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Summertime Allergies

Summertime in the metropolitan Washington, DC, Maryland, and Northern Virginia area, brings a lot of allergies for allergy sufferers. For most of us, we see the coming of Summer as a beautiful event every year because of the warmer weather and longer days it brings us. People with allergies however see the coming of Summer as a mixed bag of good and bad. Even though they may be happy with the advantages of warmer weather and daylight savings time, they are not so happy with the allergy symptoms that also occur at the same time.

In the Washington, DC metro area, tree pollens are released in the early Spring and may persist until early-June. In fact, the beginning of the tree season has come earlier and earlier over the last decade. Tree pollen is often detected in mid-February and occasionally has been seen as early as January in the Washington, DC regional area. Grass pollen usually begins to be seen in May and typically can be found throughout the Summer lasting until August. In addition, molds are seen throughout the Summer, particularly in the Washington, DC area which was built on a swamp. The humid weather is an aggravating factor for allergies and a “friend” of mold growth. Also keep in mind that normal indoor allergens such as dust mites, pet dander, and cockroaches are still present in the Summer and thus still play a major role in affecting allergic individuals in the Spring, as well as the rest of the year.

The allergies that individuals have in the Summer are referred to as allergic rhinitis (i.e., hay fever) and/or allergic conjunctivitis (i.e., eye allergies). These allergy symptoms may include sneezing, runny nose, itchy nose, nasal congestion, post-nasal drip, itchy throat, sinus congestion, sinus headaches, fatigue, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Hay fever is an interesting name because individuals with hay fever do not get a fever and they are not necessarily allergic to hay. It was initially called hay fever because hay is typically harvested in the Fall and many people had allergy symptoms in the Fall. It just so happens that ragweed pollinates at the same time that hay is harvested in the Fall, so the words hay fever actually refer to ragweed allergies in the Fall. Likewise, the words rose fever refers to tree pollen allergies. Similarly to the term hay fever, patients with rose fever had no fevers and they were not allergic to roses. It just so happens that roses bloom in the Spring when trees and grasses pollinate. Thus, rose fever refers to the Spring allergies caused by the release of tree and grass pollen.

Asthmatic individuals may experience chest tightness, wheezing, coughing, and/or shortness of breath in the Summer. In addition to the increased humidity found in the Washington, DC metropolitan area, more exercise, excessive heat, and increased air pollution (i.e., smog) are factors that occur more often in the Summer than that of other seasons. These factors may trigger or exacerbate asthma in certain sensitive individuals.

The diagnosis and treatment of Summer allergies and/or asthma begins with a comprehensive history and physical examination. Allergy skin testing or allergy blood testing is frequently done in order to identify the aeroallergen responsible for causing the annoying allergy symptoms. Medications are usually prescribed which may include oral antihistamines, nasal corticosteroids, oral decongestants, leukotriene antagonists, nasal antihistamines, nasal anticholinergic agents, eye drops, inhaled corticosteroids, and inhaled beta-agonists. In cases of perennial, multi-seasonal, and/or severe symptoms, allergy injections (i.e. allergy shots, allergy immunotherapy, allergy desensitization, allergy hyposensitization) to the responsible allergens usually provide long-term benefits and reduces the need for allergy or asthma medications.  Allergy shots are effective in 80-85% of patients and are generally taken for 3-5 years.

In addition to environmental allergies (i.e., pollens, molds, dust mites, pets), venomous stinging insect reactions are more common in the Summer than that of other months. Honey bees, yellow jackets, wasps, yellow-faced hornets, and white-faced hornets are the stinging insects native to the Washington, DC metro area. In other warmer and more southern areas of the U.S., the fire ant is a stinging insect that may also cause serious anaphylactic reactions. Anaphylactic reactions to individuals with insect sting allergies may be life-threatening and it is important to see an allergist if one has a reaction to a venomous flying insect sting. The board certified allergist, like the ones at Black & Kletz Allergy will evaluate the stinging victim with allergy testing to the stinging insects and then recommend a course of treatment. This treatment may range from a prescription for a self-injectable epinephrine device (i.e., EpiPen, Auvi-Q, Adrenaclick) to a prolonged course of allergy shots with insect sting venoms (i.e., venom immunotherapy) depending on the patient’s reaction history.

The board certified allergy specialists at Black and Kletz Allergy have been diagnosing and treating allergies, asthma, and insect sting allergies for more than 5 decades in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We see both adults and pediatric patients. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each of our 3 locations. Our Washington, DC and McLean, VA offices are Metro accessible. Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line. If you suffer from allergies, asthma, and/or insect sting allergies, please call one of our offices to schedule an appointment. You may also 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 advanced allergy treatment modalities in a amiable, considerate, and professional environment.

Asthma Triggers

Asthma is a chronic inflammatory disorder affecting the lower respiratory tract. The lower respiratory tract includes the muscular tubes that carry air in and out ofthe lungs as well as the tissues in the lungs where gas exchange takes place. The inflammation found in individuals with asthma is usually associated with inflammation of the upper respiratory tract, which includes the nose and the sinuses.

The symptoms of asthma may include a feeling of chest tightness or heaviness in the chest, wheezing (i.e., high-pitched whistling type of noise during breathing), coughing, and/or shortness of breath/difficulty in breathing. The frequency of these symptoms varies depending on the severity of the asthma. The symptoms can be intermittent or persistent. The severity is also classified as either mild, moderate, or severe.

Asthma usually begins in childhood, although it can also be diagnosed for the first time in adulthood. The course of asthma is variable. The symptoms can be mild, moderate, severe, frequent, infrequent, intermittent, and/or persistent at various times throughout one’s life.

The underlying cause for most cases of asthma is a genetic predisposition. However, several factors in the environment play a role in determining the frequency and severity of asthma symptoms. These external factors “trigger” flare-ups or exacerbations of the condition in most individuals.

Common triggers of asthma:

1. Infections: Both upper and lower respiratory infections, especially the ones caused by viruses, are notorious for triggering and aggravating asthma leading individuals to visit emergency departments. In some cases, hospitalizations are required in order to treat the patient effectively. Several viruses such as rhinoviruses, adenoviruses, myxoviruses, and coronaviruses are well-known to exacerbate asthma. Frequent hand washing, avoiding exposure to “sick” people, and timely immunizations to viruses and bacteria (e.g., influenza, coronavirus, respiratory syncytial virus (RSV,) shingles, pneumococcus) can minimize the risk of asthma flare-ups.

2. Allergens: In sensitized individuals, exposure to indoor allergens (i.e., molds, dust mite, animal dander, cockroaches), and outdoor allergens (i.e., tree pollen, grass pollen, weed pollen) could set off more frequent and more severe asthma symptoms. Environmental controls and allergy desensitization with allergen injection therapy (i.e., allergy shots, allergy immunotherapy, allergy hyposensitization) is very helpful to better control and prevent asthma symptoms, as they are effective in 80-85% of the patients that take them.

3. Irritants: Dry air, cold air, excessive humidity, smoke, pollution, chemical aerosol sprays, fragrances, colognes, and other strong odors may irritate the airways of the lungs and result in exacerbations of asthma. As these irritants cannot be “desensitized” by traditional allergy immunotherapy, avoidance is the key to reducing the risks of more severe asthma when irritants are the trigger.

4. Physical Exertion: Exercise can trigger acute attacks of asthma in certain individuals. Proper conditioning, regular use of preventive maintenance medications, and receiving bronchodilator inhaled medications prior to exercise can all help to reduce asthma exacerbations that are caused by physical exertion.

5. Occupational Asthma: Hairstylists, bakers, farmers, welders, seafood processors, textile workers, carpenters, pharmaceutical workers, chemical manufacturers, food processors, animal handlers, metal workers, painters, and adhesive handlers are at increased risk for asthma flare-ups as they may inhale harmful gases, fumes, chemicals, dyes, plastics, metals, enzymes, dust, animal proteins, and/or other particulates. These substances are known to cause wheezing, coughing, and/or shortness of breath in certain occupations, as well as exacerbations in asthmatics in individuals who work there.

The diagnosis and treatment of asthma begins with the allergist performing a comprehensive history and physical examination. The diagnosis is further enhanced by obtaining a pulmonary function test. Occasionally a chest X-ray may be needed to rule out other respiratory diseases. Allergy skin testing or blood testing is often done since both indoor and outdoor aeroallergens are often a trigger in many asthmatics. The treatment of asthma begins with prevention. It is advisable for an asthmatic individual to try to avoid triggers that are known to cause or exacerbate their asthma symptoms. Medications are utilized in the management of asthma in most asthmatics. Every asthma patient should have a short-acting beta2 agonist rescue inhaler rescue medication (e.g., albuterol, ProAir, Proventil, Ventolin, Xopenex, levalbuterol, pirbuterol, Maxair, AirSupra) on hand to use if symptoms develop or to use prophylactically before exposure to a known trigger such as exercise. In addition, many patients will need other medications in order to control their asthma symptoms. Some other medications used to treat asthma may include, inhaled corticosteroids, inhaled long-acting beta2 agonists, oral leukotrienes, oral phosphodiesterase inhibitors, oral beta2 agonists, and biologicals [e.g., Xolair (omalizumab), Nucala (mepolizumab), Fasenra (benralizumab), Dupixent (dupilumab), Tezpire (tezepelumab)]. Allergy injections, as mentioned above may also be beneficial in the treatment of asthma as it helps reduce and prevent allergic triggers such as dust mites, molds, pollens, pets, and cockroaches. It is important to note that the treatment of asthma is individualized as it differs with each individual depending on the patient’s symptoms, frequency of symptoms, severity of symptoms, triggers, medications tried in the past, and the patient’s underlying conditions.

The board certified specialists of Black & Kletz Allergy always strive to keep abreast of new developments in the field of Allergy, Asthma, and Immunology in order to offer new and emerging diagnostic and therapeutic modalities, as soon as they are available. Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at each location. In addition, the Washington, DC and McLean 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. The allergy doctors of Black & Kletz Allergy see both children and adults in the Tysons Corner, VA, McLean, VA, and Manassas, VA areas and we have been serving the greater Washington metropolitan area for over 50 decades. Please call one of our convenient offices to make an appointment or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.

Insect Sting Allergies Update

As we enter into Spring, not only should allergy-sensitive individuals be on the lookout for those annoying pollen allergy symptoms, but they should be aware of their surroundings for venomous flying insects. In the Washington, DC, Maryland, and Northern Virginia metropolitan area, the most common venomous flying insects are honey bees, wasps, yellow jackets, white-faced hornets, and yellow-faced hornets. The summer months are the peak months that insect stings occur. In the U.S., about 3% of the population experience allergic reactions to the venom of flying insect stings. Approximately a half a million individuals seek emergency room care every year for insect sting reactions in the U.S. Unfortunately, there are roughly 50 deaths reported each year from these insect sting reactions.

Honey bees live in “honeycombs” or colonies that are found in crevices of buildings or in hollow trees. Yellow jackets, on the other hand, generally nest underground and are rarely seen in the cracks in buildings or in trees. Hornets produce brown or grey oval-shaped nests above the ground which are typically located in the branches of trees or in shrubs. Wasps make nests that are made up of a paper-like material which may also be found in shrubs, but are also common under eaves and behind window shutters.

Honey bees, wasps, yellow jackets, white-faced hornets, and yellow-faced hornets all inject their venom into their subjects when they sting their prey. If a sensitive individual has an allergic reaction to a sting, they may develop either a local reaction or they may develop a more serious systemic reaction. A local reaction usually entails redness, itching, and/or swelling at the site of the sting. A systemic reaction, on the other hand, may include generalized itching, hives, swelling, chest tightness, shortness of breath, wheezing, throat tightening, abdominal cramping, fainting, and/or a drop in blood pressure. Patients with reactions are prescribed self-injectable epinephrine devices (e.g. EpiPen, Auvi-Q, Adrenaclick) so that they can be used immediately. A person who has used a self-injectable epinephrine device should immediately go to the closest emergency room.

After a sting, in some instances, an individual may have toxic (i.e., non-allergic) reaction instead of an allergic reaction, particularly if stung by several insects at once. In a toxic reaction, the body reacts to the venom as if it was a poison. This typically occurs because the individual is exposed to an over-abundance of venom at one time. A toxic reaction may cause symptoms similar to those of an allergic reaction, but in addition, may cause non-allergic symptoms such as nausea, fever, and/or seizures.

It is interesting to note that of all the venomous flying insects mentioned above, only the honey bee leaves the sting in the victim. If you are stung by a honey bee and notice the stinger stuck in your skin, you should not pull it out, as doing so may cause more of the venom to be introduced into your body. The recommended way to remove the stinger is to scrape it off with something like your fingernails, a credit card, or other flat surface. It should also be noted that honey bees will die after stinging their victims because their stingers have barbs. After stinging, as the bees try to withdraw their stingers from their prey, their abdomens rupture causing a large hole which causes the demise of the bees. It is also interesting to be aware that, in general, bumblebees do not sting. They can sting but it is uncommon. They tend to sting only when the feel threatened. Since a bumblebee’s stinger has no barbs and is therefore smooth, it does not die after stinging its prey, since their abdomens are not ruptured after stinging. Another interesting fact is that only female bumblebees can sting, as their stingers are used as a modified egg-laying device which is only present in females.

One other well-known venomous insect to bring up is the fire ant. Fire ants bite their victims. The 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. Occasionally individuals are very sensitive to the venom and will manifest systemic symptoms such as generalized itching, hives, swelling, chest tightness, shortness of breath, wheezing, throat tightening, abdominal cramping, fainting, and/or a drop in blood pressure, just like with venomous flying insects. Fire ants of course do not fly. In addition, they do not pose a large threat to residents of the Washington, DC metro area because they live in the warmer climates of the southern U.S., although they have been found in Virginia and Maryland. At least for now, fire ants are not prevalent as far north as Washington, DC, but who knows what will happen in the future, especially if global warming takes more of a stronghold.

The diagnosis of a venomous insect sting allergy is performed by board certified allergy specialist like the ones at Black & Kletz Allergy. The allergy doctor will complete a comprehensive history and physical examination. Depending on the patient’s history, allergy testing to flying insects is usually the next recommended step. Allergy testing is usually performed by allergy skin testing, although blood testing is occasionally done depending on the patient’s history.

The treatment of venomous flying insect sting allergy consists of venom immunotherapy (i.e., allergy desensitization, allergy shots, allergy injections). If the results of the skin testing are positive to any of the stinging insect venoms, it is highly recommended that the patient complete a course of venom allergy immunotherapy as it is extremely effective in preventing further anaphylactic reactions from venomous flying insect stings. Venom allergy immunotherapy involves receiving increasingly greater 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 roughly equivalent to the amount of venom in an actual sting of a flying insect. In addition to venom immunotherapy, all patients who are allergic to any of the venomous flying insects should carry a self-injectable epinephrine devices (e.g. EpiPen, Auvi-Q, Adrenaclick) as mentioned above. A patient who has used a self-injectable epinephrine device should immediately go to the closest emergency room.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating venomous flying insect allergies. We are board certified to treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from insect sting allergies, Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a comfortable, thoughtful, and professional environment.

Acute Sinusitis Update

Acute sinusitis is another way of saying an acute sinus infection. Acute, in this context, refers to a sinus infection that is less than 4 weeks old. Chronic, on the other hand, refers to a sinus infection that has persisted for more than 12 weeks. There is also a category called subacute. Subacute refers to the vast majority of sinus infections are acute in nature. Most are viral in origin and thus do not need to be treated with antibiotics. The severity of a sinus infection may vary from mild to severe. Often an individual may experience mild cold-like symptoms. In some individuals however, severe symptoms may occur which may cause that person to feel very ill, prompting them to go to an urgent care center or an emergency room for treatment.

There are 4 types of sinuses located in one’s facial bones (i.e., skull). These sinuses serve to lighten the weight of one’s skull, help with voice resonance, and to filter and moisten inhaled air when breathing through one’s nose. The names of the sinuses are as follows:

  1. Frontal sinuses: These sinuses are located in the center of the forehead region.
  2. Ethmoid sinuses: These sinuses are located just above the upper nose between the eyes. They are actually comprised of between 6-12 small air cells as opposed to large sacs like the other sinuses.
  3. Sphenoid sinuses: These sinuses are located behind the eyes but in the deeper recesses of the skull.
  4. Maxillary sinus: These sinuses are located behind the cheekbones. They are the largest sinuses.

The sinuses are vulnerable to becoming infected due to their physical nature, particularly the maxillary sinuses. When someone develops a “cold” or has nasal congestion for other reasons such as allergies (i.e., hay fever or allergic rhinitis), the small holes that drain the sinuses become clogged and/or narrowed. This obstruction of the draining system may cause a “backup” in the draining process. As a result, the fluid that has built up in the sinuses stays in the sinus since it is unable to drain properly. The fluid in the sinuses is more likely to get infected given the stagnant nature of the fluid. Fluid that just “sits” in the sinuses is very susceptible a secondary infection, particularly with a bacteria.

The pathogenesis of an acute sinus infection is more understandable if one compares the sinuses to a pond and river. We all know that algae grow in ponds because the water is stagnant. We also know that algae do not usually grow in a river due to the constant motion of a river. Regarding sinus infections, this analogy can be evident as follows: When there is no obstruction to the drainage of a sinus, the sinus acts like a river which makes it is less likely for bacteria to grow. On the other hand, when there is an obstruction to the drainage of a sinus (i.e., nasal congestion, tumors, nasal polyps), the sinus acts like a pond which makes it more likely for bacteria to grow and thus cause a sinus infection.

The symptoms one may experience when having an acute sinus infection may include any one or more of the following: The symptoms of acute sinusitis typically involve one or more of the following: nasal congestion, post-nasal drip, sinus pressure, sinus headaches, discolored nasal discharge, sore throat, clogged ears (i.e., Eustachian dysfunction), fatigue, bad breath, pain in the teeth and/or ears, cough, fever.

The diagnosis of acute sinusitis usually is made by taking a comprehensive history with an additional physical examination. Most of the time other diagnostic tests are not needed, however other methods are occasionally used in order to diagnose acute sinus infections. Such approaches may include X-rays (i.e., CT scan, MRI), direct visualization (i.e., rhinolaryngoscopy), bacterial and fungal cultures, and allergy testing.

The management of acute sinus infections ironically usually requires no treatment at all because most acute sinus infections are viral in nature. Most of the time these viral sinus infections resolve on their own. Hydration by drinking plenty of water is usually recommended. Antibiotics however may be necessary in some individuals who have a bacterial infection whether primary or secondary. Saline irrigation, decongestants, nasal corticosteroids (e.g., Flonase, Nasacort AQ, Rhinocort Aqua), and/or over-the-counter analgesics (e.g., Tylenol, Advil, Aleve) are often also used in order to help alleviate the symptoms of an acute sinus infection. In addition to treating acute sinus infections, it is also important to try to prevent them. Individuals with allergic rhinitis (i.e., hay fever) are generally more prone to sinus infections since they often have nasal congestion, which predisposes them to sinus infections. It is prudent to evaluate someone for allergies if they are prone to sinus infections. Allergy skin testing can be done either by skin testing or blood testing. There are many types of allergy medications (i.e., antihistamines, decongestants, leukotrienes, nasal medications, eye drops) that are utilized in both the prevention and treatment of acute sinusitis. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) may also be recommended in selected individuals as they are very effective in reducing or preventing allergy symptoms (i.e., nasal congestion, sinus congestion) in 80-85% of individuals on allergy shots.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating acute, subacute and chronic sinusitis as well as other allergic and immunological conditions. Our allergy specialists treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office directly or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer any sinus-related symptoms, we are here to help alleviate or hopefully end these undesirable symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a welcoming and professional setting.

New Treatment for Food Allergies

Immunoglobulin E (IgE) is an antibody that mediates allergic reactions. It interacts with the proteins (i.e., antigens, allergens) during an allergic reaction causing various chemicals and substances to be released into the bloodstream. It is those chemicals and mediators such as histamine, leukotrienes, prostaglandins, etc. that are responsible for the clinical manifestations of allergic reactions. The allergic reactions range in severity from mild itching to life-threatening anaphylactic emergencies. The offending antigens can be present in a host of different settings ranging from environmental allergens such as dust mites, animal dander, pollen, etc., to food allergies, to insect venoms allergies as well as to other allergic situations.

Xolair (i.e., omalizumab) is an antibody that blocks the actions of the IgE antibody. Xolair is classified as a “biologic” medication. It has an anti-IgE quality where it blocks the action of IgE antibodies, thus reducing the risks of allergic reactions. We have been successfully using Xolair to control allergic asthma for more than 20 years. It has also proved to be very successful in controlling chronic unexplained hives (i.e., chronic urticaria) inadequately responsive to various antihistamines in high doses. It was also approved in 2020 to treat chronic sinusitis with nasal polyps.

Millions of Americans have food allergies. Approximately 40% of children with food allergies are allergic to more than one food according to Food Allergy Research & Education (FARE). Until recently, the management of a food allergy only included the complete avoidance of the offending food, as well as to always carry an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick) for emergency use in case of a severe allergic reaction triggered by an accidental exposure to the offending food. A form of inducing tolerance to the allergic food (i.e., oral immunotherapy) has been approved by the U.S. Food and Drug Association (FDA) only for peanut in children between 4 and 17 years of age.

The results of a landmark clinical trial called OUtMATCH (i.e., Omalizumab as monotherapy and as adjunct therapy to multi-allergen OIT in food allergic children and adults) were presented at the annual scientific meeting of the American Academy of Allergy, Asthma and Immunology on February 25, 2024 in Washington, DC. The study was also simultaneously published online by the New England Journal of Medicine.

The first stage of the phase 3 OUtMATCH trial was designed to see if taking omalizumab increased the threshold for the amount of food that caused allergic reactions, thereby reducing the likelihood of reactions that might occur as a result of accidental exposures. The study team enrolled 177 children and adolescents ages 1 to 17 years and three adults ages 18 to 55 years, all with confirmed allergy to peanut and at least two other common foods among milk, egg, cashew, wheat, hazelnut or walnut.

The study participants who reacted to small amounts of these food allergens during oral food challenges were assigned at random to receive injections of either omalizumab or placebo. After 16 to 20 weeks of treatment, the participants were challenged again in a carefully controlled setting to see if they could tolerate a greater amount of food than they did at the outset.

The study results revealed that a 16-20-week course of the monoclonal antibody omalizumab increased the amount of peanut, tree nuts (cashew, hazelnut and walnut), egg, milk and wheat that multi-food allergic children as young as one-year could consume without a moderate or severe allergic reaction.

Nearly 67% of the participants who completed the treatment could consume a single dose of 600 milligrams (mg) or more of peanut protein, compared to less than 7% of participants who received placebo with 600 mg representing approximately 2.5 peanuts. This was at least 6 times the amount of peanut protein that participants could tolerate at the start of the trial. Treatment with omalizumab also yielded similar outcomes for egg, milk, wheat, cashew, walnut, and hazelnut at a threshold dose of 1,000 mg protein or more.

Based on these results, the FDA recently approved Xolair as a treatment for the reduction of Type I allergic reactions which are IgE-mediated, which includes anaphylaxis, that may occur with accidental exposure to one or more foods in adult and pediatric patients age 1 year and older with IgE-mediated food allergy. Xolair is to be used in conjunction with food allergen avoidance. Xolair is not however indicated for the emergency treatment of allergic reactions, including anaphylaxis.

In reality, the total avoidance of allergic foods is not always successful and many children and their families live in constant fear of a life-threatening reaction caused by an inadvertent exposure to the food(s) they are sensitized to. The condition may cause considerable psychosocial problems and may also negatively impact the nutrition of the patient.

This new treatment is not a license to eat the foods that one is allergic to, but it can be reassuring to families because the treatment substantially reduces the risks of severe reactions after accidental food exposures.

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 food allergies. 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 our office 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 5 decades and we pride ourselves in providing outstanding allergy and asthma care in a professional and pleasing environment.

Allergy to Nonsteroidal Anti-Inflammatory Drugs (NSAID’s)

Nonsteroidal anti-inflammatory drugs (NSAID’s) are a group of medications related to aspirin.  The group includes commonly used drugs such as ibuprofen (i.e., Motrin, Advil), naproxen (i.e., Aleve, Naprosyn), diclofenac (i.e., Voltaren), etodolac, (i.e., Lodine), among others.  These agents are widely used in order to reduce inflammation (e.g., decrease pain and reduce swelling of joints in various forms of arthritis).  They also help reduce fever caused by infections as well as relieve discomfort after injuries.

NSAID’s act by blocking an enzyme called cyclooxygenase-1 (COX-1).  Cyclooxygenase-1 acts by producing compounds known as prostaglandins.  These prostaglandins are involved in tissue inflammation which results in pain, swelling, and/or fever.  Since NSAID’s block the enzyme cyclooxygenase-1, they also inhibit the production of prostaglandins.  Thus, NSAID’s will decrease tissue inflammation and reduce pain, swelling, and fever.  Aspirin not only blocks the enzyme cyclooxygenase-1, but it also blocks the cyclooxygenase-2 COX-2) enzyme as well.  Thus, aspirin also leads to a decrease in tissue inflammation as well as a reduction in pain, swelling, and fever.  In addition, aspirin decreases the activity of blood components known as platelets.  While platelets are known to promote the clotting of blood, aspirin, on the other hand, helps prevent blood clots due to its antagonistic effect on platelets, which reduces the risk of heart attacks and strokes.

Common side effects of aspirin may include bruising and abdominal pain.  Less commonly, a stomach ulcer or stomach bleeding may occur.  Very high doses of aspirin may cause confusion or ringing in the ears (i.e., tinnitus).

Aspirin can cause allergic reactions in some individuals.  These symptoms may include flushing, generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema), nasal congestion, runny nose, and/or asthma usually within an hour of taking a tablet.  These reactions occur in approximately 1% of people receiving aspirin.  It should be pointed out that in patients with hives, nasal polyps and asthma, the risk could be as high as 30%.  The co-existence of asthma, nasal polyps, and aspirin sensitivity is termed Samter’s triad or aspirin exacerbated respiratory disease (AERD).

The manifestations of aspirin and NSAID sensitivity may include:

  • Itching, usually generalized
  • Hives
  • Swelling of soft tissues such as eyelids, lips, tongue, throat, etc.
  • Chest tightness, wheezing, coughing, shortness of breath
  • Dizziness and altered sensorium

Diagnosis:

The diagnosis of NSAID allergy is based mostly on the history of adverse effects within a short time after receiving the drug.  There is no reliable blood or skin allergy test for confirming or excluding the sensitivity to aspirin and NSAID’s.  The only way to assess aspirin sensitivity is by a graded open challenge under strict medical supervision.  Challenge testing is not always necessary, but may be advised in some circumstances in order to prove that sensitivity exists, or to prove the safety of an unrelated medication.

Treatment:

The treatment of NSAID allergy is directed at the relief of symptoms with antihistamines, bronchodilators, and epinephrine in cases of anaphylaxis.

Prevention:

Preventing NSAID reactions involves the total avoidance of aspirin and all cross- reacting NSAID’s.  As there are so many brand names of the same medication, and so many types of medications available, accidental exposure to aspirin or NSAID’s may occur.  NSAID’s are common ingredients of many over-the-counter painkillers and cold/flu remedies.

If you have ongoing hives, you should avoid aspirin and NSAID’s unless you know that you can tolerate them without a problem.  If you are already taking regular aspirin (for example, to prevent heart attack or stroke), or a regular arthritis tablet for the treatment of pain, then you should consult with your primary care physician, rheumatologist, or cardiologist about stopping the aspirin.  Your physician may tell you that you do not need to stop taking the aspirin unless your hives clearly get much worse after taking the medicine.  If you have had an allergic reaction to one type of NSAID, a challenge with a different drug can be considered if you need to take aspirin or an anti-inflammatory medication for the treatment of arthritis.

Some NSAID’s such as celecoxib (i.e., Celebrex) and meloxicam (i.e., Mobic) predominantly inhibit the cyclooxygenase-2 (COX-2) enzyme rather than the cyclooxygenase-1 (COX-1) enzyme.  Thus, they can be taken safely by many patients (but not all), who have aspirin and NSAID sensitivity.  Acetaminophen (i.e., Tylenol) and codeine do not usually cross-react with NSAID’s and can usually be taken safely for the relief of fever and/or pain.

Aspirin desensitization is a procedure that could be helpful in some patients with AERD to improve asthma control, inhibit nasal polyp growth, and to enable aspirin therapy for reducing the risk of blood clots in order to protect the heart and the brain.

The allergy specialists at Black & Kletz Allergy see both adult and pediatric patients and have over 5 decades of experience in the field of allergy, asthma, and immunology.  If you have or suspect you have a sensitivity or allergy to aspirin, NSAID, or any other medication, please call our office.  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 over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

Allergies in the Spring Update

Well, it is almost Spring again. If you are one of those individuals with Spring allergies, you know that it is time for those miserable allergy symptoms to reappear unless you do something about it. The primary cause of Spring allergies is the tree pollen, although secondary allergens often include molds. The classic symptoms of Spring allergies may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, sinus headaches, fatigue, itchy eyes, watery eyes, and/or redness of the eyes. In addition, some individuals, especially those with asthma, may also develop or experience worsening of chest tightness, coughing, wheezing, and/or shortness of breath.

The pollination of trees in the Washington, DC, Northern Virginia, and Maryland metropolitan area usually begins in March and generally lasts until early May. It is interesting to note however that the pollination of trees throughout the country has been beginning earlier and earlier as time goes on, particularly in the last 20 years. Tree pollen is now found in the Washington, DC area in early February and occasionally in January when there are unusually warm days. As a result, sensitive individuals are finding themselves bothered by tree pollen much earlier in the year than in the past. Increasing levels of carbon dioxide are being documented every year causing many scientific researchers to believe that climate change is contributing to this trend.  Carbon dioxide is the primary gas needed for the growth and development of trees along with nutrients, water, and sunlight. Changes in the climate may impact the pollen seasons of trees, grasses, and weeds by both increasing the amount of pollen produced as well as by extending the duration of the pollen season.

Tree pollination is for all intents and purposes the reproductive season for the trees. Tree pollen grains are released into the atmosphere in order to fertilize the ovules of other trees.  Tree pollen is produced and dispersed by the wind throughout the day, but their counts are highest in the morning hours. Birch, oak, cedar, elm, ash, cottonwood, hickory, and maple are the predominant tree pollens in the Washington, DC metropolitan area.

A common fallacy is that if someone has a particular tree (i.e., oak) or many of those specific trees (i.e., oak) in their yard, they are more likely to have allergy problems from those trees if they are allergic to them. This in fact is not true since pollen is disbursed all over the region and it is not unheard of for the pollen to travel over 200 miles. For this reason, people can suffer from tree pollen allergy (i.e., oak) even if they live fairly far away from that nearest tree (i.e., oak).

Another misconception people have is that they are allergic to flowers that bloom in the Spring. These individuals assume that because they are experiencing allergy symptoms in the Spring when the flowers are blooming that they are allergic to the flowers. In reality, the flowers happen to be blooming the same time that the trees are pollinating and the allergy sufferers equate their worsening allergy symptoms with the flowers that they see. It is the tree pollen that is causing their hay fever (i.e., allergic rhinitis and allergic conjunctivitis) symptoms and not the flowers. As a matter of fact, another name for hay fever is “rose fever.” It is called rose fever because roses bloom in the Spring, at the same time tree pollen levels are high. It is interesting that the names hay fever and rose fever are also inaccurate in that there is no allergy to hay or roses and there is also no fever associated with the condition.

The diagnosis of Spring allergies begins with taking a comprehensive history and performing a complete physical examination.  Allergy testing by either skin testing or blood testing is performed in order to identify the offending allergen.  Once the allergen is identified, preventive measures are recommended in order to reduce the exposure to that allergen.

Some measures to diminish exposure to pollen which helps lessen symptoms may include the following:

  • Track the the local pollen counts on our homepage by clicking Today’s Pollen Count and avoid outside activities on days with high pollen counts.
  • Avoid activities in the early morning since the pollen counts are at their highest early in the mornings.
  • Plan to go outdoors after it rains as the pollen count is lower after a rain.
  • Shower before going to bed in order to wash the pollen off.
  • Close your windows in your house and automobiles, as well as run your air conditioning in order to help prevent pollen exposure.
  • Leave your shoes outside so you do not bring the pollen into the home.
  • Change one’s clothes and wash them after being outside.
  • Wash your pet before the animal comes inside.

The treatment of Spring allergies usually includes prevention of the offending allergen(s), therapy with medications, and/or allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization). There are a variety of medications that may be used in order to treat Spring allergies. Oral antihistamines, oral decongestants, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular mast cell stabilizers, inhaled bronchodilators, inhaled corticosteroids, and inhaled anticholinergics are some of the ammunitions used to prevent and treat allergy and asthma symptoms that may occur in the Spring and other times as well. Allergy immunotherapy, (more commonly referred to as allergy shots), are very effective. They work in approximately 80-85% of the patients who take allergy shots. They take about 4-6 months however to work and the average person is on them for about 3-5 years.

If you are suffering from a prolonged “cold” and/or are not sure if your symptoms may be due to allergies and you would like to be seen by one of our board certified allergists at one of Black & Kletz Allergy’s 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment. Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day. We offer parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations. We also offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Black & Kletz Allergy provides a welcoming and thoughtful environment for you to get the state-of-the-art allergy, asthma, and immunology treatment that we have been providing the community for more than 5 decades.

Allergies and Asthma Due to Cockroaches

It is estimated that approximately 33% of people are allergic to cockroaches. Cockroaches are quite allergenic, which may attribute to the high number of individuals who are allergic to these nasty insects. There are over 3,500 species of cockroaches worldwide. Cockroaches have been around for more than 300 million years. They have adapted to living in all types of climates and are found all over the world. Cockroaches prefer to live in moist and warmer environments, so it quite common for them to live in bathrooms, basements, and kitchens. They are nocturnal, so they are rarely seen during the day.

Cockroaches also tend to be more common in the inner cities where between 30-60% of asthmatics living in an urban area are said to be allergic to cockroaches. This is particularly true of children living in inner cities where cockroaches are a major cause of asthma in these children. In fact, the percentage of cockroach sensitivity increases to between 55-80% in inner city children with asthma.

Most urban settings, including Washington, DC and Baltimore, MD, have quite a number of cockroaches living amongst them.  It is estimated that more than 75% of homes and apartments in the inner city have cockroaches present.  Even more appalling is that the number of cockroaches living in each home or apartment ranges from between 1,000 to over 300,000 insects.  If you do the math, then for every cockroach you see in the home, there are approximately 800 cockroaches in that home that you don’t see.

When one talks about cockroaches causing allergies, it refers mostly to symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and asthma. The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus headaches, and/or fatigue. Allergic conjunctivitis symptoms may include itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. Asthma symptoms are usually characterized by wheezing, chest tightness, coughing, and/or shortness of breath. There is a very strong correlation between chronic asthma and cockroach allergy. Other environmental allergens such as dust mites, mold, and pets can also cause year-round allergy symptoms and must also be evaluated when diagnosing an allergic or asthmatic patient for perennial symptoms.  In addition to causing allergies and asthma, cockroaches can also carry and transmit various diseases such as gastroenteritis, cholera, dysentery, hepatitis, salmonella, typhoid fever, leprosy, parasites (i.e., roundworms, Giardia, Toxoplasmosis), polio, etc.

The causative agent of cockroach allergy is the cockroach allergens themselves.  These allergens are found in the feces, saliva, and exoskeleton of the cockroach.  The most common cockroach allergens are Bla g 1, Bla g 2, and Per a 1.  Other cockroach allergens include Bla g 4, Bla g 5, Bla g 6, Bla g 7, Bla g 8, Bla g 9, Per a 2, Per a 3, Per a 4, Per a 5, Per a 6, Per a 7, Per a 8, Per a 9, and Per a 10. The latter are not as important in causing allergy symptoms to cockroach but they may play a role in some individuals.

The diagnosis of cockroach allergy begins with a comprehensive history and physical examination. Allergy skin testing or blood testing is often performed in order to confirm a cockroach allergy. In individuals with asthma, particularly inner city residents, a pulmonary function test is often performed. The management of cockroach allergies begins with preventing exposure to cockroaches. If there are cockroaches at home, getting a pest control company to help eliminate the cockroaches is your best start. In addition, there are some things that should be tried at home which may include:  making sure to close up any holes in the walls or baseboards in order to decrease entry and exit paths for cockroaches; not leaving dirty dishes in the sink or on kitchen countertops; not bringing food into the bedrooms; keeping the garbage and food in closed containers; and/or making sure that there are no leaky pipes or faucets. For the treatment of cockroach allergy, there are a plethora of medications that may be used to help alleviate the unwanted symptoms. Oral antihistamines, oral decongestants, oral leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular mast cell stabilizers and/or ocular antihistamines all can be used to decrease allergy symptoms caused by cockroach allergy. Asthma symptoms may be controlled with oral leukotriene antagonists, inhaled corticosteroids, inhaled long acting beta agonists, and/or inhaled short acting beta agonists. Oral corticosteroids may be needed in recalcitrant cases. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are a very effective means to treat cockroach allergy and are used in both adult and pediatric patients. They are efficacious in about 80-85% of the cases of allergic rhinitis, allergic conjunctivitis, and/or asthma. Most individuals are on allergy injections for approximately 3-5 years.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating cockroach allergies and asthma for more than 5 decades. We treat both pediatric and adult patients. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking. For further convenience, our Washington, DC and McLean, VA offices are Metro accessible. Our McLean office location offers a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. For an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. If you suffer from allergies and/or asthma symptoms, we are here to help lessen or hopefully end these undesirable symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a relaxed, thoughtful, and professional environment.