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Pollen Allergies

Pollen is comprised of a powdery substance whose individual grains contain the male part (i.e., anthers) of seed-bearing plants. The pollen causes the female part of the same type of flower to produce seeds. Pollen is carried to other plants via the wind or by insects. It is when the pollen is dispersed by the wind that individuals are exposed to it by breathing in and inhaling the pollen-infested air. As a result, certain individuals become sensitized and develop allergies to pollen. People who develop pollen allergies may manifest their symptoms in various manners. Some individuals develop allergic rhinitis (i.e., hay fever) and suffer from mostly nasal symptoms. Others are affected mostly around and in their eyes and acquire a condition termed allergic conjunctivitis. Still other people can develop asthma as a result of the exposure to pollen.

The amount and type of pollen released into the air is dependent on various weather factors as well as the time of year. The air temperature, humidity, rain, and wind speed can and do affect the amount of pollen in the air. Pollen counts are highest on dry, warm, and windy days. The pollen counts tend to be the highest in the early mornings. The amount of pollen in the air at a given time can be measured and is published to the public as the pollen count. You can find out today’s pollen count in the Washington, DC Northern Virginia, and Maryland metropolitan area by clicking “Today’s Pollen Count” at the top right of our website. The time of year also is a major factor in determining the type of pollen that is in the air. In general, tree pollen is present in the early Spring, while grass pollen is present in the late Spring. Ragweed and other weed pollen are prevalent in the late Summer and early Fall. In the Washington, DC metro area, the trees begin to pollinate in late February, peak in mid- to late-April, and end in late-May or early-June. The grasses begin to pollinate in late-April to early-May, peak in late-May or early-June, and end in August. Ragweed, the principal weed to affect most sensitive individuals, generally begins to pollinate in mid-August, peak in late September, and end in late-October coinciding with the first frost.

In the Washington, DC metro region, there are specific species of trees, grasses, and weeds that are endemic to that area. The most common tree pollens in the area include birch, maple, oak, cedar, hickory, ash, beech, cottonwood, poplar, sycamore, alder, elm, and mulberry. Common grass pollens include Timothy, Bermuda, Johnson, Kentucky bluegrass, meadow fescue, and rye. Similarly, the most common weeds in the Washington, DC area include and ragweed, lamb’s quarters, English plantain, pigweed, cocklebur, mugwort, and sorrel. Of course, there are other varieties of trees, grasses, and weeds in the Washington, DC region but these other varieties are not as prevalent as the ones mentioned above.

It is interesting to note that the “pretty” trees (i.e., flowering trees and plants) generally do not cause allergies when compared to the “ugly” trees (i.e., non-flowering trees and plants). The reason this is true is that “pretty” trees (e.g., cherry, dogwood, magnolia, eastern redbud) have pollen that is heavy in weight and thus are not dispersed into the air as much as the lighter pollens found with “ugly” trees (e.g., birch, maple, oak). If the pollen is not in the air, individuals do not become exposed and thus sensitized to it and allergies to the pollen do not occur. “Pretty” trees consequently need to rely on bees to cross-pollinate since the wind is unable to efficiently disperse their heavy pollen. They have flowers in order to attract bees. Bees will land on the flowers and the pollen sticks to their abdomens. The bees then fly to another tree and land on a new flower and simultaneously cross-pollinates this flower. On the other hand, “ugly” trees have adapted to having no flowers by having pollen that is light in weight. They depend on the wind to cross-pollinate. It is through exposure to the light-weight pollen in the air that sensitive individuals will develop their allergies.

The most common symptoms of pollen allergies may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy eyes, watery eyes, redness of the eyes, itchy throat, sinus pressure, sinus headaches, snoring, fatigue, wheezing, chest tightness, coughing, and/or shortness of breath. It is not uncommon for allergic individuals to develop sinus infections as a result of their allergies.

The diagnosis of pollen allergies is performed by a board certified allergist such as the ones at Black & Kletz Allergy. The diagnosis begins with a comprehensive history and physical examination. Allergy testing by skin testing or blood testing is usually done in order to ascertain the cause of the allergy. Depending on the patient, pulmonary function tests may be performed if symptoms of asthma are present.

The treatment of pollen allergies depends on the type and severity of symptoms. Treatment usually begins with prevention (i.e., avoiding the offending allergen, if possible). A wide array of medications is available to treat pollen allergies. They include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, nasal decongestants, eye drops, inhaled bronchodilators, inhaled corticosteroids, inhaled anticholinergics, and biologicals. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) are very effective as they work in 80-85% of individuals with allergic rhinitis, allergic conjunctivitis, and asthma. Most individuals are on allergy shots for 3-5 years. Note: Allergy shots are even more effective for insect sting venom allergies (e.g., bees, wasps, yellow jackets, hornets).

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating pollen-induced allergies such as allergic rhinitis, allergic conjunctivitis, and asthma for many years in both adults and children.  Black & Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of the offices have on-site parking.  In addition, the Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call us or alternatively you can click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists of Black & Kletz Allergy are always ready to help you with your allergy, asthma, sinus, dermatological, and immunological needs.  Black & Kletz is dedicated to providing outstanding allergy care to you and your family as we have been doing in the Washington, DC metropolitan area for more than 50 years.

Rhinitis – Is It Due to Allergies or Something Else?

Rhinitis is a term that means inflammation of the mucus membranes of inside the nose. It is a very common condition. Rhinitis can either be acute or chronic. Acute rhinitis is inflammation of the mucus membranes of the inner nose that lasts up to 4 weeks in duration. It is not uncommon for acute rhinitis to last a few days as in the case of the common cold. Chronic rhinitis, on the other hand, is inflammation that lasts more than 4 weeks in duration. The symptoms of rhinitis may include runny nose, nasal congestion, post-nasal drip, and/or sneezing. Rhinitis can be classified into allergic rhinitis and nonallergic rhinitis. For the paragraph below, nonallergic rhinitis is further divided into rhinitis caused by infections and by other nonallergic stimuli.

The inflammation of rhinitis may be caused by any of the following:

  • Allergies – Allergic rhinitis due to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, cockroaches, etc.
  • Infections – Viral, bacterial, or parasitic
  • Other Nonallergic Stimuli
    • Foods – Gustatory rhinitis due to spicy foods, alcohol, or other foods
    • Hormonal imbalance – Thyroid disease, pregnancy, menstruation, etc.
    • Medications – Rhinitis medicamentosa due to oxymetazoline and phenylephrine nasal sprays; other medication-induced rhinitis due to nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen, meloxicam), beta blockers (e.g. metoprolol, propranolol, carvedilol), alpha blockers (e.g., doxazosin, terazosin, tamsulosin), diuretics, antidepressants (e.g., chlorpromazine, risperidone, amitriptyline), aspirin, oral contraceptives, calcium channel blockers (e.g., amlodipine, nifedipine, verapamil), erectile dysfunction medications (i.e., phosphodiesterase 5 inhibitors such as sildenafil, vardenafil, and tadalafil)
    • Emotional issues – Stress
    • Asthma – There is a higher association of rhinitis with asthma
    • Exercise – May act as a trigger of rhinitis
    • Airborne Irritants – Air pollution, strong scents, cigarette smoke, smog, etc.
    • Pregnancy – Probably as a result of hormonal changes
    • Gastroesophageal Reflux Disease (GERD)
    • Decreased Blood Flow – Atrophic rhinitis in mostly elderly individuals
    • Environmental Changes – Change in barometric pressure, temperature, and/or humidity
    • Structural Defects – Deviated septum, enlarged nasal turbinates, tumors, enlarged adenoids, nasal polys, etc.
    • Inflammatory/Immunologic Disorders – Sarcoidosis, granulomatous infections, Wegener granulomatosis, Churg-Strauss, amyloidosis, midline granuloma, relapsing polychondritis, etc.
    • Cerebrospinal Fluid Leak – Cerebrospinal fluid rhinorrhea is caused by the leaking of brain fluid out of the nose. Some of the causes may include head trauma, tumor, congenital birth defect, and increased intracranial pressure.
    • Nonallergic Rhinitis with Eosinophilia (NARES) – A syndrome that has symptoms consistent with allergic rhinitis but without evidence of atopy as allergy skin testing is negative. In addition, nasal cytology demonstrates more than 20% eosinophils. Anosmia (i.e., lack of the ability to smell) is a prominent feature which is usually not seen with allergic rhinitis.
    • Obstructive Sleep Apnea – Allergic rhinitis increases the risk of developing obstructive sleep apnea.

Some complications of rhinitis may include sinusitis, middle ear infections, nasal polyps, and/or an interruption of daily activities at home, school, and work due to being less productive since rhinitis is known to decrease the quality of life. After the “common cold,” rhinitis is the second most common cause of missed school or work days.

Prevention of the offending triggers of rhinitis will help to mitigate one’s symptoms. Although it is not always possible to avoid the triggers of rhinitis, one can do their best to try to evade them. It is important not to use over-the-counter nasal decongestants as they just cause a temporary improvement in nasal symptoms. Continued use of nasal decongestants [e.g., Afrin (oxymetazoline)] may cause “rebound” nasal congestion. This “rebound” nasal congestion occurs when an individual suddenly discontinues the use of nasal spray. The nasal congestion that occurs as a result of stopping the medication tends to feel worse than the initial nasal congestion before the nasal decongestion was used. The instructions on oxymetazoline nasal spray clearly states that it should not be used for more than 3 days. This paradoxical condition is called rhinitis medicamentosa. In addition to avoiding triggers and avoiding nasal decongestants, vaccines for viruses (e.g., influenza, measles, rubella) and bacteria (e.g., diphtheria, Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae) may help reduce the likelihood of infectious agents that will cause rhinitis.

The diagnosis of rhinitis is best made by a board certified allergist such as the ones at Black & Kletz Allergy. A comprehensive history and physical examination are important to diagnosing rhinitis. Allergy testing via skin tests and/or blood tests are also typically performed. A CT scan of the sinuses may be necessary to diagnose chronic sinusitis in some individuals who do not improve with standard treatments.

The treatment of rhinitis largely depends on the cause of the rhinitis. It is important for the allergist to determine the cause as treatment is usually tailored to the cause. Some treatment modalities for rhinitis may include saline irrigation, nasal corticosteroids, oral antihistamines, nasal antihistamines, oral decongestants, nasal anticholinergics, and leukotriene antagonists. Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy hyposensitization) are a very effective therapy for the treatment of allergic rhinitis and asthma. Allergy shots have been used for more than 100 years in the U.S. and are effective in 80-85% of individuals who take them. They are usually taken for 3-5 years.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating rhinitis, as well as all other types of allergic conditions and asthma. We 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 rhinitis, we are here to help alleviate or hopefully end your bothersome symptoms 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, caring, and professional environment.

Pregnancy Rash – Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is the most common skin disease of pregnancy. This polymorphic (i.e., different shapes and forms) skin eruption occurs in approximately 0.5% or 1 in 200 pregnancies. The cause of this condition is generally unknown.

Individuals with this condition exhibit a very itchy (i.e., pruritus) rash that usually begins in the last trimester, but can began earlier in the pregnancy. The rash usually begins in stretch marks on the abdomen, but spares the area around the umbilicus (i.e., belly button) and within a few days begins to spread to the legs, feet, arms, neck, and/or chest. It tends to spare the face, palms, and soles. Skin distension (i.e., stretching) is thought to be a possible trigger for this condition.

It is more common to occur in a first pregnancy than in subsequent pregnancies. Likewise, it is more common to occur in pregnant women who are carrying a male fetus, pregnant with multiple births (e.g., triplets more than twins), and/or who have gained excessive weight during their pregnancy.

Initially the rash presents as red, hive-like (i.e., urticarial) bumps (i.e., papules) and later may develop into larger red, swollen patches (i.e., plaques). In lighter-skinned individuals, the rash may appear to be surrounded by a thin, white halo.

 

CAUSES:

The exact cause of pruritic urticarial papules and plaques of pregnancy is not exactly known.

One theory hypothesizes that when the skin of a pregnant woman is stressed or stretched, the connective tissues can be damaged. This damage causes inflammation which can result in a red, swollen rash.

Another theory of the cause of PUPPP is that it is due to an immune response to fetal cells. During pregnancy, some cells from the fetus migrate throughout the mother’s body. It is these fetal cells that can trigger an immune response in the mother, which in turn causes the rash.

DIAGNOSIS:

The diagnosis is usually established by the history and appearance of the rash and its association with intense itching. There are no specific diagnostic tests and skin biopsy usually reveals non-specific findings. A skin biopsy is sometimes done in order to differentiate the rash from similar rashes caused by herpes gestationis, prurigo of pregnancy, and atopic dermatitis (i.e., eczema).

Rarely, the baby can be born with a mild form of the rash of pruritic urticarial papules and plaques of pregnancy, but this rash soon fades. It should be noted that PUPPP does not cause any other problem for the baby.

TREATMENT:

Pruritic urticarial papules and plaques of pregnancy continues until delivery then usually resolves within 1–3 weeks. Rarely, it may persist for longer. In some cases, this relates to retained placental products.

There is no curative treatment for PUPPP, apart from delivery. Symptoms can be controlled using the following:
⦁ Emollients (i.e., moisturizers) applied liberally and frequently as required
⦁ Topical steroids applied thinly once or twice daily to the red itchy patches
⦁ A short course of systemic steroids (e.g., prednisone) in severe PUPPP
⦁ Antihistamine tablets appear safe in late pregnancy, although they may make the baby drowsy upon delivery

It is very uncommon for pruritic urticarial papules and plaques of pregnancy to recur. If it recurs, it is likely to be a milder case. It should also be noted that there is no long-term risk for either the mother or unborn child despite frequently severe itching.

The board certified allergists at Black and Kletz Allergy have over 5 decades of experience in diagnosing and treating all types of allergic skin conditions.  We treat both pediatric and adult patients, and of course pregnant patients.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We have been servicing the Washington, DC, Maryland, and Northern Virginia metropolitan area for many years and we look forward to providing you with the utmost state-of-the-art allergy care in a warm and pleasant environment.

Asthma – What You Need to Know

Asthma is a fairly common disease in the U.S. Asthma is a chronic disease that causes inflammation of the bronchial tubes (i.e., breathing tubes) resulting is symptoms that may include chest tightness, wheezing, shortness of breath, and/or coughing. According to the Centers for Disease Control and Prevention (CDC), approximately 25 million people in the U.S. have asthma which equates to 1 in every 13 individuals or 7.7% of the population. Note that 7.5% of children in the U.S. have asthma. Asthma is more common in adult women (9.1%) compared with adult men (6.2%), however, in children, boys are affected more than girls (8.3% vs. 6.7% respectively). Regarding race and ethnicity, asthma prevalence in the U.S. decreases in the following order: Native American (10.5%) > African American (9.6%) > White (8.2%) > Hispanic (6.0%) > Asian (4.7%). The fatality rate per million in individuals with asthma in the U.S. decreases in the following order: African American (21.8%) > Native American (11.3%) > White (9.5%) > Asian or Pacific Islander (8.5%) > Hispanic (6.3%). From the above statistics, one can see that the fatality rate is not based on the prevalence. It should also be noted that the asthma prevalence has been increasing over the last few decades even though there are more treatment modalities available now than ever before.

Asthma is characterized by the class it is designated. Asthma is categorized as follows: mild intermittent, mild persistent, moderate persistent, and severe persistent. The classification depends on how often one experiences symptoms, how often symptoms are causing nighttime awakenings, if the symptoms are disrupting normal activities, and how often one uses their rescue inhalers. In addition to these categories, asthma can also be classified as exercise-induced asthma, cough-variant asthma, nocturnal asthma, occupational asthma, asthma with associated COPD (i.e., chronic obstructive pulmonary disease), cardiac asthma (i.e., not actually asthma but congestive heart failure and other heart disease that masquerades as asthma since the symptoms are very similar to asthma), allergic asthma (i.e., an older classification which is not used anymore), nonallergic asthma (i.e., an older classification which is not used anymore).

In addition to asthma, there are several conditions that mimic asthma in its presentation and some of them are as follows: cardiac asthma (mentioned above), vocal cord dysfunction and/or paralysis, GERD (i.e., gastroesophageal reflux disease), sinusitis, upper respiratory tract infections (i.e., URI’s), COPD (e.g., chronic bronchitis, emphysema), bronchiectasis, cystic fibrosis, thyroid gland tumors, lung or chest tumors, pulmonary embolism, anxiety, pneumonia, and food aspiration.

The diagnosis of asthma requires a comprehensive history and physical examination in conjunction with a pulmonary function test. Additional measures may be needed depending on the history and physical examination and may include allergy skin or blood tests, chest X-ray, other types of bloodwork, sweat chloride test, CT scans, and others. The treatment of asthma is catered to each specific patient based on the frequency and severity of their symptoms. A host of medications may be utilized and range from just a rescue inhaler (i.e., short acting beta 2 inhalers) for intermittent asthma to biologicals (i.e., Xolair, Fasenra, Nucala) for more moderate-to-severe cases. Other therapeutics utilized to treat asthma may include inhaled corticosteroids, long acting beta 2 inhalers, combination inhalers of corticosteroids and long acting beta 2 inhalers, leukotriene antagonists (e.g., Singulair, Accolate, Zyflo), methylxanthines (e.g., theophylline), and oral corticosteroids. The prevention of asthma symptoms can usually be achieved through allergy immunotherapy (i.e., allergy shots, allergy injections, allergy hyposensitization, allergy desensitization) as well as to attempt to avoid triggers that can exacerbate one’s asthma.

The board certified allergists at Black & Kletz Allergy have had more than 50 years of experience in diagnosing and treating asthma in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both children and adults and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our office locations. The Washington, DC and McLean, VA offices are also Metro accessible. We offer 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 one of our offices or alternatively you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are happy to help you diagnose and treat your asthma as well as any other allergy-related or immunological condition that you might have.

What Can Be Done for Hives?

Hives (i.e., urticaria) are a fairly common occurrence which is usually very annoying to the individual who suffers from them. They are often called “welts” by the general public and “wheals” by allergists. Hives are itchy, red blotches on the skin that are usually raised. Some affected individuals may experience a burning sensation while others notice a stinging sensation. Hives, in some instances, may be flat and not raised. The size of an individual hive may range from very small to rather large. They can also coalesce with other hives to create giant “plaques” of hives. Hives can be various shapes and are usually not symmetrical. They often look like mosquito bites but without the actual bite. They can occur anywhere externally on the body (e.g., face, neck, extremities, back, abdomen) or be located internally (e.g., throat, intestines). When they are internal, symptoms such as swelling of the throat, abdominal pain, or diarrhea may ensue. When hives occur on the lips, tongue, eyes, or ears, it is not uncommon for the individual to notice only swelling of these body parts. This swelling is termed angioedema. Angioedema is essentially a hive that is in the deeper tissue layers. As a result, the lesion appears as a swelling, opposed to a hive. Either way, both are bothersome to the person who is afflicted with either or both of them.

Hives are basically grouped into two main categories, although there are actually more than two. The first category is referred to as acute urticaria. Acute urticaria is a condition where the hives occur for 6 weeks or less. If hives linger on and persist for more than 6 weeks, they are called chronic urticaria. Some cases of hives may last for months and even years in a small percentage of patients. Approximately 25% of the general population in the U.S. develop hives at some point in their lives. Each episode of hives generally last less than 24 hours in duration but may last for days or weeks in certain circumstances.

The diagnosis of hives begins with a comprehensive history and physical examination by a board certified allergist such as the allergists at Black & Kletz Allergy. The workup for hives will vary depending on what was discovered in the history and physical examination in conjunction with how long the hives have been present. For many individuals, a medication allergy is to blame. For others, a food may be the culprit. For those who present with chronic urticarial (i.e., hives that have persisted for more than 6 weeks), bloodwork is generally needed in order to rule out a multitude of diseases and conditions that are known to cause hives. Despite all of the bloodwork done on a patient with chronic urticaria, approximately 95% of these individuals will have normal test results. If the workup is completely negative, the term idiopathic chronic urticaria is used as a diagnosis. This basically is a fancy way of saying that no identifiable cause was discovered to cause the hives of that individual. Some of the conditions that are known to be associated with chronic urticaria include thyroid disorders, autoimmune disorders (e.g., systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis), hepatitis B, other infections, cancers, complement disorders, and physical elements (e.g., heat, cold, pressure, exercise, vibration), to name a few.

The treatment of hives can range from avoidance to using medications. Antihistamines are usually the first line of defense of most cases of hives. Beta-2 agonists such as Pepcid (famotidine) are often utilized to enhance the effect of the antihistamine when an antihistamine alone is not enough to prevent hives. Leukotriene antagonists [e.g. Singulair (montelukast)] are often added to the regimen is difficult-to-treat hives. In recalcitrant disease, oral corticosteroids may be used to bring the hives under control for a short time since the use of long-term steroids is not ideal because of the risks and many side effects that may develop. Xolair (omalizumab) injections are used for idiopathic chronic urticaria in patients where other therapy is unsuccessful. Xolair injections Xolair are very effective in the management of chronic hives.

The board certified allergists at Black & Kletz Allergy have had more than 50 years of experience in diagnosing and treating asthma in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We treat both children and adults and have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our office locations. The Washington, DC and McLean, VA offices are also Metro accessible. We offer 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 one of our offices or alternatively you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy are happy to help you diagnose and treat your asthma as well as any other allergy-related or immunological condition that you might have.

Latex Allergy

Allergic reactions on exposure to latex occur in approximately 1 to 3% of the general population in the United States.

Natural rubber latex comes from the sap of the rubber tree, Hevea brasiliensis. Allergic reactions to products made with latex develop in persons who become sensitized to proteins contained in natural rubber latex. “Synthetic latex” on the do not contain these proteins and do not cause reactions. Synthetic latex is often found in some paints and in some hand products.

There are over 40,000 products that contain natural rubber latex. Some of the common products that contain natural rubber latex which could trigger an allergic reaction in a sensitized individual on exposure include:

  • Elastic
  • Balloons
  • Condoms
  • Koosh Balls
  • Dental dams
  • Rubber bands
  • Latex gloves
  • Therapy bands
  • Bandage adhesives
  • Rubber accelerators
  • Red rubber catheters
  • Vial Stoppers, IV tubing, Stethoscopes
  • Baby bottles, nipples, pacifiers etc.

Latex allergy generally develops after repeated exposure to medical and/or consumer products containing natural rubber latex. Healthcare workers, spina bifida patients, workers with occupational exposure, and patients with multiple surgeries are at high risk for developing sensitivity to natural rubber.

Symptoms:

Latex allergy can cause two different type of allergic reactions:

  • Immediate hypersensitivity – A reaction which are mediated by the IgE antibody (i.e., Type I reaction). The symptoms may be mild initially but get progressively more severe with repeated exposures. Initial symptoms typically may include itching (i.e., pruritus), redness of the skin, hives (i.e., urticaria), itchy eyes, itchy throat, runny nose, and/or nasal congestion beginning within a few minutes after exposure to latex. It may lead to asthma symptoms such as chest tightness, coughing, wheezing, and/or shortness of breath. The more severe reactions are life-threatening episodes known as anaphylaxis, which involves multiple organ systems. Anaphylaxis may lead to low blood pressure, loss of consciousness, even be fatal.
  • Allergic contact dermatitis – A delayed type hypersensitivity allergic reaction mediated by T-lymphocytes (i.e., Type IV reaction). This type of reaction predominantly causing skin rashes. It is usually caused by certain chemicals used in the manufacturing process. The symptoms usually manifest a few days after exposure and can mimic poison ivy-like reactions causing blisters and eczema-like rashes.

Direct physical contact with latex products is not needed to trigger an allergic reaction. Inhalation of airborne latex particles can occur when latex proteins combine with the powder from products and form aerosolized particles that become airborne. These particles get into the eyes, nose, mouth, and/or lungs where the protein may be absorbed through these moist mucous membranes. Anaphylaxis and severe asthmatic reactions have been caused by inhaling latex proteins in the air resulting from the powder in the latex glove.

Cross Reactivity:
Up to 50% of patients sensitized to latex also can react adversely to certain foods on exposure. Bananas, avocados, and kiwis are the most common foods that cause allergic reactions in latex-sensitive individuals. Less commonly, latex-sensitive individuals may also react to potatoes, tomatoes, figs, and bell peppers.

Diagnosis:
Elevated levels of specific antibody to the latex protein in an individual’s serum (i.e., blood) in the context of the clinical presentation of sensitivity to rubber products, usually confirms the diagnosis of immediate hypersensitivity to latex. There is no FDA approved skin test antigen for latex allergy diagnosis at this time. Contact sensitivity to latex is primarily diagnosed based on the history of exposure and subsequent development of skin lesions.

Treatment:
As there is no desensitization available for latex allergy. Avoidance of exposure is the predominant modality of preventing allergic reactions. Patients with confirmed latex sensitivity should wear a medical bracelet indicating the condition. They should also carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) for use in case of anaphylactic reactions. It should be noted that if one is to use the self-injectable epinephrine device, that individual should go immediately to the closest emergency room for follow up.

Prevention:
Switching from latex gloves to powder-free low protein latex gloves and non-latex gloves in health care settings (e.g., medical offices, dental offices, hospitals) have dramatically reduced the incidence of severe reactions in the past several years. Awareness of all products possibly containing natural rubber and avoiding them is the only certain way of preventing serious reactions to latex.

The board certified allergists at Black and Kletz Allergy have over 5 decades of experience in diagnosing and treating allergic conditions including latex allergy.  We treat both adult and pediatric patients.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible. We offer 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 one of our offices or alternatively you may click Request an Appointment and we will respond within 24 hours by the next business day.  If you have or suspect a latex allergy or have other allergies, asthma, and/or immunological conditions, we would be delighted to help you as we have been serving the greater Washington, DC metropolitan area for many decades.

New Treatments for Chronic Cough

Why do we cough? Coughing is a natural defense mechanism to expel excessive mucus, microbes, and irritant substances from our airways which acts to protect our lungs from the potential damage caused by them. Coughing, however, can also be a bothersome symptom and is one of the most common reasons why patients consult their doctors.
The sound of a cough is produced after forcible expiration (i.e., breathing out) against a closed glottis (i.e., voice box) as the air flows out when the glottis suddenly opens. A cough is defined as “acute” when it persists for less than 3 weeks, subacute when the duration is between 3 and 8 weeks, and chronic if it continues to be present for longer than 8 weeks.

Approximately 12% of U.S. population experiences a chronic cough at some point in their lives. It is more common in women than in men and generally peaks between the 5th and 6th decades of life. A chronic cough can be very bothersome which may negatively impact one’s quality of life. A severe cough may lead to vomiting, broken ribs, bleeding, incontinence, sleep disturbance, social distress, and/or depression.

Common causes of a chronic cough:

  • Asthma
  • Medications such as ACE (angiotensin converting enzyme) inhibitors and some diabetes mellitus medications
  • Upper airway cough syndrome (e.g., post-nasal drip)
  • GERD (i.e., gastroesophageal reflux disease) – Also known as acid reflux.
  • Environmental irritants
  • Tobacco use
  • Eosinophilic bronchitis
  • Tumors

Initial evaluation begins with obtaining a comprehensive history, which includes:

  • Duration of the condition
  • Characteristics of the cough
  • Triggers for the cough (e.g., environmental, dietary)
  • Medications taken (e.g., over-the-counter, herbal, prescriptions)

“Red flags” in the history suggesting a serious illness may include:

  • Coughing up blood (i.e., hemoptysis)
  • Chronic smoking with a new cough
  • Difficulty in breathing
  • Persistent hoarseness
  • Difficulty in swallowing
  • Vomiting
  • Fever
  • Weight less
  • Swollen hands and/or feet
  • Abnormal examination
  • Abnormal chest X-ray

Treatments:

  • Upper airway cough syndrome: Post-nasal drip is usually a result of inflammation of the nose and throat either from allergens or irritants. This condition frequently responds to either antihistamines or nasal sprays or the combination of both antihistamines and nasal sprays.
  • Asthma: Cough may be the only symptom of asthma (e.g., cough variant asthma) and can be controlled with inhaled corticosteroids and/or oral leukotriene modifiers (e.g., Singulair, Accolate, Zyflo)
  • Non-asthmatic eosinophilic bronchitis: A trial of oral corticosteroids such as prednisone for 1 to 2 weeks is usually helpful in relieving the cough.
  • GERD: Approximately 10% of the population report frequent “heartburn” from acid reflux. Lifestyle modifications and medications to reduce acid secretion (e.g., Prilosec, Nexium, Prevacid) for 4 to 8 weeks will usually result in a substantial improvement of the cough.
  • Speech evaluation and speech therapy may be useful in certain situations.

If the cough does not respond to the above treatments at the correct dosage for a sufficiently long duration, it is termed a chronic refractory cough.
New medications which target the neurological pathways and block the cough reflex are actively being investigated and are as follows:

  • Sodium channel blockers: Similar to local anesthetics such as lidocaine.
  • Neurokin-1 (NK-1) receptor antagonists (e.g., Orvepitant, Aprepitant)
  • Purinergic receptor antagonists: Gefapixant is the name of one of the most promising drugs currently in development which exhibited significant efficacy in controlling a refractory cough. It is undergoing phase 3 clinical trials at this time. It is given by mouth twice a day. Side effects reported so far include taste disturbances.

The board certified allergists at Black & Kletz Allergy have been treating coughs in adults and children in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Black & Kletz Allergy provides on-site parking at all of their convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA locations are Metro accessible and there is a complementary shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call any one of our offices to schedule an appointment for your allergy, asthma, or immunology needs. Alternatively, please click Request an Appointment and we will respond within 24 hours on the next business day.

Spring Allergies

Historically, March is the month that many trees begin pollinating in the Washington, DC metropolitan area. This year, trees have begun to pollinate in February, as the temperatures in the metro area have been higher than normal for a typical Winter. We will begin to see tree pollen marked by a yellowish coating on our automobiles soon. For many allergic individuals, this represents a tumultuous time for those who are sensitized to tree pollen. Birch, cedar, ash, oak, elm, cottonwood, hickory, and maple are the predominant trees producing pollen in our area during the Spring.  This time of the year is the reproductive season for the trees. As a result, the tree pollen grains are released into the atmosphere in order to fertilize the ovules of other trees.  This process is called pollination. Pollen is produced and then dispersed by the wind throughout the day, however, the tree pollen counts are highest during the morning hours.

Pollen grains are not harmful or noxious when inhaled, unless an individual’s immune system mistakes the pollen as potentially hazardous and subsequently mounts a defensive attack on them.  This process is called allergic sensitization and results in the release of certain chemical mediators such as histamine and leukotrienes, which are mediators of the annoying symptoms of allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies).

Over the past decade, several scientists have noticed a steady increase in the tree pollen counts across the country.  Many scientific researchers believe, although controversial, that climate change is contributing in part to this trend of increasing pollen counts.  Carbon dioxide is the primary gas needed for the growth and development of trees, (along with sunlight, water, and nutrients), and increasing levels of carbon dioxide are being documented every year.  These changes in the climate may impact the pollen season of not only trees, but in addition, may affect the pollination of both grasses and weeds. Climate change may cause an increase in the amount of pollen produced as well as cause an extension of the duration of the pollen seasons.

What are the symptoms of Spring allergies?
The most common symptoms of Spring allergies may include sneezing, clear runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, itchy eyes, watery eyes, red eyes, puffy eyes, cough, itchy ears, clogged ears, sinus headaches, sinus congestion, sinus pressure, snoring, and/or fatigue.  In asthmatics, the pollen can also trigger chest tightness, coughing, wheezing, and/or shortness of breath.

How are Spring allergies diagnosed?
Spring allergies are diagnosed by board certified allergists such as the allergy specialists at Black & Kletz Allergy who first take a comprehensive history and perform a detailed physical examination.  Allergy testing is often done either by skin testing or occasionally via blood testing in order to identify the offending allergen.  Once the allergens are known, preventive measures are recommended in order to reduce exposure to the allergens.
Some preventive measures to reduce exposure to pollen and to minimize symptoms may include the following:

  • Track the local pollen counts on the homepage on our website, www.bkallergy.com by clicking Today’s Pollen Count and avoid outdoor activities on days where the pollen count is high, especially in early morning hours.
  • Go outdoors shortly after it rains, as the water keeps the pollen from blowing from place to place.
  • Change and clothes after wearing them worn outside.
  • Leave shoes outdoors in order to help prevent bringing pollen into the home.
  • Wipe down a pet’s fur and/or wash the pet before he/she comes indoors.
  • Shower off the pollen from skin and hair before going to bed.
  • Close the windows in automobiles and at home to keep the pollen out.
  • Run the air conditioner in automobiles and at home.

How are Spring allergies treated?
Begin using antihistamines and nasal corticosteroid sprays early in the season. They are more effective if begun before the onset of symptoms and if taken daily throughout the season. Other common types of prescription medications may include decongestants, leukotriene antagonists, nasal antihistamines, nasal anticholinergic agents, eye drops, inhaled corticosteroids, and inhaled beta-agonists. In cases of persistent or severe symptoms, consider allergy desensitization (i.e. allergy shots, allergy immunotherapy, allergy injections, allergy hyposensitization) to the pollen, which usually provides a long-term benefit and reduces the need for medications. They are effective in 80-85% of patients. They are generally taken for 3-5 years.

The board certified allergists at Black & Kletz Allergy have 3 locations in the Washington, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our 3 office locations have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  Our McLean office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  The allergy specialists at Black & Kletz Allergy diagnose and treat both adult and pediatric patients.  To schedule 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.  The allergy doctors at Black & Kletz Allergy have been serving patients with hay fever, asthma, sinus disease, hives, eczema, insect sting allergies, food allergies, medication allergies, and immunological disorders for more than 50 years.  If you are bothered from allergies, it is our mission to improve your quality of life by reducing or preventing your undesirable and annoying allergy symptoms.