Category Archives: UNCATEGORIZED

Unusual and Uncommon Allergies

Most everyone is aware of the classic and common allergies that many individuals suffer from routinely.  Allergies to dust mites, molds, pollens, pets, and/or cockroaches usually manifest themselves as symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), and/or asthma.  Food allergies are not uncommon and it commonly known that the most common food allergens are milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish.  When people think of allergies of the skin, they often think of atopic dermatitis (i.e., eczema), allergic contact dermatitis (i.e., poison ivy, poison oak, poison sumac, cosmetic allergy), and hives (i.e., urticaria).  All of these allergies are relatively common but there are a number of allergies that are uncommon and/or unusual that are very interesting.  It is some of these more unusual and uncommon allergies that we will explore in the following paragraphs.

 

Uncommon Food Allergies:

 

  • Oral Allergy Syndrome (Pollen Fruit Syndrome; Pollen/Food-Associated

            Syndrome):  An allergic reaction in the mouth usually causing itching that

            occurs in certain allergic individuals that have certain pollen allergies.

            Classic examples include birch tree allergies and reactions to raw apples,

            kiwi, apricots, cherries, peaches, plums, pears, avocados, celery, and/or

            carrots.  Ragweed allergies and reactions to melons, cucumbers, zucchinis,

            and bananas.  In this disorder, the raw fruit or vegetable looks similar

            structurally to the pollen and the body “thinks” that the food is the pollen

            and an allergic reaction (e.g., itchy mouth) occurs.  Interestingly, if the food

            is cooked and or processed, the individual can usually tolerate the food

            without any symptoms.

 

  • Mammalian Meat Allergy:  Some individuals that are bitten by a Lone Star tick may develop a meat allergy due to the development of an antibody to a carbohydrate called galactose-alpha-1,3-galactose (i.e., alpha-gal).  This carbohydrate is found on all mammalian meat (e.g., beef, pork, lamb, venison, whale). When an individual with the alpha-gal antibody eats any mammalian meat, the meat triggers the release of the chemical called histamine.  It is the histamine that causes the allergic symptoms which usually appear 4-8 hours after the consumption of the meat. Symptoms may include generalized itching (i.e., pruritus), hives, and/or swelling (i.e., angioedema).

 

  • Chamomile Tea:  Chamomile is related to ragweed and some ragweed-sensitive individuals may also react to chamomile tea and chamomile lotions.  Symptoms can range from allergic rhinitis symptoms to anaphylactic shock, although it is rare to have such a violent reaction.

 

  • Gelatin Allergy:  Some individuals are allergic to gelatin; however, this allergy is rare.  Gelatin is a protein formed when connective tissue from animals is boiled.  Some individuals are allergic to this protein and when exposed, they can have an allergic reaction that may also be quite severe.  Gelatin may be found in chewy candies, frosted cereals, and in some vaccinations such as the flu shot.

 

  • Wine:  Certain individuals are hypersensitive to sulfating agents used in processing certain foods, beverages, and drugs.  Sulfur dioxide and several forms of inorganic sulfites that release sulfur dioxide when used as food ingredients are known collectively as sulfating agents.  The preservative sulfite is used in the production of wine and other foods. Some individuals, especially asthmatics, are sensitive to sulfites and should avoid certain foods that may contain sulfites such as sauces, gravies, soups, wine vinegar, processed meats, dried/frozen/canned fruits and vegetables, and occasionally salad bars.

 

  • Hot Dogs and Deli Meats:  Hot dogs and various deli meats are highly processed foods that contain many additives.  An allergic reaction after eating these meats could be due to any of these added ingredients.  It is believed however that nitrate and nitrite additives are generally the cause in most instances.

 

  • Water:  Yes, individuals can be allergic to water.  It is quite rare, however, there are some individuals who have a condition called aquagenic urticaria.  If one has this malady, the contact with water will cause itching and hives. There is no optimum treatment for this disorder at the present time

 

Uncommon Non-Food Allergies:

 

 

  • Latex Allergy:  Latex or natural rubber allergies can range from a mild irritation of the skin to a severe anaphylactic reaction.  Common latex products include latex gloves, condoms, dental dams, adhesive bandages, balloons, waistbands, tires, and pacifiers, to name a few.  It is interesting to note that there are similar proteins in natural rubber latex and certain foods (e.g., avocados, chestnuts, papaya, bananas, kiwis), so cross-reactivity can occur.

 

 

  • Sex:  There are individuals that have a disorder called seminal fluid hypersensitivity whereby they are allergic to the seminal fluid of a particular person.  It is generally an allergy to a specific man’s seminal fluid and not necessarily to all men. The symptoms can range from just a minor irritation on the skin, to hives, to anaphylaxis.  Symptoms can be avoided with the use of condoms. Many times, in vitro fertilization is needed in order for the couple to conceive without risk to the allergic individual.

 

  • Sunlight:  A small percentage of the population have a sensitivity to sunlight where they may develop hives, itchy skin, rash, nausea, and/or headache.  Solar urticaria is a condition where hives form upon exposure to sunlight.

 

  • Exercise:  Exercise may trigger a generalized itching, hives, swelling, asthma, and/or anaphylaxis, depending on the person.  These conditions are called, exercise-induced pruritus, exercise-induced urticaria, exercise-induced angioedema, exercise-induced asthma, and exercise-induced anaphylaxis respectively.  In some instances, an individual must exercise in the cold air for symptoms to occur. In others, a specific food must be eaten a few hours before exercise in order for there to be an allergic reaction.  This is called food-dependent-exercise-induced urticaria. An example of this is a person who can eat celery without problems and they can exercise without problems. However, if they eat celery within 2 hours before exercise, they will develop hives.  Patients with these conditions should never exercise alone and if they exercise, should always stop exercising at the first sign or symptom of their allergy.

 

  • Cold:  Cold can be a trigger for some individuals to develop generalized itching, hives, swelling, asthma, and/or anaphylaxis.  The names of the corresponding conditions are cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, cold-induced asthma, and cold-induced anaphylaxis respectively.  Similar to exercise above, these patients should avoid the cold, if possible.

 

  • Money:  Individual with nickel allergy may develop allergic contact dermatitis from handling coins.  Metal allergy is not that uncommon, but having reactions to holding coins is fairly uncommon.  Obviously, the condition is more prevalent in individuals who handle money more often such as bank tellers and cashiers.

 

  • Scratches:  Some individuals have a disorder called dermatographism where a simple scratch or pressure on the skin will cause the affected area to develop hives in a linear pattern to match the scratch.  The name dermatographism means “skin writing” so it is possible to write a word on the individuals’ skin just by writing the word using a fingernail on the skin. Approximately 5 minutes later, the word is visible in a reddish and raised fashion.

 

There are more uncommon allergies than mentioned above, but the ones listed above give some indication of the diversity of unusual allergies.  Individuals can be allergic to almost anything. It is a combination of the patient’s awareness of their symptoms and situation in conjunction with the allergist’s knowledge that is needed in order to diagnose and then prevent and/or treat such unusual allergies.

 

The board certified allergists at Black & Kletz Allergy have 3 office locations in the Washington, Northern Virginia, and Maryland metropolitan area.  The allergy doctors at Black & Kletz Allergy treat both pediatric and adult patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean office has 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.  The allergy specialists at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, eczema, hives, insect sting allergies, immunological disorders, medication allergies, and food allergies for more than 50 years.  If you suffer from any allergy, whether unusual or not, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.

 

Keratoconjunctivitis and Eye Allergies

Keratoconjunctivitis is term used to describe inflammation of the cornea and conjunctiva.  Keratitis specifically is the inflammation of the cornea (i.e., the transparent dome that covers the pupil and the iris of the eye). Conjunctivitis, on the other hand, is the inflammation of the conjunctiva [i.e., the thin membrane covering the sclera (i.e., the white of the eye) as well as the lining of the inner part of the eyelids].  It is more commonly referred to as “pink eye.” Keratoconjunctivitis is one of the most common causes of red and irritated eyes as millions of individuals visit doctors for this condition every year.

 

Most of the cases of keratoconjunctivitis and conjunctivitis are due to allergies.  Conjunctivitis due to allergies is referred to as allergic conjunctivitis.  Infections are another common cause of keratoconjunctivitis and conjunctivitis with viruses accounting for most of the infections across all age groups.  Of note, conjunctivitis caused by bacteria is more common in children. Other infectious agents may include a parasite or a fungus. It should also be noted that an injury to the eye can inflame the cornea or conjunctiva without a secondary infection.

 

Types of Keratoconjunctivitis:

Keratoconjunctivitis sicca is also commonly known as dry eye syndrome.  Dry eye occurs when either the eye does not produce enough tears or when the tears evaporate too quickly.  It can also occur when there is an imbalance in the tear mixture.  Tears are comprised of water, fatty oils, and mucus. Individuals need the correct mixture of all three of these ingredients in order to properly nourish one’s eyes.  Some of the more common causes may include allergies, contact lens use, pregnancy, meibomian gland (i.e., glands in eyelids that excrete oil into the tears) dysfunction, and certain medications such as (e.g., antihistamines, some blood pressure medications, hormone replacement therapy, antidepressants).

Epidemic keratoconjunctivitis (EKC) is an eye infection caused by a specific virus called the human adenovirus.  It is also known as “adenoviral keratoconjunctivitis” or just “viral keratoconjunctivitis.”

The incubation period of EKC is long and it is very contagious.  It tends to spread quite easily especially when individuals are in close quarters (e.g., dormitories, hospitals, schools, arenas, movie theaters).

There’s no specific treatment for EKC.  Symptoms typically last a few weeks in duration before abating.  Adenoviruses may also target the digestive, respiratory, and genitourinary tracts.

Vernal keratoconjunctivitis (VKC) is a recurrent, chronic allergic inflammation of the eyes.  It generally results in small, round bumps known as giant papillae underneath the eyelid.  VKC generally affects the upper eyelids more than the lower eyelids. The symptoms are much more common in the Spring with the arrival of pollen, particularly tree and/or grass pollen.

The cause is thought to be an allergic disorder, but may also involve genetic and/or immune system disorders.  It is more common in tropical environments and is more common in boys than in girls.

Atopic keratoconjunctivitis (AKC) is a chronic inflammatory disease of the eye that usually affects patients with a history of atopic dermatitis (i.e., eczema).  Males are affected with AKC more often than females, and it is more likely to involve the lower eyelids more than the upper eyelids.

Symptoms characteristically worsen in the Winters.  Without treatment, AKC may lead to serious complications such as:

  • Ulceration
  • Keratoconus (i.e., thinning and bulging cornea)
  • Corneal vascularization (i.e., growth of new blood vessels into the cornea

Herpetic keratoconjunctivitis is an infection caused by the herpes simplex virus, particularly Type 1.  Touching one’s eyes after touching a cold sore may transfer the virus to the eyes.

Allergic keratoconjunctivitis refers to any keratoconjunctivitis caused by an allergen.  Vernal keratoconjunctivitis and atopic keratoconjunctivitis, for example, are included in this group.  The allergies can be seasonal or perennial in nature.

 

Symptoms of Keratoconjunctivitis:

Symptoms range from mild to severe.  The symptoms may vary depending on the cause.  Some symptoms associated with keratoconjunctivitis may include:

  • Redness
  • Itchiness/Burning
  • Puffy eyelids
  • Discharge from the eyes (i.e., watery eyes)
  • Stickiness of the eyes (i.e., eyes become “glued shut”)
  • Light sensitivity (i.e., photophobia)
  • Dryness
  • “Foreign body” sensation in the eyes
  • Blurry of vision (usually mild)

 

Diagnosis of Keratoconjunctivitis:

The diagnosis can be made based on the medical history, symptoms, and visual inspection of the eyes.  Depending on the initial findings, a physician may also want to examine:

  • Visual acuity
  • Under the eyelids
  • Ocular pressure
  • Pupillary reactions
  • Discharge of the eyes
  • Corneal sensation

In some cases, one may need to be tested for:

  • Allergens
  • Viruses
  • Autoimmune disorders
  • Genetic conditions

 

Treatment of Keratoconjunctivitis:

Treating the symptoms:

One may need a combination of therapies which may include:

  • Topical antihistamines or mast cell stabilizers
  • Preservative-free lubricating gels and ointments
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Topical corticosteroids

In cases of severe keratoconjunctivitis sicca, punctal plugs may be inserted to reduce the drainage of the tears into the nose. 

Treating the underlying condition(s):

Some viral infections, such as herpes, may require treatment with topical or oral antiviral medications.  Any underlying autoimmune or genetic conditions may also need specific treatments.

Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergists are trained and very familiar with allergic eye disorders such as mentioned above.  The allergy specialists at Black & Kletz Allergy diagnose and treat both adults and children.  We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  If you are experiencing what appears to be allergy symptoms associated with your eyes, please call us to schedule an appointment.  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 needs of allergy and asthma sufferers in the Washington, DC metro area for more than 5 decades.

Eczema Exacerbations

patient with eczemaWhat are some of the causes?

As we enter into the season of colder days and nights in the Washington, DC metropolitan area, we are exposed to colder and drier air.  The cold and dry air in conjunction with lower humidity levels predispose individuals to flare-ups of eczematous skin conditions.

Layers of clothing during outdoor activities and returning to overheated homes can trigger a cycle of sweating, itching, scratching, and irritation.  Dry heat from our furnaces will evaporate the normal protective oils of one’s skin which may lead to cracking of the skin.

The smoke emitted by indoor fireplaces and wood burning stoves in combination with exposure to dust and dust mites may cause exacerbations of allergies, eczema, and asthma in individuals predisposed to these conditions.  Parched air can dry up the normal moisture in the mucus membranes leading to nose bleeds as well as a burning sensation in the eyes. 

The pile of wet leaves in people’s yards create a breeding ground for the molds to grow and their spores may trigger allergic rhinitis (i.e., hay fever), asthma, and eczema (i.e., atopic dermatitis) in sensitized individuals.  The wool in one’s sweaters can irritate sensitive skin and cause itching (i.e., pruritus) and rashes.

Other common triggers of eczema may include hot water, smoke, sweat, extreme temperatures, perfumes, colognes, cleaning solutions, scented laundry detergent, scented candles, scented soaps, scented shampoos, scented dryer sheets, fabric softeners, pets, molds, pollens, skin infections, stress, and certain foods in people with known food sensitivities.

What can be done in order to improve the situation?

Thorough and regular moisturizing of the skin with emollients (e.g., creams, ointments, lotions, gels) is the best protection against flare- ups of individuals with eczema.  Thick oil-based creams and/or ointments generally help protect the skin from excessive dryness better than water-based lotions. “Soak and seal” methods are efficacious in helping prevent the loss of moisture from the skin.

Direct exposures to sources of dry heat (e.g., radiant warmers) should be avoided.  If the HVAC system does not have a central humidifier, an ultrasonic water vaporizer in the bedrooms, especially during nights, will reduce excessive dryness of the mucus membranes and the skin.

Long, hot showers can strip the skin of its natural oils.  Shorter, lukewarm showers or baths are skin-friendly. Milder soaps, detergents, and shampoos without fragrances are kinder to the skin.

Woolen and synthetic clothes can irritate the skin and cause itching when they are in direct contact with skin.  Natural fabrics such as cotton and cashmere are less likely to cause flare-ups of itching and rashes while in direct contact with skin.

In spite of above measures, if eczema does flare-up, one may need to use medications in order to control eczema.  Below are a list of several medications used to treat eczema:

1.) In order to manage eczema, it is very common to use topical anti-inflammatory medications (e.g., topical corticosteroids) for a short period of time.

2.) The itching usually responds well to first generation antihistamine medications.

3.) Second generation antihistamines may also help and have the advantage of being generally non-sedating.

4.) Eucrisa (crisaborole) ointment 2% is a nonsteroidal cream that is quite efficacious in the treatment of eczema and has very few side effects.    The most common side effect is a mild burning or stinging sensation of the skin where the ointment is applied. Eucrisa ointment 2% is indicated in the treatment of eczema in children ages 2 years of age and older as well as in adults.

5.) Topical immunosuppresants are commonly used in both children and adults.  The two most common medications in this class include Protopic (tacrolimus) ointment and Elidel (pimecrolimus) ointment.  They are both fairly effective and are steroid-free. Protopic can be used in children 2 years of age and older as well as in adults.  Elidel is approved for children 3 months of age and older as well as for adults.

6.) Rarely, a short course of oral corticosteroids may be necessary during severe exacerbations of eczema, although the use of oral corticosteroids is generally avoided due to the potential side effects that corticosteroids can produce.

7.) If all else fails, there is a class of medications called “biologicals” that may be utilized and has been very effective in the treatment of eczema.  Dupixent (dupilumab) is currently the only biological that is FDA-approved to treat moderate-to severe-eczema. It is currently approved for adolescents (12 years of age and above) as well as for adults.  Of note, Dupixent also is approved for the treatment of asthma in patients 12 years of age and older, as well as in adults with chronic rhinosinusitis with nasal polyps (CRSwNP).

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating eczema as well as other skin conditions [i.e., hives (urticaria), contact dermatitis, poison ivy].  We are board certified to treat both pediatric and adult patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half a century.  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 from eczema or other skin-related disorder, we are here to help alleviate or hopefully end these unwanted 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 friendly and professional environment.

Cat, Dog, and Other Pet Allergies

German Shepherd Dog and cat togetherTwenty percent of the U.S population have cat allergies and 10% of the population have dog allergies.  In the U.S., the most common pet are dogs, which are followed by cats as the second most common pet. Approximately 70% of homes having at least one pet.  This is a higher percentage of homes with pets than in the past as more and more families are acquiring pets. In addition to cats and dogs, some other common pets include birds (e.g., parakeets, parrots), fish, rabbits, rodents (e.g., guinea pigs, hamsters, gerbils, chinchillas, rats, mice) reptiles (e.g., snakes, lizards, turtles, geckos), hermit crabs, ferrets, horses, and spiders.  Horses normally do not live in people’s homes, but they may be rather allergenic. In recent years, there is a fad of owning miniature horses which in some cases do live in their owner’s house. This is probably not a good idea in general, but for those who are allergic to horses, it is especially unwise.

Allergies to pets are in fact really an allergy to the specific proteins that are produced by a particular pet.  In dogs, the major protein responsible for allergies to dogs is called “Can f 1.” This protein produced by dogs is most commonly found in the dog’s dander, saliva, and urine.  In cats, the major proteins associated with allergies are known as “Fel d 1” and “Fel d 4.” These two proteins are responsible for most of the suffering in individuals with cat allergies.  Similarly, most of the proteins that cause allergies in cats are concentrated in the sebaceous glands in the skin (i.e., dander), the saliva, and the urine. Unlike dogs, cat dander tends to “stick” to things such as walls, carpeting, clothing, bedding, etc. and is commonly transported from the home to home or home to work environments.  If the Fel d 1 protein is measured on a cat owner’s clothing, bedding, or upholstered furniture at work, it is likely that the protein will be found. In addition, it may take months for these proteins to dissipate and become undetectable, despite a thorough cleaning of the home, due the stick-to-itiveness of cat dander. Note that since the protein is also found in urine, cat litter boxes are a rich source of these proteins and allergic individuals should avoid exposure to litter boxes.  In dogs, fortunately the protein Can f 1 is not as “sticky” as the cat proteins, but still can adhere to walls, clothing, carpeting, bedding, etc. Interestingly, there is an increased incidence of horse allergy in some individuals that have cat and/or dog allergies due to a common protein that is shared between all three animals. In rodents, in addition to the allergenic protein being present in the urine, dander, and saliva, certain rodents such as mice contain allergenic proteins in their mouse droppings.

In addition to pet allergies, there are additional potential medical hazards to consider when owning certain pets.  Mice and rats carry many diseases such as the bubonic plague, Hantavirus pulmonary syndrome (HPS), leptospirosis, tularemia, rat bite fever (RBF), lymphocytic choriomeningitis, salmonellosis, and Lassa fever.  Exposure to birds can cause infections and diseases such as psittacosis, salmonellosis, allergic alveolitis, campylobacteriosis, avian flu, avian tuberculosis, Newcastle disease, cryptosporidiosis, and giardiasis.  Reptiles can irritate one’s skin. Snakes can cause life-threatening allergic reactions from the venom that is introduced from a snake bite.

As a general rule, if an individual is allergic to a specific pet, it is advisable not to own that pet.  Even though this seems pretty obvious, a majority of individuals still choose to either acquire a pet or keep an existing pet that they own despite that the pet causes unwanted allergy symptoms.  This is understandable, although not advisable, since a pet becomes a member of the family and often causes great happiness.

One myth to debunk is that there are “hypoallergenic” cats and dogs to get if one is allergic to such a pet.  While some pet-allergic individuals feel that they have reduced allergic symptoms around short-haired cats and/or dogs that do not shed (e.g., poodles), most scientific studies do not support this phenomena.

Obviously, the best way to combat pet allergies is to completely avoid them as mentioned above.  If this is not an option, one can take some measures to reduce their exposure to the allergens that cause pet allergies.  Brushing your cat or dog frequently and bathing your cat or dog often will help reduce the levels of cat and proteins. It is also advisable to prevent the pet from entering your bedroom.

The symptoms of pet allergies are similar to any other type of environmental allergy.  The symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, puffy eyes, headaches, sinus congestion, itchy skin (i.e., pruritus), hives (i.e., urticaria), wheezing, chest tightness, coughing, and/or shortness of breath.

The treatment of pet allergies begins with avoidance of the offending pet as previously mentioned.  Medications used for the management of pet allergies may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, and/or asthma inhalers.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are very effective in treating pet allergies as they are also very efficacious in the management of dust mite, mold, and pollen allergies.  They work in 80-85% of patients with allergies and have been used in the U.S. for more than 100 years.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults and children with pet allergies.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to offer high quality allergy and asthma care in a compassionate professional environment.

Is It the Common Cold or Allergies

As we are in the Fall season and approaching Winter, many individuals may experience a clear runny nose, post-nasal drip, sneezing, sore throat, nasal congestion, sinus pressure, headache, coughing, and/or fatigue.  The question to many becomes, “Do I have a common cold or do I have Fall/Winter allergies? It is a common question to an even more common complaint. How does someone know if they are having allergies rather than the common cold?  Well, if someone does not have a history of allergic rhinitis (i.e., hay fever) and they develop the above-mentioned symptoms, they probably are not experiencing allergies, unless these symptoms persist for several weeks or more.  If the symptoms persist, one should consult a board certified allergist like the ones at Black & Kletz Allergy.  The allergy specialist can help identify if one has allergies vs. are the symptoms a result of a lingering cold or a secondary bacterial infection (e.g., sinus infection, upper respiratory infection, pneumonia)?

The common cold is caused by a variety of viruses (e.g., rhinovirus, human coronavirus, influenza viruses, parainfluenza virus, human respiratory syncytial virus (i.e., RSV), enteroviruses other than rhinovirus, and adenoviruses).  There are over 200 viruses associated with the common cold, although rhinovirus accounts for most of them. In addition, approximately 25% of colds are caused by unknown factors, which are presumed to be due to unidentifiable viruses.

Of particular importance to infants and young children is the human respiratory syncytial virus which can be fairly severe in these age groups and cause life-threatening illness in approximately 1-2% of infants and young children who get the virus.  RSV may also cause serious symptoms in individuals whose immune systems are compromised, as well as in individuals with chronic heart or lung disease. Most of the time, RSV has a mild self-limited course in children and adults resulting in a cold-like illness.  In fact, almost all children get RSV by the age of 2. It is only this 1-2% of infants and young children, some individuals whose immune systems are compromised, and some people with chronic heart or lung disease who go on to develop more serious symptoms which may include pneumonia (i.e., infection of the lungs), and/or bronchiolitis [i.e., inflammation of the bronchioles (small breathing tubes in the lungs].  Infants and young children with this more severe course often require intravenous antibiotics and fluids, oxygen, and sometimes need to be placed on a ventilator for a short period of time in order to help them through the respiratory distress that can accompany this virus. In addition, infants and young children that develop complications from RSV may be more likely to develop asthma in the future.

While discussing the common cold, there is a common myth to debunk regarding the development of the common cold and environmental factors.  It is a myth that being out in the cold weather will cause a cold. The traditional theory is that a cold can be “caught” by the prolonged exposure to cold weather, which is probably how the disease got its name.   It is much more likely that in the Fall and Winter months, when it happens to be cold outside, some of the viruses that cause the common cold occur more frequently during this time period.  If these viruses are more prevalent during this time period, it stands to reason that we are exposed to more of these viruses at this time and therefore are more likely to “catch” a cold in these colder months.  One other factor to consider is that once a few individuals develop colds, since it is easily transmissible, more and more people who are in close contact will then develop colds. This process becomes exponentially larger and before you know it, “almost everybody” has a cold.

What about someone who does have a history of allergies?  If they develop the classic symptoms of a cold in the Fall or Winter as mentioned in the first paragraph, is it their allergies or a common cold?  The same basic formula applies to them. If the symptoms are present for a week or two, one is to assume it is a common cold. However, if the symptoms last several weeks or more, then one is to assume that their allergies are playing a role.  The allergens that typically cause allergic rhinitis symptoms in the Fall and Winter include dust mites, molds, pets, cockroaches, and other animals such as rodents. Allergy testing can be done via skin or blood testing. If an environmental allergy is identified, it is important to try to prevent exposure to the allergens.  If that does not relieve the symptoms, then there are host of medications that can be utilized in order to help mitigate one’s allergy symptoms.

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 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 friendly and caring environment for you to get the top quality allergy, asthma, and immunology treatment that we have been providing the community for more than 50 years.

Mast Cell Disorders

master cell imageA mast cell is a component of the immune system that is involved in the allergic response.  Mast cells contain histamine and other chemical mediators. These chemicals are released into the bloodstream and then into the surrounding tissues during an allergic reaction.

In a disorder called “mastocytosis,” individuals harbor excessive numbers of mast cells in the bone marrow and other organs.  It is important to note that this condition may occur both in children and adults. Individuals with mastocytosis frequently experience generalized itching, flushing, skin rashes, abdominal cramps, nausea, vomiting, diarrhea, shortness of breath, dizziness, and/or passing out (i.e., syncope). 

Children are more likely to have symptoms limited to the skin whereas the majority of adults have systemic symptoms which usually involve multiple organ systems.  These symptoms are similar to that of anaphylaxis. In addition, these individuals are more sensitive to various triggers such as temperature changes, certain medications, spicy foods, alcohol, bee stings, etc.  Occasionally they suffer anaphylaxis spontaneously without exposure to any obvious trigger(s).

The first step in the diagnosis of this condition is a comprehensive history taking note of the specific symptoms, as well as their onset, progression, and severity.  Physical examination sometimes reveals freckle-like skin lesions called “urticaria pigmentosa” which typically appear over one’s thighs, abdomen, etc. These spot-like skin lesions can lead to hives (i.e., urticaria) upon stroking the skin (also known as Darier’s sign), as well as after exposure to temperature changes (e.g., taking hot showers).  This occurs as a result of the compression of mast cells.

The most helpful diagnostic laboratory test is a serum tryptase level, which is usually elevated in systemic mastocytosis.  Urine examination also can be useful in detecting higher levels of metabolites of various chemical mediators of allergic reactions.  Confirmation of the diagnosis usually requires a skin biopsy, bone-marrow examination, evaluation of organ functions, and occasionally genetic studies.

The usual course of treatment of this condition is avoidance of exposure to the known triggers of mast cell activation in order to prevent acute symptoms. There are several medications that are utilized in order to treat this condition.  Antihistamines block the effects of histamine, which is one of the most common mediators of allergic reactions. As a result, antihistamines [e.g., Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine)] are the most commonly used medications to treat mast cell disorders.  A medication called cromolyn is helpful to alleviate the gastrointestinal symptoms (i.e., abdominal cramping, nausea, vomiting) that may occur with mast cell disorders including. Aspirin, ketotifen and leukotriene modifiers [e.g., Singulair (montelukast), Accolate (zafirlukast), Zyflo (zileuton)] are also sometimes employed in the treatment of mast cell disease.

It is important to note that individuals with mast cell disorders are also at risk for fractures due to osteopenia and/or osteoporosis, and bone health needs special attention.  More aggressive forms of systemic mastocytosis may require interferon, immune modulators, and/or chemotherapeutic agents.

All patients with established mast cell disorders need to have ready access to epinephrine auto-injectors (e.g., EpiPen, Auvi-Q, Adrenaclick) at all times to be used at the onset of symptoms suggestive of anaphylaxis.  Once used, it is important for the individual to go to the closest emergency room. It is also important for patients with mast cell disorders to make surgeons and anesthesiologists aware of their mast cell disorder in case a surgical procedure is needed, as surgery can also be a trigger systemic symptoms.

The board certified allergists 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 mast cell 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 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 50 years and we pride ourselves in providing excellent allergy and asthma care in a professional and pleasant setting.

 

Dust Allergies

Dust is a very common allergen which can cause havoc among sensitized individuals.  Most people are not aware that the cause of dust allergies are dust mites. Dust mites are microscopic animals belonging to the class Arachnida.  Arachnids are arthropods which are invertebrate animals that have an exoskeleton (i.e., external skeleton), a segmented body, along with paired jointed appendages.  In addition to mites, some other examples of arachnids include spiders, ticks, and scorpions.  Dust mites, which are also known as house dust mites, are between 0.2 to 0.3 mm. in length and are translucent, making them almost invisible to the naked eye.

Dust mites survive by eating the dead skin of humans and pets as it flakes off their bodies.  They also eat some varieties of mold. They live throughout the world except at high altitudes (i.e., above 5,000 feet).  Dust mites are generally found in bedding (e.g., pillows, mattresses, box springs, blankets), upholstered furniture, carpeting, drapes, and curtains.  They tend to thrive in humid conditions where the relative humidity is above 50%. The allergenic components of dust mites are the exoskeleton and their fecal deposits.  Since the exoskeleton and fecal deposits are relatively heavy in nature, they are not suspended for long in the air. Thus, they are generally found on the floor and other surfaces.  The dust that you see in the air is not usually composed of dust mite allergens unless the floor or surface is disturbed. If this occurs, the dust mite allergens only remain in the air for a couple of hours or less.  The two major species of dust mites that are highly allergenic and tend to affect sensitized individuals in the U.S. are Dermatophagoides farinae (i.e., American house dust mite) and Dermatophagoides pteronyssinus (i.e., European house dust mite).  

Individuals who are allergic to dust mites may exhibit signs and symptoms of allergic rhinitis (i.e., hay fever), allergic conjunctivitis, and/or asthma.  These symptoms may include sneezing, runny nose, nasal congestion, postnasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sore throat, snoring, fatigue, sinus headaches, wheezing, coughing, chest tightness, and/or shortness of breath.

The diagnosis of dust mite allergy requires a thorough history and physical examination by a board certified allergist like the ones at Black & Kletz Allergy.  Testing to dust mites can be done via skin or blood testing.  The severity of the dust mite allergy can also be assessed. Once diagnosed, the allergist will recommend several preventative measures that should be implemented by the allergy sufferer.

 

Some of these preventative measures may include:  

1.)  Covering the pillows, mattress, and box spring with allergy-proof encasings

2.)  Washing the bedroom sheets in hot water (greater than or equal to 130 °F) 

3.)  Vacuuming carpeting at least once a week

4.)  Keeping the relative humidity less than or equal to 45%

5.)  Reducing or eliminating stuffed animals and other dust-gathering toys

6.)  Replace bedroom wall-to-wall carpeting to hardwood or vinyl flooring

7.)  Use a HEPA filter in the HVAC system and replace the filter every 3 months

 

The treatment of dust mite allergies may include the use of oral antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergic medications, allergy eye drops, inhaled corticosteroids, inhaled bronchodilators, allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization), and/or biologicals (e.g., for the treatment of moderate to severe asthma).

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating dust mite allergies for many decades in the Washington, DC, Northern Virginia, and Maryland metropolitan areaWe have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our Washington, DC and McLean, VA offices 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.  The allergists at Black & Kletz Allergy are extremely knowledgeable about the most current treatment options for patients with allergic rhinitis, allergic conjunctivitis, and asthma and can promptly answer any of your questions.  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 area for more than 50 years and we look forward to providing you with excellent state of the art allergy and asthma care in a friendly and pleasant environment.

 

Trick-or-Treat Allergies on Halloween

Every year, several children are taken to emergency departments on Halloween day for the management of severe allergic reactions.  What is meant to be a fun-filled activity can turn out to be a harrowing experience for some families. A few general precautions made by families can prevent most allergic emergencies in children and are as follows: 

  1. Many families understand how to read labels on foods and avoid those that contain ingredients that their children are sensitized to. However, most “fun-sized” candies handed out while trick-or-treating either do not have any labeling at all or they may contain different ingredients than regular sized packages.
  2. Preventing children with food allergies to trick-or-treat without adult supervision as well as avoiding candies without proper labeling can prevent a life-threatening reaction.  It is a good practice for severely allergic individuals to carry epinephrine self-injectable devices (e.g., EpiPen, Auvi-Q, Adrenaclick) while trick or treating.
  3. Children with food allergies should be taught to politely refuse homemade foods such as cookies and cupcakes that may be unsafe for them.
  4. Ragweed and mold spores are the most common environmental aeroallergens in the Fall in many geographical areas in late October.  In addition, exposure to cats and dogs are not uncommon while trick or treating. Exposure to these allergens may trigger allergic rhinitis (i.e., hay fever) and/or severe respiratory allergic reactions.  The use of allergy and/or asthma medications before heading out may be protective.  Showering, washing one’s hair, and changing into fresh new clothes after trick or treating will reduce airborne allergen exposure.
  5. Cold air is a known irritant and prolonged exposure to cold air may aggravate asthma in susceptible children.  Frequent indoor breaks and covering the nose and mouth while outdoors can minimize this risk. Children with a history of asthma should also take their rescue inhalers [e.g., albuterol (Proventil, ProAir, Ventolin), levalbuterol (Xopenex)] with them while trick-or-treating.
  6. Haunted houses with smoke machines may pose a danger to children and adults with severe asthma.  Exposure to smoke of any kind can cause an acute asthma exacerbation. Preparation and avoidance are necessary in order to prevent severe asthma attacks.
  7. Halloween costumes containing strong chemicals may be irritating to children with sensitive skin and as a result a flare-up of their eczema (i.e., atopic dermatitis) may occur.  Latex-containing masks as part of the costume may be especially deleterious to children with a history of latex allergy.  Children with a sensitivity to metals such as nickel may be exposed to nickel buttons and buckles in costumes which may lead to itching and skin rashes

 

To help insure that a food allergic child can participate in Halloween and have as much fun as the next child, although nothing is guaranteed, there is a program run by the Food Allergy Research and Education (FARE) organization called the “Teal Pumpkin Project”.  This FARE-sponsored international program has been in place since 2014.  It began in Tennessee by the mother of a severely food allergic child.  The Teal Pumpkin Project’s purpose is to raise awareness of the severity of food allergies and show support to families who have food allergic children.  This is done by painting a pumpkin the color teal and then placing it on one’s front porch to signify that “non-food” treats are available at that location on Halloween night.  The color teal is used because it represents food allergy awareness.  Typically, “non-food” treats may include toys, crayons, stickers, rings, bracelets, necklaces, glow sticks, hair accessories, coins, finger puppets, balls, bookmarks, spider rings, vampire fangs, whistles, etc.

It important to point out that the Teal Pumpkin Project is not exclusionary and it still promotes the option of distributing normal trick-or-treat candy to children without food allergies.  It recommends that the “non-food” items be kept in a different bowl than the traditional candy bowl.  FARE provides a “Teal Pumpkin Project Participation Map” on its website so that participating houses can be easily assessed by the parents of food allergic children.

 

Being cognizant of the hidden dangers of trick-or-treating and proactive in preventing allergen exposures can greatly reduce parents’ anxiety as well as help children fully enjoy the Halloween experience.  The board certified allergists at Black & Kletz Allergy have had over 5 decades of experience in diagnosing and managing food and environmental allergies, asthma, and eczema in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Both food and environmental allergies can be diagnosed by a thorough history and physical examination along with prick skin testing and/or blood testing.  We would be happy to see you in one of our 3 convenient locations 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 our office or alternatively, you may click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy is proud to provide quality allergy, asthma, and immunology care in a relaxed compassionate environment.