very effective way to combat allergies and asthma. Allergy shots are 80-85% effective and are generally taken for 3-5 years.

Not all individuals with allergy symptoms however are actually “allergic.” These individuals will have negative allergy skin tests or blood tests. If this occurs, the person is said to have non-allergic rhinitis or vasomotor rhinitis. They typically can have the same symptoms as someone with hay fever except they usually do not have itching of the nose, throat, or eyes.

The symptoms in individuals with non-allergic rhinitis may have intermittent symptoms or they can be perennial in nature. The physiology of non-allergic rhinitis is enlargement of the blood vessels inside the nostrils and subsequent leakage of fluids into the surrounding tissues resulting in excessive mucus and swelling of the mucus membrane linings and nasal turbinates. The cause of non-allergic rhinitis is unknown.

The triggers of non-allergic rhinitis may include: environmental irritants (e.g., pollution, dust, smoke, strong odors, fumes, chemical sprays, colognes, perfumes, potpourri, temperature changes, changes in humidity, viral infections (e.g., common cold, influenza), hormonal changes (e.g., thyroid disease, pregnancy, menstruation, emotional or physical stress, sleep apnea, gastrointestinal esophageal reflux disease (GERD), alcohol, rhinitis medicamentosa (i.e., prolonged or overuse of over-the-counter decongestant nasal sprays such as Afrin or Neosynephrine), gustatory rhinitis (i.e., food-related runny nose caused by an overstimulation of the vagal nerve. It is triggered by eating any type of food, but most often by hot or spicy foods), and various medications [(e.g., ibuprofen, aspirin, certain blood pressure medications (e.g., beta-blockers, ACE inhibitors), antidepressants, sedatives, and oral contraceptives].

The diagnosis of vasomotor or non-allergic rhinitis is established when an individual has the classic symptoms of hay fever but has negative allergy skin tests or blood tests and there is no evidence of infection. It is a diagnosis of exclusion since there are no specific tests to diagnose non-allergic rhinitis. It is rather the lack of positive allergy tests that are needed to diagnose the condition.

The treatment of non-allergic rhinitis begins with avoiding any triggers that cause symptoms. If one cannot avoid the triggers, an over-the-counter or homemade saline solution may be helpful in alleviating symptoms. Corticosteroid nasal sprays may also be helpful in decreasing nasal congestion due to their anti-inflammatory actions. Anticholinergic and antihistamine nasal sprays are also helpful in diminishing nasal symptoms. Oral decongestants can be taken in order to decrease nasal congestion in individuals who do not have a contraindication to using them such as individuals with hypertension, pregnancy, etc.

Note: If left untreated treated, complications may arise in individuals with non-allergic rhinitis which may include nasal polyps, middle ear infections, sinus infections (i.e., sinusitis), lack of concentration, poor school performance, and/or decreased productivity at work.

The board certified allergy doctors at Black & Kletz Allergy see both pediatric and adult patients and have over 5 decades of experience in the field of allergy, asthma, and immunology. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been providing first-rate allergy and asthma care in the greater Washington, DC metropolitan area for over 50 years and we look forward to continuing to provide you with the highest state-of-the-art allergy care in a friendly and relaxed environment

Grass Allergies

Environmental allergies affect about 50 million Americans in varying degrees of severity. For a majority of these individuals, the symptoms are aggravated seasonally and triggered by exposure to outdoor allergens.

Most of these allergens are pollens, which are tiny microscopic grains that help in the fertilization of plants. These pollens are produced by trees, grasses, and weeds. Trees produce most of the pollen in the early Spring and grasses pollinate in the late Spring and early Summer in the Washington, DC, Northern Virginia, and Maryland geographical area. There is also a period in March and April when both trees and grasses release pollen. Ragweed is the most common weed and its pollen causes seasonal allergy symptoms in the Fall. Ragweed pollen usually begins to pollinate in mid-August in our region, peak in September and taper off after the first frost.

Types of Grasses:
The most common grasses that release pollen triggering allergy symptoms are as follows:

  • Orchard
  • Timothy
  • Sweet Vernal
  • Perennial Rye
  • Bermuda

There are also other less common types of grasses that can cause seasonal allergies.

Symptoms:

  • Itchy, runny, stuffy nose
  • Itchy, watery, red, puffy eyes
  • Itchy throat
  • Itchy ears
  • Sneezing
  • Post-nasal drip
  • Cough

Pollen can also affect the sinuses causing facial pressure and headaches. Some individuals also experience itching and skin rashes after exposure to the grass.

Many asthmatics are also sensitive to the grasses and can experience a flare-up of their symptoms which may include chest tightness, wheezing, coughing, and/or shortness of breath during the grass pollen season.

Diagnosis:

The diagnosis of grass allergies begins with a comprehensive history and physical examination. Skin tests and blood tests are 2 types of allergy tests that are used in order to confirm the diagnosis of grass allergy. Skin tests necessitate pricking of the intact skin with a sharp plastic lancet which has been dipped in a fluid containing the chemical extracts from different pollens with positive and negative controls. An individual sensitized to one or more grass pollens will show a raised itchy bump at the site of the skin test site of the corresponding pollen extract after 15 to 20 minutes. The other test is a laboratory test which analyzes the blood sample for the presence of specific antibodies. If someone exhibits the typical nasal and eye symptoms of grass allergies and tests positive for grass allergy, the condition is called allergic rhinitis (i.e., hay fever) and allergic conjunctivitis respectively. As mentioned previously, allergies to grass can also trigger asthma in certain individuals.

Treatment:

Avoidance:

After the diagnosis of grass allergy is confirmed, the first step in the management is to avoid exposure to the offending grass pollen to the best of one’s ability. Below are some recommended ways on how to avoid the pollen exposure:

  • Stay indoors on high pollen days with the doors and windows closed
  • Change clothes after outdoor activities
  • Before going to bed, take a bath or shower and wash one’s hair to remove the pollen
  • Lawns should be cut short, reducing the ability of the grasses to release pollen
  • Wash bedding in hot water at least once a week

Medications:

  • Oral antihistamines – To reduce sneezing, itching, and runny nose
  • Nasal sprays – To help relieve nasal congestion and post-nasal drip
  • Eye drops – To minimize itching, watering, and redness of the eyes

Desensitization:

Allergen immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a procedure offered by our allergy and immunology practice in order to build up tolerance to the pollens that an individual is sensitized to. This process is effective in minimizing the need for medications and preventing the allergy symptoms even after exposure to the pollen.

Allergen immunotherapy is over 100 years old in the U.S. and it is considered the standard of care when environmental controls and medications do not give adequate relief from symptoms or when medications cause undesirable side effects. This treatment modality is instrumental in improving the quality of life of allergy sufferers. It is effective in 80-85% of the individuals who take allergy shots and is usually a 3-5 year process.

The board certified allergy doctors at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of grass allergies as well as other pollen and environmental allergies such as dust mites, molds, pets, and cockroaches. In addition, we also treat asthma, eczema, skin disorders (e.g., hives, generalized itching, swelling episodes, poison ivy, poison oak, poison sumac), food allergies, medication allergies, insect sting allergies, eosinophilic esophagitis, mast cell disorders, and immunologic disorders. Black & Kletz Allergy treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call one of our offices to make an appointment 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 serving the Washington, DC metropolitan area for more than 50 years and we pride ourselves in providing exceptional allergy and asthma care in a professional and pleasant setting.

Allergies to Insect Stings

Now that Spring has sprung, one is more likely to be stung by a flying insect, although the summer months are when insect stings occur the most. In the Washington, DC, Northern Virginia, and Maryland metropolitan area, the most common flying insects that cause stings include the honey bee, wasp, yellow jacket, white faced hornet, and yellow faced hornet. Honey bees live in colonies or “honeycombs” that are found in cavities of buildings or in hollow trees. Yellow jackets usually nest underground and unlike their fellow honey bees, they are rarely seen in cracks in masonry or woodpiles. Hornets produce grey or brown football shaped nests above the ground which are typically located in shrubbery or in branches of trees. Wasps make nests that are made up of a paper-like material which may be found behind shutters, in shrubs, or under eaves. Approximately 3% of individuals in the U.S. experience allergic reactions to the venom resulting from flying insect stings. Roughly 500,000 individuals in the U.S. seek emergency room care every year for insect sting reactions. Unfortunately, there are about 50 deaths reported each year from these reactions.  Though they can occur at any time of the year, they are most common in the summer months in our greater Washington, DC metropolitan area.

It should be noted that there is another type of stinging insect that individuals should be aware of, although it does not fly, nor is it common in the Washington, DC metro area. Fire ants will bite and sting. They inject their venom while stinging which can lead to anaphylactic reactions (i.e., anaphylaxis) in some allergic individuals. Although anaphylaxis can occur, the more typical reaction to a fire ant is that of a local burning pain with an accompanying red bump that can turn into a white fluid-filled pustule within a day or two. As mentioned above, they are not common in the Washington, DC metropolitan area however, the first documented infestation of fire ants in the state of Virginia was in 1989. Fire ants have also been found in Maryland.

When stung by a flying insect, most people have either no reaction at all or they have a small local reaction at the site of the sting. Individuals with this type of response are at no increased risk for an anaphylactic reaction than that of the general population. Some individuals will develop a large swollen red area where they were stung. This large local reaction can reach the size of a baseball in some instances. Even though there is a large local reaction, there is no increased risk of an anaphylactic reaction from the insect sting. On the other hand, approximately 3% of individuals will develop a systemic reaction to an insect sting which may include hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling (i.e., angioedema), chest tightness, shortness of breath, wheezing, abdominal cramping, and/or drop in blood pressure.

The diagnosis of an insect sting allergy is done by board certified allergists like the ones at Black & Kletz Allergy. The allergist will perform a comprehensive history and physical examination. Depending on the history taken from the patient, allergy testing to flying insects is usually the next step. Allergy testing is usually done by the preferred method of skin testing, although blood testing is occasionally performed depending on the situation.

If an individual has a positive allergy test to any of the stinging insect venoms, it is highly recommended that this individual go on a course of venom allergy immunotherapy (i.e., allergy desensitization, allergy shots, allergy injections) as it is tremendously efficacious in preventing further anaphylactic reactions from flying insect stings.  Venom allergy immunotherapy involves receiving progressively larger doses and volumes of insect venom to the patient weekly over a period of 10 weeks, then every 2 weeks for 1 dose, then every 3 weeks for 1 dose, then a maintenance dose every 4 weeks for 1 year, and then the maintenance dose can be reduced to every 6 weeks for several more years.  This maintenance dose is essentially comparable to the amount of venom in an actual flying insect sting.

All patients with flying insect sting allergies are prescribed a self-injectable epinephrine device such as EpiPen, Auvi-Q, or Adrenaclick. If one uses a self-injectable epinephrine device, they should go immediately to the closest emergency room. It is also important to note that unlike other flying stinging insects, honey bees leave their stinger in the skin of their victims. If one sees a stinger at the site of a sting, one should not pull out the stinger. It should be scraped off with a finger nail, credit card, or other flat surface. Pulling out a stinger can cause more venom to be introduced into the person’s body which can obviously be more detrimental.

The board certified allergy doctors at Black & Kletz Allergy will promptly answer any questions you may have regarding insect stings or any related conditions. Our allergy doctors have been diagnosing and treating insect sting allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We have 3 convenient locations in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is on-site parking at each location and both 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. To schedule an appointment, please call us at any one of our 3 locations. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is dedicated in providing the most up-to-date diagnostic and treatment modalities in the field of allergy, asthma, and immunology.

Food Intolerance

Unpleasant symptoms occurring after ingestion of a food could be due to a food allergy or food intolerance.

What is the difference between a food allergy and a food intolerance? Is it necessary or important to distinguish between the two terms? How is the food allergy or intolerance diagnosis established? Are these conditions managed differently?

The term “allergy” traditionally refers to a phenomenon where the immune system considers a substance as “foreign” and subsequently mounts a defensive attack against it. The symptoms of these allergic reactions are caused by the release of a variety of chemical mediators of inflammation such as histamine, prostaglandins, and leukotrienes, to name a few.

These allergic reactions can be mediated by either the humoral (i.e. antibodies are involved) or the cellular (i.e., lymphocytes are involved) arms of the immune system. The IgE antibody-mediated (i.e., humoral-mediated) reactions usually produce symptoms within minutes of exposure to the offending agent. The typical symptoms may include itching, sneezing, hives, swelling of soft tissues (e.g., lips, tongue, throat), and/or difficulty in breathing. These reactions are usually more severe and can occasionally be life-threatening. The lymphocyte-mediated (i.e., cell-mediated reactions), on the other hand, are also called delayed hypersensitivity reactions, as the symptoms usually appear a few days after the exposure to the triggering agents. An example of a delayed hypersensitivity reaction is an allergic reaction that occurs due to contact with a chemical or metal. In most cases of this type of contact dermatitis, skin manifestations in the form of itching and/or a rash occur.

Food “intolerance” usually denotes a difficulty in processing the food by the gastrointestinal tract. Sometimes the term “food sensitivity” is used instead of food intolerance. Various enzymes are needed in order to break down the proteins, sugars and fats in the food we eat. When there is a deficiency of an enzyme needed to breakdown food, that food will not be properly digested. As a result, bothersome symptoms such as abdominal pain/discomfort, abdominal bloating, nausea, diarrhea, and/or constipation after eating may occur.

Lactose intolerance is a common example of a food intolerance. Lactose is the sugar found in dairy products and it requires the enzyme called lactase in order to digest it. Many adults do not have enough lactase to process the lactose, and as a result, the undigested sugars become fermented in the intestines which then in turn may cause increased gas production. Thus, the symptoms associated with lactose intolerance may include abdominal bloating, flatulence, abdominal pain, and/or diarrhea after the consumption of dairy products.

Gluten is a protein found in wheat, barley and rye. Gluten helps foods hold their shapes such as breads, pasta, and cereals. Many individuals have an intolerance to gluten because they cannot process it well in their digestive tracts. This intolerance to gluten may result in symptoms such as abdominal discomfort/pain, abdominal bloating, nausea, diarrhea, and/or constipation.

Celiac disease is an immunologically mediated disorder where antibodies cause damage to the lining of the small intestine leading to difficulty in digesting gluten. This condition causes a variety of symptoms and is suspected by elevated antibody levels in the blood and confirmed by a biopsy of intestinal mucosa.

The diagnosis of food allergy is established by the demonstration of specific antibodies to proteins in the food, either by skin prick tests with various food antigens or by laboratory evaluation of an individual’s blood sample. The food skin prick tests and the blood tests are typically negative in cases of food intolerance.

The management of food allergy involves the complete elimination of the offending food from the diet, particularly since there is a possibility of severe adverse reactions in food-allergic individuals. In addition to avoiding the offending food, a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) is usually prescribed depending on the severity of the allergic reaction described by the food allergy sufferer. If the self-injectable epinephrine device is ever used, one should go immediately to the closest emergency room.

It is important to note that there are desensitization protocols for certain foods which may enable the development of tolerance to allergic protein. This process is called oral immunotherapy or oral desensitization. Oral food desensitization helps reduce the risks of severe food reactions occurring after accidental exposures. Even if an individual is undergoing oral immunotherapy, a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) will be prescribed. If it is ever used then one should go immediately to the closest emergency room.
The management of food intolerance also involves avoidance of the suspected foods to the extent possible while substituting with other foods which are better tolerated to ensure adequate nutrition.

Lactose intolerance can be managed by the substitution of lactose-free dairy products in the diet and/or supplementation of the lactase enzyme (available in powder and pill forms such as Lactaid) when lactose-containing foods are consumed.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating food allergies and food sensitivities for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking. The Washington, DC and McLean, VA 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. Please call for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides itself in providing quality allergy, asthma, and immunology care to the Washington, DC, Northern Virginia, and Maryland metropolitan area community.

Allergies of the Eyes

women with red eyes

It is March again, and this marks the start of Spring. In the Washington, DC, Northern Virginia, and Maryland metropolitan area, trees are pollinating in the month of March. The pollination of trees is a major trigger for many allergy sufferers as it may cause either allergic rhinitis (i.e., hay fever) symptoms, allergic conjunctivitis (i.e., eye allergies) symptoms, or both to occur simultaneously. The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus headaches, and/or snoring. The typical symptoms of allergic conjunctivitis may include itchy eyes, watery eyes, redness of the eyes, thick sticky discharge of the eyes, puffy eyelids, and/or eyelids sticking together especially in the mornings when awakening. Even though the likely candidate for an increase in ocular or nasal allergy symptoms in the month of March is likely to be the tree pollen, one cannot rule out other allergies such as allergies to molds, dust mites, pets, and/or cockroaches.

Allergic conjunctivitis is often categorized into 2 types:

  • Seasonal allergic conjunctivitis – Associated with seasonal allergies mostly common in the Spring or Fall. Tree and grass pollens are usually responsible for Spring symptoms whereas weeds are usually responsible for symptoms in the Fall.
  • Perennial allergic conjunctivitis – Associated with year-round allergies such as allergies to dust mites, molds, pets, and/or cockroaches.

Most allergic individuals who have allergic conjunctivitis also have allergic rhinitis at least to some extent. Some allergic individuals who have allergic conjunctivitis and/or allergic rhinitis also have asthma and/or eczema (atopic dermatitis). Asthma triggered by environmental allergens such as dust mites, molds, pollens, pets, and cockroach is essentially a continuation of the allergies past the nose and throat into the lower respiratory system. Individuals with asthma may experience wheezing, shortness of breath, chest tightness, and/or coughing. Asthmatics and individuals with eczema may also have concomitant allergic rhinitis, allergic conjunctivitis, or both.

Allergic conjunctivitis is usually diagnosed by board certified allergists, such as the ones at Black & Kletz Allergy, by way of a comprehensive history and physical examination. The individual is usually allergy tested by skin testing or blood testing in order to determine the offending allergens that are causing the symptoms of allergic conjunctivitis (i.e., itchy eyes, watery eyes, redness of the eyes, puffy eyelids, eyelids sticking together). Once the allergens are identified, it is advisable to try to avoid them if at all possible. Below are several recommendations on measures to help avoid allergens that may contribute to allergic conjunctivitis:

  • Close the windows of one’s cars and house.
  • Follow the local pollen count at www.bkallergy.com by clicking Today’s Pollen Count.
  • Change one’s clothes and shower after spending a long time outdoors.
  • Leave one’s shoes outdoors after being outside.
  • Wash hair/fur of one’s pet after it comes inside from outdoors.
  • Go outside after it rains since the pollen count is “washed away” temporarily.
  • Use antihistamines and/or nasal sprays early in the pollen season.
  • Consider allergy shots (see below) if more persistent or severe symptoms to pollens or molds occur, since they are effective in 80-85% of individuals with allergic rhinitis and/or allergic conjunctivitis.

On many occasions it is difficult, if not impossible, to avoid the allergens, so medications are prescribed. These medications may include allergy eye drops and/or oral antihistamines. Since it is quite common for individuals with allergic conjunctivitis to also have associated nasal symptoms (i.e., allergic rhinitis), many will also receive prescriptions for nasal sprays, oral leukotriene antagonists, and/or oral decongestants. Allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) are very effective in the treatment of allergic conjunctivitis, allergic rhinitis, and asthma as they work in 80-85% of the patients that take them. Allergy shots have been given to treat allergies for more than 100 years. They are given to individuals of all ages, from small children to the elderly. The average length of time that one undergoes allergy immunotherapy treatment is typically from 3-5 years.

It is also important for the allergist to rule out other causes of “pink” or red eyes when someone presents with redness of the eyes. Infections of the eyes (i.e., viral, bacterial, fungal, parasitic), chemical irritants, pollutants, foreign body, anterior uveitis, subconjunctival hemorrhage, and blood thinning medications can all cause “pink” or red eyes.

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

Allergies in February?

If you are suffering from allergy symptoms and you live in the Washington, DC, Northern Virginia, and Maryland metropolitan area, you are not alone. There may be many reasons why this is so. You should understand that there are a variety of allergens that could be affecting you, even in February. We will discuss some of them below.

It should be noted that dust allergy is an allergy that occurs throughout the year. Dust is always present no matter how clean you are. In fact, it is not typically the dust particles that you often see in the air near a well-lit window that is the culprit in someone with dust allergies. It is the dust mites that are primarily responsible for causing the annoying symptoms in a dust-allergic individual. Dust mites are arachnids like spiders and ticks. They are microscopic and live off of the dead skin that sloughs off all individuals. A dust-allergic individual is actually allergic to the dust mite’s feces as well as its exoskeleton. The 2 common species of dust mites in the U.S. are Dermatophagoides farinae (i.e., American house dust mite) and Dermatophagoides pteronyssinus (i.e., European house dust mite). Both species are responsible for causing or contributing to both allergic rhinitis (i.e., hay fever) and asthma. The classic symptoms of allergic rhinitis may include sneezing, nasal congestion, runny nose, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus pressure, sinus pain, headaches, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Asthma symptoms, on the other hand, may include wheezing, chest tightness, coughing, and/or shortness of breath. Even though dust is a perennial allergen, it can worse for some individuals in the Winter, when a house is generally more closed up compared with the other seasons.

Mold is another perennial allergen that is bothersome to many individuals with allergic rhinitis and/or asthma. Although molds tend to be present in every season, they tend to be more abundant in the Fall, when leaves fall off of the trees and sit on the wet ground. This setting is perfect for molds as the moisture is a catalyst for mold growth. It should be noted that Washington, DC was built on a swamp and is thus is a great environment for molds to grow. Many individuals who live in the Washington, DC metro area are bothered by this abundance of mold and as a result suffer more than they would have if located in a different part of the country. Mold, just like dust, can cause or aggravate both allergic rhinitis and/or asthma. Mold-sensitive individuals may complain of runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus headaches, snoring, sinus pressure, sinus congestion, sinus pain, watery eyes, itchy eyes, redness of the eyes, swelling of the eyes, chest tightness, wheezing, coughing, and/or shortness of breath depending on whether they exhibit allergic rhinitis symptoms, asthma symptoms, or both. In addition, there are conditions like allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal sinusitis that occur because of an allergy to molds where an inflammatory reaction ensues. These 2 disorders are more involved than that of the standard allergic rhinitis situation, thus requiring more specialized tests and more complex treatments in the diagnosis and management of these conditions.

Lastly, when one thinks about allergies in the month of February, one must think of tree pollen. In the metro Washington, DC area, trees begin to pollinate earlier than they have done even 10 years ago. In the past, trees would typically begin to pollinate in late February. In the last few years however, we have seen pollination begin in early February! This early tree pollination is what accounts for the earlier symptoms of hay fever felt by allergy sufferers in the Washington, DC area. Tree pollen also causes or aggravates both asthma and/or allergic rhinitis. Again, tree-sensitive individuals may experience nasal congestion, post-nasal drip, runny nose, sneezing, itchy nose, itchy throat, itchy eyes, watery eyes, puffy eyes, redness of the eyes, snoring, sinus pain, headaches, sinus congestion, sinus pressure, coughing, chest tightness, wheezing, and/or shortness of breath depending on whether they have asthma symptoms, allergic rhinitis symptoms, or both.

It must be stated that many allergy sufferers are allergic to more than one of these allergens (i.e., allergic to dust, molds, and tree pollen), and thus may exhibit far worse symptoms than if they were allergic to only one or two of them. In these individuals with multiple allergen sensitivity, they will most likely have allergy symptoms for much longer than the month of February or even one season. They usually have allergic rhinitis and/or asthma symptoms throughout the year.

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

Allergy Skin Testing in Children

Many parents wonder at what age can children be skin tested for allergies?

Skin testing is a simple and common procedure used to detect what an individual is sensitized (i.e., allergic) to. It entails the application of a small amount of a chemical antigen, which is extracted from the natural allergy causing substance, on the skin and then interpreting the result after approximately 15 to 20 minutes. Allergic individuals carry proteins called specific antibodies. These antibodies, which are found in the bloodstream, react to various external allergenic triggers depending on the sensitivity of the child.

When the antigen or allergen is introduced into the top layers of the skin with a small plastic toothpick-like applicator, the corresponding antibodies react with the antigen and release chemicals, such as histamine, at the site of reaction. These chemicals cause stretching of the blood vessel walls as well as fluid leakiness into the surrounding tissues. A positive skin test reaction will appear as a small raised bleb or wheal with redness surrounding the raised bleb at the site of the skin test area. This reaction confirms the presence of specific antibodies against the antigen and thus proves that the child is allergic to the substance being tested since it triggered the production of these antibodies.

The ability of the skin to react to outside allergy-causing substances is present at birth. It is true that most children do not develop sensitivities to outdoor allergens such as tree, grass, and/or weed pollens until about the age of 2 or 3. However, they can be sensitized to indoor allergens (i.e., dust mites, pet dander, cockroach) much earlier than that. Many infants can be allergic to foods even during the first few weeks of life. Since this is true, it is appropriate to skin test young children as soon as they develop allergy-related symptoms.

The consideration of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is not the only reason to skin test children. If we can detect which food a child is sensitized to, we can prevent food-induced reactions by eliminating the offending food and substituting it with suitable alternatives. The identification of specific indoor environmental allergy triggers in young children will also enable us to implement proper control measures in order to reduce their exposure to those allergens which will in turn reduce their symptoms and decrease the need for medications.

Allergy skin testing is mainly done in children when one is trying to assess if a child may have food allergies, allergic rhinitis (i.e., hay fever), insect sting (i.e., bees, wasps, hornets, yellow jackets) allergies, medication allergies, and/or asthma. Although skin testing is the preferred method, the allergist will determine which type of allergy testing is appropriate for each child depending on whether the child is taking a medicine that may prevent or reduce a reaction to a skin testing substance, has a skin disorder that makes it difficult to see the results of skin testing, or has had a previous allergic reaction to skin testing with severe symptoms, which is extremely uncommon. Skin prick testing in children causes very little discomfort and is well tolerated. It is also safe and as stated above, adverse effects from skin testing are extremely rare.

The board certified allergy specialists at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about allergy skin testing for both children and adults. Dr. Michael Kletz and Dr. Appaji Gondi at Black and Kletz Allergy, have been diagnosing and treating individuals with hay fever (i.e., allergic rhinitis), asthma, sinus problems, insect sting allergies, hives (i.e., urticaria), eczema (i.e., atopic dermatitis), swelling episodes (i.e., angioedema), food and medication allergies, and immunological problems for more than 60 years combined. We have an office in Washington, DC and 2 other offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA. All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations are also Metro accessible. There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. For an immediate appointment, please call us or you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy pride themselves in providing excellent state-of-the-art allergy and asthma care in a professional and compassionate environment.