Category Archives: UNCATEGORIZED

Can Fatigue be a Symptom of Allergies?

• January 30, 2019
• BY BLACK & KLETZ ALLERGY

In this ever increasing complicated and stressful world that we live in, many individuals find themselves complaining of fatigue.  Most people chalk it up to being overworked or to too much stress in their lives, but fatigue can be a symptom of a multitude of illnesses.  Amongst these ailments, fatigue is often a symptom of allergies.  When an individual suffers from allergies such as hay fever (i.e., allergic rhinitis), asthma, or sinus disease (as a result of allergies), it is not uncommon to feel fatigued.  This is often from the body becoming “worn down” from constantly “fighting” the offending allergens.  In asthmatics, patients may also complain of fatigue because the shortness of breath that frequently accompanies asthma contributes to their lethargy.  In patients with sinus disease, there is often an associated sinus infection (e.g., acute sinusitis, chronic sinusitis) which also may “wear down” the body as most infections typically do, and as a result, fatigue develops in these individuals.

There are some patients with allergies where the only symptom is fatigue.  It is important however for the board certified allergist such as the ones at Black & Kletz Allergy, to recognize that not everyone with fatigue suffers from allergies.  In addition, even if someone has allergies, their fatigue may not be the cause or sole cause.  There are many other diseases and/or conditions where an individual may complain of fatigue.  These conditions should be ruled out rather than just assume that their allergies are the sole cause of their fatigue.

What are some conditions that can cause fatigue other than allergies, asthma, or sinus disease?  Below are some of the more common factors and/or disorders that can be associated with fatigue not including the aforementioned allergies, asthma, and sinus disease:

• Anemia
• Chronic obstructive pulmonary disease (COPD) (e.g., chronic bronchitis, emphysema)
• Depression
• Liver disease
• Kidney disease
• Heart disease
• Thyroid disease
• Diabetes
• Autoimmune disorders (e.g., systemic lupus erythematosus, rheumatoid arthritis)
• Fibromyalgia
• Sleep apnea
• Inflammatory bowel disease (e.g., chronic ulcerative colitis, Crohn’s disease)
• Medications (e.g., antihistamines, antidepressants, anti-anxiety medications, blood pressure medications)
• Alcohol or drug use

There are numerous other factors and/or conditions that may play a role in causing fatigue and it is advisable to also be examined by your primary care physician when you are experiencing fatigue.

The diagnosis of allergies begins with a comprehensive history and physical examination.  Allergy testing is usually performed by utilizing the skin testing method, however, blood tests can also be done.  The treatment of allergies begins with avoidance measures in order to reduce the exposure of an individual with the offending allergen.  If avoidance measures are not satisfactory, medications are used in order to alleviate the symptoms.  There are a wide variety of medications used to treat allergies and thus the fatigue that may be associated with them.  Ironically, many over the counter allergy medications (e.g., antihistamines) can cause fatigue and/or drowsiness.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization, allergy hyposensitization) is a very effective treatment modality used for the treatment of allergies and allergic asthma.  It is effective in 80 – 85% of the patients that undergo allergy immunotherapy.  The usual course of treatment with allergy shots is usually between 3 – 5 years.

The board certified allergy specialists at Black & Kletz Allergy has 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.  All 3 of our office locations have on-site parking.  In addition, our 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.  The allergists of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  For an appointment, please call our office or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergy doctors at Black & Kletz Allergy have been helping patients with fatigue, hay fever, asthma, sinus disease, hives, eczema, medication allergies, food allergies, insect sting allergies, and immunological disorders for more than a half a century.  If you suffer from fatigue and want to decipher if they are being caused by allergies, it is our mission to determine if your fatigue is stemming from allergies.  Then it is our goal to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms including fatigue.

Can Allergies be Prevented?

• January 30, 2019
• BY BLACK & KLETZ ALLERGY

Do probiotics have a role in preventing allergies?

While some studies demonstrated a protective effect of probiotics on the development of eczema, other studies have shown no effect on the development of other allergic diseases.  In view of the conflicting results of various studies, probiotics are not currently recommended for preventing allergies.

How about fish oils?

There is no convincing evidence at this time that taking fish oil supplements have any significant benefit in preventing allergies.

Will dust mite avoidance measures cut down the risk of developing allergies and/or asthma?

Unless an individual is already sensitized to dust mites, avoidance measures to reduce the exposure to dust mites have not proved to reduce the chances of developing allergies, eczema, or asthma.

Should I avoid pets?

There is no reason to remove pets from the household unless a person’s allergies and/or asthma flares up when he or she is exposed to the pets.  Even if an individual’s symptoms are tied to their exposure to pets, it is often very difficult for them to get rid of their pets, as the pets are considered part of the family.  If an allergy sufferer’s symptoms appear to worsen when exposed to their pets and he or she is unwilling to remove the pets from their home, it is advised to keep the pets out of the bedroom where that individual usually spends at least 7-8 hours per day or night.

If I restrict some foods while I am pregnant and/or while breastfeeding, would that prevent my child from having food allergies?

Avoidance of common allergy-causing foods such as peanuts, tree nuts (e.g., almonds, Brazil nuts, cashews, hazelnuts, pecans, walnuts), eggs, fish, shellfish, soy, dairy, etc. has not been shown to reduce the risk of children developing food allergies.  In fact, restrictions in one’s diet during pregnancy and lactation have been linked to a decreased weight gain by babies and should be avoided.

Should I delay introduction of any foods to my infant to prevent food allergies?

Some studies showed that babies exclusively breastfed for the first 3 to 4 months of life are less likely to develop food allergies and eczema during the first 2 years of life.  As a general rule, solid foods should be introduced around 6 months of age, preferably while still breastfeeding.  This however should be confirmed by your pediatrician.  Common allergenic foods containing peanut, egg, fish, cow’s milk and soy should be given to babies before 12 months of age.  Again, this should be determined by your pediatrician.  Studies of children at high risk of developing allergies (i.e., children with eczema and/or with a family history of allergies) have demonstrated that early introduction of these foods will reduce the risk of developing food allergies in later life.

Is soy milk or goat’s milk better to prevent allergies than cow’s milk formula?

No.  Studies have showed that soy-based formulas or goat’s milk does not prevent the development of food allergies in children.

What should I do if I suspect that my child has a food allergy?

Accurate diagnosis by standardized testing is essential before treatments are contemplated.  If the tests confirm allergies to specific foods, avoidance of those foods and substitution with suitable alternatives, supervised by your board certified allergist, like the allergy specialists at Black & Kletz Allergy are recommended.  Special alternative formulas are available for children with cow’s milk and/or soy milk allergies.

Will allergy injections (i.e., immunotherapy, desensitization) prevent allergies?

The current indications for allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is to treat established environmental allergies.  However, there is emerging evidence that treating children with allergic rhinitis (i.e., hay fever) with allergy injections to “switch off” their allergies may reduce the risk of them developing new allergies and asthma later in life.

The board certified allergists at Black and Kletz Allergy have been diagnosing and treating allergies and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We see both adults and pediatric patients.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each of our 3 locations.  Our Washington, DC and McLean, VA offices are Metro accessible.  Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line.  If you suffer from allergies, asthma, sinus problems, hives, or immunological disorders, please call us to make an appointment.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated in providing the most state-of-the-art allergy treatment in a warm, caring, and professional environment.

Winter Allergy Symptoms

• December 31, 2018
• BY BLACK & KLETZ ALLERGY

As we approach the Winter in the Washington, DC, Northern Virginia, and Maryland metropolitan (Mid-Atlantic) area, the temperatures naturally fall and the resulting cold air can play havoc with many people.  “Allergic” signs and symptoms may appear in allergic patients as well as non-allergic individuals.  The “allergic” symptoms can vary in intensity and they commonly affect different parts of the body such as the nose, eyes, lungs, and/or skin.

Symptoms based on the parts of the body:

Nose:  The cold air of Winter can act as an irritant to anyone whether the individual has allergies or does not have allergies.  The typical symptoms that may occur include runny nose, nasal congestion, post-nasal drip, and nosebleeds (i.e., epistaxis). 

Patients with nonallergic rhinitis (i.e., vasomotor rhinitis) will experience these symptoms despite the fact that allergy testing is negative because these individuals are bothered by irritants such as cold air, cigarette smoke, air pollution, dusts, strong odors, chemicals, etc.  Nosebleeds are usually a result of the cold dry air which is common during the Winter.

On the other hand, patients with allergic rhinitis (i.e., hay fever) can exhibit the same symptoms during the Winter as the patient with nonallergic rhinitis, however, their symptoms are generally due to a true allergy to allergens that are prevalent in the Winter months.  The most common allergens during these months include dust mites, molds, pets, and cockroaches.  Nosebleeds may be due to either a side effect of a corticosteroid nasal spray (e.g., Flonase, Nasacort, Rhinocort, Nasonex, Qnasl, Omnaris) used in the treatment of allergic rhinitis or the result of the cold dry air that accompanies the Winter weather.

Eyes:  Similar to the effects that the cold air has on the nose, the cold air can affect ones’ eyes in very much the same way.  The two characteristic symptoms exhibited when the eyes come in contact with cold air in an allergic or nonallergic individual include watery eyes and redness of the eyes.  Itching of the eyes is generally not seen unless an individual is allergic and is reacting to one of the allergens common during the Winter (e.g., dust mites, molds, pets, cockroach).

Lungs:  Cold air is a common trigger that exacerbates asthma symptoms (e.g., chest tightness, shortness of breath, wheezing, coughing) in asthmatic individuals.  Most asthmatics have an underlying allergic diathesis and in turn their asthma may also be exacerbated by common Winter allergens such as molds, dust mites, pets, and/or cockroaches.  Of note, cockroaches are a very common and potent allergen that aggravates the symptoms of asthma in asthmatic children living in inner cities.  In nonallergic, non-asthmatic people, the cold air can also cause asthma-like symptoms, but generally the symptoms are milder in severity.

Skin:  When the temperature drops in the Winter, the cold air can cause two similar conditions referred to as Raynaud’s disease (i.e., primary Raynaud’s) and Raynaud’s phenomenon (i.e., secondary Raynaud’s) depending on whether there is an underlying medical problem.  Raynaud’s disease is not associated with another medical condition and is more common than Raynaud’s phenomenon which is associated with other medical conditions.  The most common underlying medical problems that may be associated with Raynaud’s phenomenon may include connective tissue diseases (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma, Sjögren’s syndrome), smoking, atherosclerosis, carpal tunnel syndrome, injuries to the hands and/or feet, and certain medications (e.g., migraine headache medications, beta blockers, ADHD medications).

Regarding the skin, there are 4 conditions that all act on the skin and can be lumped into one entity as they are all very similar.  The only difference between them is the severity of the reaction when an individual is exposed to the cold. The 4 conditions include cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis.  In cold-induced pruritus, the cold air will cause a susceptible person to have itchy skin. In cold-induced urticaria, the individual will develop hives upon contact with something cold. People with cold-induced angioedema will develop swelling episodes when exposed to the cold.  Lastly, some individuals may develop anaphylaxis when they are exposed to the cold which obviously can be very serious and potentially fatal. It is important to see a board certified allergist if you have one of these conditions, as a self-administered epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) is typically prescribed, particularly for cold-induced angioedema and cold-induced anaphylaxis.  It is also important to note that any person who needs to use a self-administered epinephrine device should go immediately to the closest emergency room after using the device.

Winter is almost here and the temperatures outside have already begun to drop into the “cold” range.  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.  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.  The allergy doctors of Black & Kletz Allergy diagnose and treat both pediatric and adult patients.  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, hives, eczema, generalized itching, anaphylaxis, medication allergies, insect sting allergies, food allergies, and immunological disorders for more than 50 years.  If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your unwanted and aggravating allergy symptoms.

Cow’s Milk Allergy

• December 13, 2018
• BY BLACK & KLETZ ALLERGY

About 2% of children in the United States are allergic to cow’s milk.  The condition usually begins in the first year of life and can affect both breastfed and formula-fed infants.  A majority of the children usually “outgrow” the allergy by 5 years of age, however not all children “outgrow” milk allergies.

Immediate hypersensitivity reactions (Type I allergy reactions) to cow’s milk are mediated by an antibody (i.e., Immunoglobulin E or IgE) to the protein in milk.

Symptoms:

The symptoms of milk allergy usually appear within minutes of ingestion and may involve multiple body systems.  Below are some common symptoms that may be associated with cow’s milk allergy:

Skin:  Itching, redness, hives, swelling

Respiratory:

Upper:  Nasal congestion, runny nose, sneezing, hoarseness

Lower:  Coughing, wheezing, chest tightness, shortness of breath

Eyes:  Redness, itching, puffiness of eyelids

Heart:  Pallor, fainting, dizziness

Gastrointestinal:  Abdominal pain and/or cramping, vomiting, diarrhea

Diagnosis:

• Skin prick testing
• Cow’s milk specific serum IgE via blood testing
• Oral food challenge

A double-blind oral challenge with food under controlled conditions under medical supervision is considered the gold standard in the diagnosis of food allergies. It may not be needed however when the clinical presentation is highly suggestive of the diagnosis and when it is supported by appropriate test results.

Treatment:

Currently, the only FDA-approved treatment for cow’s milk allergy is strict avoidance of all exposure to cow’s milk protein.  It is also very important to have an emergency treatment plan in case of an accidental ingestion and/or exposure.

Cow’s milk proteins are found in all dairy products including milk, cheese, yogurt, butter, ice cream, and pudding.  Other foods such as breads, cookies, crackers, and cakes may also contain milk products. In packaged foods, milk may be listed as a major ingredient or in the “may contain” list.  Sometimes, a product will convey that the food was made in the same facility as other foods that contain milk. Parents also must be aware of the possibility of cross contamination of milk with other foods, especially in restaurants.  Other products that contain casein, whey, hydrolysates, lactose, lactulose, lactoglobulin, lactoferrin, lactalbumin, ghee, rennet, artificial butter flavor, artificial cheese flavor, and/or curd should also be avoided. It is also a good idea for parents of a child with cow’s milk allergy to share his or her allergy with caregivers, teachers, principals, school nurses, neighbors, relatives, and parents of the child’s friends so that they are all aware of the allergy and what to do if the child comes in contact with cow’s milk.

Some children with cow’s milk allergy may be able to tolerate baked milk foods as prolonged heating at high temperatures can denature the protein making it less allergenic.  However children with established cow’s milk allergy should be fed baked milk foods only if they pass the oral challenge with baked food under medical supervision. It is best and recommended, however, to avoid baked milk foods just to be on the safe side.

Medications:

Self-injectable epinephrine devices (e.g., EpiPen, Auvi-Q, Adrenaclick) should be readily available to treat a severe reaction after accidental exposures.  Milder reactions may be treated with antihistamines such as Benadryl (i.e., diphenhydramine).

Resolution:

As mentioned before, an oral food challenge is the gold standard to establish if the allergy has been “outgrown,” however, in some cases, this may not be feasible to do in a doctor’s office.  The board certified allergist may repeat food allergy tests may every year to determine whether it is safe to perform oral food challenges.

Cow’s milk is a very important source of nutrition in infants and young children, as it contains carbohydrates, fats, protein, and various essential minerals and vitamins. When milk is being avoided, children should be fed proper nutritional substitutes in adequate quantities and parents may need guidance from a certified dietician to choose the alternative foods.

The board certified allergists at Black & Kletz Allergy have 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.  The allergy specialists at Black & Kletz Allergy are extremely knowledgeable regarding cow’s milk allergies as well as other food allergies.  We diagnose and treat both pediatric and adult patients.  In addition, we treat patients with environmental, medication, insect sting, and skin allergies, asthma, sinus disease, and immunological disorders.  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 care in a friendly and professional environment.

Vaccines for Adults with Lung Disease

• November 14, 2018
• BY BLACK & KLETZ ALLERGY

Every year, thousands of people in the U.S. get very sick from diseases that could be prevented by vaccines.  People with asthma and chronic obstructive pulmonary disease (COPD) (e.g., emphysema, chronic bronchitis) are at a higher risk than the general population for complications from vaccine-preventable diseases.

Asthma and COPD cause the airways of the lungs to swell.  In addition, these conditions cause mucus secretions to become thick, resulting in the blockage of the swollen airways which may lead to breathing difficulties.  Certain viral and bacterial infections affecting the lungs can also cause swelling of the airways and thicken the secretions. This combination can lead to serious complications such as pneumonia and/or respiratory failure.

Immunizations provide the best protection against infections which may aggravate asthma and/or COPD.  The side effects from vaccinations are generally mild and self-limited.

The following vaccinations are strongly recommended for people with lung diseases:

1. 1. Influenza:

The 2018-2019 vaccine has been updated from last season’s vaccine to better match circulating viruses.  Immunity from this vaccination usually begins to develop after approximately 2 weeks.

Injectable influenza vaccines (i.e., flu shots) are approved for use in individuals aged 6 months and older.  Flu shots have a long established safety record in people with asthma. Individuals with asthma can receive either a trivalent or a quadrivalent vaccine.

The nasal spray vaccine is recommended as an option for use in people 2 through 49 years of age.  It should be noted that anyone with asthma is at increased risk for wheezing after receiving the nasal spray flu vaccine.  Nasal spray vaccine is also not recommended for pregnant women, individuals with weakened immune systems and their care givers, and children 2 through 4 years of age who have had a history of wheezing in the past 12 months.  It is important to note that the influenza virus in the nasal spray vaccine a live attenuated (i.e., weakened) virus compared with a killed virus that is used in a flu shot.

People with egg allergies can receive any recommended age-appropriate influenza vaccine that is otherwise appropriate, if given the approval by their primary care physician.  Individuals who have a history of severe egg allergy (i.e., those who have had any symptom other than hives after exposure to egg) should be vaccinated in a medical setting, supervised by a physician who is able to recognize and manage severe allergic reactions.  Again, if one has an egg allergy, one should always check with their primary care physician about getting a flu vaccination and only receive it, if approved by the primary care physician.

In addition to getting a flu vaccine, people with asthma should take everyday preventive actions including covering coughs, washing hands often, and avoiding individuals who are sick.

2. Pneumococcal Vaccines:

Pneumococcus is a bacteria that causes thousands of infections, such as meningitis, bloodstream infections (e.g., sepsis), pneumonia, and ear infections. Pneumococcal vaccines are very good at preventing severe disease.  Two types of vaccines are available:

The pneumococcal conjugate vaccine (e.g., PCV13 or Prevnar) protects against 13 strains of pneumococcal bacteria.  It is recommended for young children and adults 65 years of age or older. Older children and adults younger than 65 years of age who are at increased risk for getting pneumococcal disease may also need a dose of PCV13.

The pneumococcal polysaccharide vaccine (e.g., PPSV23 or Pneumovax) protects against 23 types of pneumococcal bacteria.  It is recommended for all adults 65 years of age and older, as well as for individuals 2 years of age and older who are at increased risk, such as those with asthma and/or COPD.

Both vaccines are recommended and generally they should be given 1 year apart.

3. Diphtheria, Tetanus, Pertussis:

This combination vaccine protects against 3 serious bacterial infections, namely diphtheria, tetanus, and pertussis (i.e., whooping cough).  DTaP is the childhood vaccine, and Tdap is the pertussis booster vaccine for preteens, teens, and adults. A Td booster is recommended once every 10 years.  Most Ob/Gyn doctors will recommend the Tdap to all pregnant women. It is usually recommended in the 3rd trimester.  The Tdap is also usually recommended for each subsequent pregnancy.  In addition, pediatricians generally recommend that all care-givers and individuals that will be in close and frequent proximity to the newborn also be vaccinated with Tdap.

4. Shingles:

Shingles is a painful and/or itchy rash that usually develops on one side of the body, often the face or torso.  It is caused by the re-activation of the chickenpox virus (i.e., varicella-zoster virus) that has been lying dormant in a nerve of an individual.  The rash consists of small blisters that typically scab over in 7 to 10 days and generally clears up within 2 to 4 weeks. For some individuals, the pain can last for months or even years after the rash disappears.

A new shingles vaccine called Shingrix (i.e., recombinant zoster vaccine) was licensed by the U.S. Food and Drug Administration (FDA) in 2017.  It is recommended that healthy adults 50 years of age and older receive two doses of Shingrix, 2 to 6 months apart. Shingrix provides strong protection against shingles and the complication of long term pain.  Patients who have previously received Zostavax, an older shingles vaccine, are recommended to subsequently receive Shingrix, as it is more efficacious.

The board certified allergists/immunologists at Black & Kletz Allergy have expertise is immunizations as well as the diagnosis and treatment of immunological conditions.  In addition to diagnosing and treating immune disorders, the allergy specialists at Black & Kletz Allergy diagnose and treat a wide array of allergic conditions such as hay fever (i.e., allergic rhinitis), sinus disease, asthma, hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), anaphylaxis, insect sting allergies, food allergies, medication allergies, and eosinophilic esophagitis.  We have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer parking at each location and the Washington, DC and McLean, VA locations are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

If you would like to schedule an appointment, please call us to schedule a visit at your desired location.  Alternatively, you may click Request an Appointment and we will respond to you within 24 hours by the next business day.  Black & Kletz Allergy has been treating allergy, asthma, and immune-related conditions for more than 50 years in the Washington, DC and Northern Virginia metropolitan area.  We are board certified to see both adult and pediatric patients and we are determined to improve the quality of life in individuals who may suffer from unwanted allergies, asthma, sinus disease, or immune dysfunction.

Sinusitis vs. Allergies

• November 14, 2018
• BY BLACK & KLETZ ALLERGY

Many individuals are unsure whether they have sinusitis (i.e., sinus infection) vs. typical “allergies.”  Sinusitis generally refers to infected sinuses, however, sinusitis technically means “inflammation of the sinuses.”  Typically, sinusitis is a direct result of either a “cold” or allergies (i.e., allergic rhinitis, hay fever).  The symptoms of each condition are usually very similar and the differences can be very subtle, however there are several things to look at in order to help differentiate between the two disorders.  In both allergic rhinitis and sinusitis, most patients will experience one or more of the following symptoms: nasal congestion, runny nose, post-nasal drip, sneezing, itchy eyes, and/or watery eyes.  Patients with sinusitis, however, may also experience one or more of the following symptoms in addition to the symptoms above: sinus headaches, thick discolored mucus from the nose, sore throat, cough, sinus pressure, teeth pain (particularly the upper teeth), fatigue, malodorous breath, decreased sense of taste/smell, and/or mild fever.

When someone develops a sinus infection, it may be acute, chronic, or recurrent:

Acute sinusitis is the most common form of sinusitis.  It is the classic example of a sinus infection. Individuals typically will complain of sinus or facial pressure, headaches, nasal congestion, thick discolored nasal mucus, post-nasal drip with or without a sore throat, and/or cough.  Patients often will say that they had a “cold” before the sinus infection began. Others will give a history of being exposed to something that they were allergic to such as pets, pollens, dust, etc. The treatment may entail the use of antibiotics (generally if the symptoms have been present for more than 1 week), nasal corticosteroids, antihistamines, decongestants, and/or mucolytics (i.e., mucus thinners).  It should be noted that most cases of acute sinusitis are caused by viruses and thus antibiotics are not necessary. If the symptoms persist and/or get worse, however, antibiotics are often used.

Chronic sinusitis is not as common as acute sinusitis, but is generally more difficult to treat.  An allergist should suspect chronic sinusitis when the patient has had symptoms for a long time, a sinus infection is recurrent, and/or fatigue becomes more prevalent.  The symptoms of chronic sinusitis may include all of the symptoms found with acute sinusitis except a fever is less common with chronic sinusitis. In addition to the symptoms found in acute sinusitis, patients with chronic sinusitis may exhibit a decreased sense of taste/smell, fatigue, malodorous breath, and/or cough.  The cough tends to be a “barky” cough, although any cough may occur. The diagnosis of chronic sinusitis is usually verified by a CT scan of the sinuses. It will show thickened mucus membranes of the sinuses compared with an “air-fluid level” found in patients with acute sinusitis. In addition to using antihistamines, nasal corticosteroids, decongestants, and/or mucolytics, the treatment of chronic sinusitis generally involves a 30 day course of antibiotics.  If the infection is recalcitrant, another 30 day course of an antibiotic may be necessary. In some individuals, sinus surgery may be necessary in order to eradicate the infection. The surgical procedure may also be directed at creating better drainage of the sinuses, in order to help prevent future sinus infections.

Recurrent sinusitis is actually repetitive acute sinus infections.  They can occur for a variety of reasons, some of which are as follows:

1.) If an acute sinus infection is not completely eradicated, the focus of the bacterial infection remains, and the bacteria may grow back causing another acute sinus infection.

2.) The wrong antibiotic or an antibiotic that the bacteria is not as sensitive to may cause a sinus infection to return.

3.) Allergic patients that have been exposed and re-exposed to large amounts of allergen(s) can develop recurrent sinus infections.

4.) Re-exposure to different viruses may cause recurrent sinusitis

5.) Individuals with immune dysfunctions may develop recurrent sinusitis.

It is important to note that many individuals think that they are experiencing recurrent sinus infections, when in fact they have an indolent chronic sinus infection with intermittent worsening symptoms.  This gives the patient the false impression that they are getting recurrent acute sinus infections. It takes a board certified allergist in order to realize that the individual may have a chronic sinus infection instead of recurrent infections, as the treatment of the 2 conditions is very different.  The treatment of recurrent sinusitis is essentially the same as that of an acute sinus infection.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating all types of sinus infections, as well as all types of allergic conditions and asthma.  We are board certified to treat both adult and pediatric patients and have been doing so in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 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 or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  If you suffer from allergies and/or sinus-related symptoms, 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 relaxed, caring, and professional environment.

Treatments for Food Allergy

• October 24, 2018
• BY BLACK & KLETZ ALLERGY

Approximately 15 million Americans are affected by some form of food allergy and nearly 6 million of those are children under 18 years of age.  Many epidemiological studies indicate that the prevalence (i.e., the proportion of individuals in a population having the condition) of food allergy is increasing over the past 2 decades.  Genetic and possibly environmental factors predispose individuals to the development of many allergic disorders including food sensitivity.

Though a large number of foods can cause allergic reactions, in the United States, milk, egg, and peanut are the 3 most common allergenic foods.  Current management strategies require strict avoidance of these foods. Despite the intent of strict avoidance, accidental ingestion of allergenic foods can and does happen.  This may result in a severe reaction which may require the use of a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick). An individual who is susceptible to severe food allergies may result in considerable anxiety which may impact the quality of life of that individual as well as their families.

Several clinical trials are now looking at various treatment options in an attempt to reduce the risk of severe reactions with accidental exposures.  These involve different types of gradually increasing exposures to foods at regular intervals under controlled conditions.

1. Desensitization:  An increase in reaction threshold to a food allergen while receiving active treatment.
2. Sustained unresponsiveness:  A lack of a reaction to a food allergen after active therapy has been discontinued after a period of time.  It requires some level of continued allergen exposure.
3. Remission:  A temporary state of non-responsiveness off therapy.
4. Oral tolerance:  A complete lack of clinical reactivity to an ingested food allergen.  It does not depend on continued food allergen exposure.

Several types of immunotherapy, including oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and epicutaneous immunotherapy (EPIT), are under active investigation for the treatment of food allergy.

1. Oral Immunotherapy:  This form of immunotherapy requires the daily ingestion of an allergen powder (e.g., peanut protein along with lipids and carbohydrates) that is mixed with another food and ingested.  OIT involves treating patients with escalating doses of the offending food, with the hope of slowly inducing desensitization to that food. Adverse reactions of this therapy may include systemic reactions, gastrointestinal symptoms, and/or skin manifestations.  Some trials have demonstrated that the use of anti-IgE (i.e., Xolair (omalizumab) with OIT will allow updosing to proceed more quickly and with fewer allergic side effects. Other studies are also investigating whether adding adjuvants such as probiotics to peanut can increase the efficacy of the therapy.
2. Sublingual Immunotherapy:  This therapy requires the application of an allergen extract in the sublingual space (held under the tongue for 2-3 minutes and then swallowed) on a daily basis over the time of treatment.  SLIT is well tolerated with minimal side effects that are typically limited to oropharyngeal itching or tingling.
3. Epicutaneous Immunotherapy:  This approach involves the application of a small allergen patch to the back or upper arm.  The patches are changed at 24-hour intervals over years of therapy. EPIT is generally well tolerated.  Typically, only mild skin irritation is noted at the patch site for the majority of patients.

In comparing the different types of immunotherapy for food allergy, OIT has the greatest amount of clinical desensitization, followed by SLIT and then EPIT.  Allergic side effects to the different treatments are in the same order with OIT having the most allergic side effects.

Despite the 3 types of desensitization methods that are utilized for food allergies, there are still gaps in our knowledge and unanswered questions to be answered:

1. The optimal dose, frequency, and duration of OIT are unknown.
2. Is maintenance therapy or food ingestion required to maintain remission?  If so, at what dose and what frequency?
3. Is a combination or sequence of either OIT, SLIT, and/or EPIT better than one treatment alone?

Though these treatment options are not yet approved by the FDA, the future looks promising for the treatment of food allergies as research continues to answer some of previous unanswered questions.

The board certified allergists at Black & Kletz Allergy have been diagnosing food allergies in both adults and children for over 5 decades.  As of yet, there are no FDA-approved methods to treat food allergies, although several methods are being researched at this time.  As of now, the gold standard approach to treat food allergies is to strictly avoid the offending food. It is very important to identify the specific food that one is allergic to in order to avoid it in the future.  Black & Kletz Allergy has 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The allergy specialists are able to test for most foods and can be done by either blood tests or allergy skin tests.  We offer onsite parking at each one of our locations 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.  If you feel you may have a food allergy and/or a food intolerance, please call us today to schedule an appointment. 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 eager to help you find out if you are allergic to foods and to identify which ones.  This will allow you live in less fear by avoiding the offending food as well as have a detailed plan on what to do if you would accidentally ingest the given food.

Histamine Fish Poisoning

• September 24, 2018
• BY BLACK & KLETZ ALLERGY

Histamine is the chemical that is responsible for most allergy-related symptoms. It is usually stored inside cells called mast cells.  When one is exposed to allergens that he or she has been previously sensitized to, (e.g., pollens, dust mites, molds, animals, certain foods), the preformed specific antibodies react with their proteins (i.e., antigens) which cause a release of histamine and other similar substances from the mast cells into the tissues of the body.  These chemicals in turn trigger various symptoms such as itching, sneezing, wheezing, coughing, runny nose, watery eyes, nasal congestion, post-nasal drip, etc.

Fish is one of the most common foods that cause food allergies.  Sensitive individuals may experience allergic reactions after consuming fish.  The classic mechanism of this type of allergic reaction is caused by antigen-antibody interactions.  However, there are some people who are not sensitized or allergic to fish but can experience similar symptoms after eating fish.  In these individuals, the symptoms are brought on by a different mechanism.

Many types of fish naturally contain a chemical called histidine.  When the fish are not properly stored and refrigerated, bacteria overgrowth occurs in and on the fish.  These bacteria release an enzyme called histidine decarboxylase which converts the naturally occurring histidine in the fish to a chemical called histamine.  The enzyme is resistant to freezing and heating and can persist even after the bacteria are eliminated by normal cooking techniques. The resulting high levels of histamine cause the same symptoms as an allergic reaction, but the underlying mechanism is a type of toxicity rather than a true allergy.

This condition used to be called scombroid fish poisoning, as fish belonging to Scombridae family (e.g., tuna, mackerel, marlin, swordfish) were originally implicated.  Later, many other non-scombroid fish such as mahi-mahi, sardine, herring, anchovy and bluefish were also found to cause this condition. The preferred current terminology is called “acute histamine toxicity.”

The symptoms usually begin 30 minutes to 2 hours after eating the fish.  The most common manifestations may include:

1. Generalized itching
2. Reddish rash over the neck, upper torso, and/or upper extremities
3. Throbbing headache
4. Nausea, vomiting, abdominal cramps, and/or diarrhea
5. Palpitations and/or dizziness
6. Anxiety and/or chest tightness
7. Swelling of the face and/or the tongue
8. Difficulty in breathing

The diagnosis is usually made from the patient’s history.  The appearance of the fish is sometimes described as honeycombed. Some affected individuals also experience a sharp, metallic, bitter, and peppery taste while eating the fish.  Laboratory tests are usually not helpful as histamine is rapidly degraded and cannot be detected in blood or urine samples within 1 to 2 hours after the onset of symptoms. The presence of a specific IgE antibody in the blood to the fish usually indicates an allergic reaction and not a toxic reaction due to the high levels of histamine.  Clusters of individuals exhibiting similar symptoms after eating the same meal generally points more to histamine poisoning rather than an allergic reaction.

The treatment of this condition involves medications that focus on the relief of symptoms. Antihistamines [H-1 blockers (e.g., Benadryl, Claritin, Allegra, Zyrtec) along with H-2 blockers (e.g., Zantac, Tagamet)] are useful in relieving the itching and rash.  Corticosteroids may be appropriate in certain more severe situations. Bronchospasm which may cause wheezing, shortness of breath, chest tightness, and/or coughing can be treated with albuterol inhalations. Rarely, some people may also need intravenous hydration.  Fortunately, most cases of histamine toxicity are self-limited and the symptoms often resolve spontaneously within 6 to 8 hours.

The prevention of acute histamine toxicity requires proper and continuous refrigeration of fish until the time of cooking.  This should prevent bacterial overgrowth and likewise the conversion of histidine to histamine.

The board certified allergists at Black and Kletz Allergy have 3 convenient locations [Washington, DC; McLean, VA (Tysons Corner, VA); Manassas, VA] in the Washington, DC metropolitan area.  The allergy doctors have been trained in providing allergy care for both adults and children.  They in fact have been diagnosing and treating adults and children with allergies for more than 50 years.  They will promptly answer any questions you may have regarding food allergies, food sensitivities, food toxicities, and related disorders.  The allergy specialists can also help you with other allergic conditions such as asthma, hives, swelling episodes, insect sting allergies, medication allergies, contact dermatitis, generalized itching, eczema, sinus disease, anaphylaxis, eosinophilic disorders, and immune disorders.

All 3 offices of Black & Kletz Allergy offer on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call our office to schedule an appointment or alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day.