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Aspirin Allergy and Its Relationship to Allergies and Asthma

Aspirin-Exacerbated Respiratory Disease (AERD) is an acquired condition in which the sensitivity to aspirin and/or related drugs (e.g., nonsteroidal anti-inflammatory drugs or NSAID’s) is associated with long term inflammation of the upper and lower airways.

How common is AERD?
Approximately 8% of the adults in the U.S. are asthmatics and 9% of those individuals have AERD. About 13% of U.S. adults have chronic nasal and/or sinus disease and 15% of those have AERD.

AERD is a clinical syndrome consisting of:
1. Growth of polyps inside the nose
2. Chronic sinus inflammation and/or recurrent sinus infections
3. Persistent asthma, which is often difficult to control
4. Allergic sensitization to aspirin and/or other nonsteroidal anti-inflammatory drugs (NSAID’s)

What causes AERD?
Although the exact cause remains unknown, a disorder in the metabolism or breakdown of a chemical called arachidonic acid is at the root of the condition. Aspirin is not the cause of the disorder, but in sensitive individuals, ingestion of aspirin will aggravate the underlying respiratory symptoms, probably by increasing the levels of inflammatory chemical mediators called leukotrienes. This process also leads to the accumulation of excessive numbers of eosinophils (i.e., “the allergy white blood cell”) in the respiratory tract.

Clinical Features:
1. Severe nasal congestion
2. Overgrowth of polyps in the nose, which typically recur after surgical removal
3. Decreased sense of taste and/or smell
4. Facial pressure and pain
5. Frequent headaches
6. Moderate to severe asthma causing wheezing, coughing, chest tightness and/or shortness of breath
7. Fatigue caused by sleep deprivation
8. Significant opacification of the sinuses seen in X-rays and CT scans of the sinuses

Diagnosis:
The diagnosis is suspected when there is a history of an exacerbation of one’s asthma following ingestion of aspirin and/or NSAID’s. The diagnosis is confirmed if the symptoms are induced or aggravated during an oral aspirin challenge, where incremental doses of aspirin are administered by mouth under the close monitoring by a board certified allergist.

Treatment Options:
Complete avoidance of aspirin and other salicylates (e.g.,diflunisal (Dolobid); salsalate (Disalcid), as well as other related NSAID medications called COX-1 inhibitors (e.g., all NSAID’s except celecoxib) will help some patients attain better control of their symptoms. For some individuals, however, these medications can be substituted for other similar NSAID pain relievers called COX-2 inhibitors [e.g., celecoxib (Celebrex)] without adverse effects. Note that Celebrex (celecoxib) is currently the only approved COX-2 inhibitor NSAID in the U.S. Some, but not all, of the common available NSAID’s which are COX-1 inhibitors include [e.g., ibuprofen (Motrin, Advil); naproxen (Aleve, Anaprox); fenoprofen (Nalfon); flurbiprofen (Ansaid); ketorolac (Toradol); diclofenac (Voltaren, Arthrotec); etodolac (Lodine); sulindac (Clinoril); oxaprozin (Daypro); indomethacin (Indocin); tolmetin (Tolectin); nabumetone (Relafen); piroxicam (Feldene); meloxicam (Mobic)]. Avoidance of aspirin is not always possible due to the need for aspirin in the management of heart, blood vessel, and joint diseases. In addition, even with the avoidance of aspirin and NSAID’s, AERD patients usually experience progressive airways disease, despite aggressive surgical intervention and/or topical or systemic anti-inflammatory treatment with corticosteroids and leukotriene antagonists like montelukast (Singulair), zafirlukast (Accolate), and zileutin (Zyflo).

For these individuals that need to be treated with aspirin, aspirin desensitization followed by regular long term intake of aspirin is an alternative option. Multiple studies have shown that desensitization and daily treatment with aspirin can significantly improve overall symptoms and quality of life, decrease formation of nasal polyps and sinus infections, reduce the need for oral corticosteroids and sinus surgery, and improve nasal and asthma scores in patient with AERD. Significant clinical improvement is seen in as little as 4 weeks after treatment.

The procedure for aspirin desensitization involves administering aspirin by mouth in gradually increasing doses at regular intervals, while closely monitoring for adverse effects in a controlled setting such as an allergy office. The process can take 1 to 2 days.
There is a potential for adverse reactions during the procedure like nasal congestion, generalized itching (pruritus), hives (urticaria), swelling of the soft tissues (angioedema), wheezing, breathing difficulty, drop of blood pressure, and/or anaphylaxis. In case of a minor adverse reaction, they may be treated with medications. After observation for about 3 hours, the last dose can be repeated. Many individuals will be able to successfully finish the procedure in spite of some untoward reactions. Pre-treatment with leukotriene antagonists (e.g., montelukast) play a role in minimizing the risk of reactions during the desensitization procedure.

Aspirin desensitization reduces nasal congestion and nasal polyp formation, improves respiratory symptoms, reduces the need for surgery, and decreases the need for ongoing medications. The board certified allergists at Black & Kletz Allergy have had over 50 years of experience with patients who have aspirin sensitivity. Desensitization in patients who are sensitive to aspirin can be done in any of our 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our offices and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that transports patients between our McLean, VA office and the Spring Hill metro station on the silver line. For 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. Black & Kletz Allergy treats both adults and children suffering from all types of allergies (i.e., hay fever, food, medication, insect stings), asthma, sinus problems, hives, swelling episodes, eczema, and immunologic disorders. We strive to provide exceptional quality allergy and asthma care to the Washington, DC metro community in a friendly and professional setting.

Molds and Your Health


As we enter into the leaf-falling season, according to allergy specialists Gainesville, VA residents trust, some of us may experience a flare-up of mold-related health issues.  Molds are tiny fungi and grow well in damp environments.  Wet leaves form a substrate on which various types of molds can flourish. The microscopic spores released from growing molds float in the air and we breathe in these mold spores.

Exposure to certain molds can cause adverse human health effects through three specific mechanisms:

  1. Generation of a harmful immune response (e.g., allergic or hypersensitivity pneumonitis)
  2. Direct infection by the organism
  3. Toxic/irritant effects from mold byproducts

ALLERGY:

It is estimated that approximately 10% of the population have IgE antibodies to common inhalant molds.  About half of these individuals (5% of the population) are predicted to have, at some time, allergic symptoms as a consequence of exposure to fungal allergens.  The best allergy specialists Gainesville, VA residents rely on, have stated that sensitization to molds, particularly Alternaria alternata, has been linked to the presence, persistence, and severity of asthma.  Alternaria alternata is also referred to as “leaf fungi.”

Allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal sinusitis are two conditions which result from the hypersensitivity to certain molds in the Aspergillus family which causes excessive tissue inflammation in the lungs and sinuses respectively.  Hypersensitivity pneumonitis is an uncommon but important disease that can occur as a result of mold exposure, particularly in occupational settings with high levels of exposure.

INFECTION:

Common superficial fungal infections like thrush, jock itch (i.e., tinea cruris), and toenail fungus are determined by local changes in the skin barrier and can occur in healthy individuals.

Host features (such as a compromised immune system) rather than environmental exposure, are the major determining factors of more severe opportunistic fungal infections.

TOXICITY:

The occurrence of mold-related toxicity from exposure to inhaled mycotoxins (i.e., toxins produced from molds) in non-occupational settings is not supported by the current data and its occurrence is improbable, according to allergy specialists in Gainesville, VA.

IRRITATION:

An irritant is a material causing ‘‘a reversible inflammatory effect on living tissue by a chemical action at the site of contact.’’ The eyes and the upper and lower respiratory tracts are usually affected by exposure to molds.  Irritant effects are dose related and their effects are transient, disappearing when the exposure has diminished or ended.

ASSESSMENT:

In individuals with chronic inflammatory conditions affecting the respiratory tract, (e.g., allergic rhinitis, allergic conjunctivitis, asthma), the measurement of IgE antibodies to mold proteins by skin testing and/or blood testing is very helpful in the identification of the specific agents that trigger and aggravate allergic symptoms.

Allergy specialists Gainesville, VA residents trust, state that the measurement of specific IgE and IgG antibodies to certain mold proteins via blood testing can aid in the diagnosis of ABPA and/or hypersensitivity pneumonitis in people presenting with clinical manifestations suggestive of these conditions.

The board certified allergists at Black & Kletz Allergy have had many years of experience in diagnosing and treating mold-related health issues and offer services through our 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We diagnose and treat both adults and children who suffer from allergies, asthma, sinus problems, eczema, food allergies, insect sting allergies, medication allergies, hives, swelling episodes, generalized itching, and immunological conditions.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each office and the Washington, DC and McLean, VA offices are Metro accessible.  The McLean, VA office offers 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 schedule an appointment, if you suffer from mold allergies or any other type of allergy, sinus condition, or asthma.  You can also click Request an Appointment and we will respond within 24 hours by the next business day.  The best allergy specialists Gainesville, VA has to offer have been committed to providing high quality allergy care to the greater Washington, DC community for more than 50 years.

Generalized Itching and What Should Be Done About It

Everyone has had an itch here or there, but as an allergist Washington DC patients rely on might attest, generalized itching (itching all over the body) does not occur in everyone.  Generalized itching (i.e., pruritus) is not uncommon and is very annoying to the person suffering from this condition.  It often may be associated with hives (i.e., urticaria), and/or angioedema (i.e., swelling).  The intensity of the itching can range from mild to very severe.  It can be so bothersome that it decreases the quality of life for that individual.

In many cases, the generalized itching is short-lived and subsides in a couple of days.  In a number of cases, however, it persists more than a couple of days and the duration can last for years in extreme cases.  Most individuals have tried over-the-counter topical creams and/or oral medications with minimal or no effect by the time they seek help from an allergist Washington DC patients trust.

The board certified allergist at Black & Kletz Allergy have seen and treated thousands of cases of generalized pruritus throughout the years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our 3 office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA affords us the opportunity to treat patients in such adjacent Northern Virginia cities, some of which include Arlington, VA, Alexandria, VA, Falls Church, VA, Vienna, VA, Great Falls, VA, Reston, VA, Herndon, VA, Sterling, VA, Annandale, VA, Oakton, VA, Burke, VA, Centreville, VA, Haymarket, VA, Chantilly, VA, Gainesville, VA, Fairfax, VA, Springfield, VA, Warrenton, VA, Dumfries, VA, Culpeper, VA, Ashburn, VA,  Leesburg, VA, and Purcellville, VA.  In addition, we also treat many patients from Maryland due to its proximity to our offices largely from the following cities:  Chevy Chase, MD, Bethesda, MD, Potomac, MD, Great Falls, MD, Rockville, MD, Gaithersburg, MD, Darnestown, MD, Germantown, MD, Olney, MD, Wheaton, MD, Silver Spring, MD, College Park, MD, Beltsville, MD, Hyattsville, MD, Clinton, MD, Bowie, MD, Columbia, MD, Annapolis, MD, and Baltimore, MD.

It may be important to see an allergist in Washington, DC for generalized pruritus in order to try to find out the cause.  At Black & Kletz Allergy, it begins with a thorough history and physical examination.  There are many causes of itching ranging from different allergies (e.g., foods, medications, contact with allergens) to various systemic medical conditions, some of which may be serious.  It is therefore important that a cause be identified, so that either the allergen is avoided or treatment can be aimed at the underlying systemic condition responsible for the manifestation of the itching.  In many acute (i.e., less than 6 weeks in duration) cases of generalized pruritus, no testing is needed as a thorough history and physical examination may be enough in order to figure out the cause.  When the duration exceeds this length of time and/or symptoms are very bothersome, allergy tests and/or blood tests may be indicated in order to find the cause of the itching.  Either way, patients are treated on their first visit with medications in order to stop their itching.

Contact an allergist Washington DC residents respect
The allergy doctors at Black & Kletz Allergy treat both adults and children.  If you suffer from itching, hives, swelling episodes, or any other allergy such as hay fever, asthma, sinus conditions, and/or eczema, please call one of our 3 offices to make an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  All of the offices offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  Black & Kletz Allergy has been providing high quality allergy, asthma, and immunology care to the greater Washington, DC metro area for more than 50 years. Call us today for an allergist Washington DC is proud to have in its community.

Climate Change and Allergic Disease | Allergist Tysons Corner VA

The Allergists Tysons Corner VA Trust Explain the Effects of Climate Change on Your Allergies
The climate in places like Tysons Corner, VA, Falls Church, VA, and Gainesville, VA, as well as the rest of the Washington, DC metropolitan area, plays a significant role in producing allergens that annoy sensitized individuals.  The DC metro area was built on a swamp and there tends to be high counts of mold spores throughout the year, particularly from the Spring through the Fall.  Our humid Summers also account for excessive mold growth.  Pollen production is also a major problem in the Washington, DC metro area, mostly in the Spring and Fall.

Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate has steadily changed over the past several decades and it is likely to continue to change in the near future.  This climate change has the potential to alter the incidence and severity of allergic and respiratory diseases in humans in the following ways:

  1. Climate warming and higher carbon dioxide levels will lead to longer pollen seasons.
  2. More hot summer days will generate ozone which triggers more flare-ups of breathing difficulties for people with chronic respiratory conditions like asthma.
  3. With rising sea levels and changes in rainfall patterns, mold allergies are likely to increase.
  4. Warming conditions may lead to the increased prevalence of biting and stinging insects, as well as the potential for more infectious tropical diseases that are transmitted by mosquitoes (e.g., Zika virus, chikungunya, dengue fever, encephalitis, malaria).
  5. The effect of fewer cold winter days on respiratory infections from viruses and bacteria is unpredictable.

More energy efficient and tighter homes will lead to an increase in indoor air pollution.  Accumulation of volatile organic compounds, radon gas, smoke, particulates, and protein allergens will increase the risk of respiratory illnesses.  In addition, higher water vapor and moisture levels will increase dust mite populations and cause an escalation of mold growth.

“Green practices” like composting facilities may cause increased respiratory diseases through the increased fungal burden that they put into the air.  Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde.  Inhaling particles coated with these chemicals contribute to asthma and chronic obstructive pulmonary disease (i.e., bronchitis, emphysema).

Ragweed flowers earlier and produces more pollen in urban locations where carbon dioxide concentrations and temperatures are higher.  The same effect can be seen with other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures such as keeping the indoor humidity lower to limit dust mite and mold growth, as well as decreasing outdoor activities on high pollen days, can help minimize allergic symptoms and reduce the need for medications.
Contact a Top Allergist Tysons Corner VA Relies On
The board certified allergists Tysons Corner VA trusts at Black & Kletz Allergy see patients from Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as many other cities and towns in the Washington, DC, Northern Virginia, and Maryland metropolitan area. They are ready to work with you in teaching you how to improve your environment which subsequently will help relieve your allergic and asthmatic symptoms.  The allergy doctors at Black & Kletz Allergy treat both adults and children.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking 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 Springhill metro station on the silver line.  Please call one of our convenient offices to make an appointment or if you prefer, you can click Request an Appointment and we will respond within 24 hours.  Black & Kletz Allergy has been providing excellent allergy and asthma care to the general population of the greater DC area for more than 50 years in a caring and professional setting.

It is the Summer – What You Should Know About Insect Sting Allergies

From Allergy Doctors Vienna VA Patients Trust
Now that the weather in Tysons Corner, VA, Gainesville, VA, and Falls Church, VA and the rest of the Washington, DC metropolitan area has warmed up, as it is now Summer, the risk of an insect sting has increased.  The most common stinging insects in the Washington, DC metro area are honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  They all introduce their venom into their subjects when they sting their prey.  In some cases, people have toxic (i.e., non-allergic) reactions to the insect stings, particularly if stung by several insects at the same time.  The body, in this case, generally reacts to the venom as if it was a poison.  This can occur because the victim is exposed to an over-abundance of venom at one time.  A toxic reaction can cause symptoms similar to those of an allergic reaction, but also may include symptoms such as nausea, fever, and seizures.  This can be life-threatening and depends on the amount of venom injected into the individual.  On the other hand, about 3% of individuals experience true allergic reactions, which is usually not dependent on the amount of venom, but to the allergic response to the venom by the individual.  These allergic reactions can also be life-threatening.

When stung, most individuals have no reaction or a small local reaction.  People with this type of response are at no increased risk for a systemic (anaphylactic) reaction than that of the general population.  Other people will develop a large local reaction, where the area that was stung gets red and very swollen.  This large local reaction can reach the size of a baseball in some cases.  Still, however, there is no increased risk in these individuals of a systemic or anaphylactic reaction from the insect sting.  On the other hand, a small percentage of individuals will develop a systemic reaction to an insect sting which may include some or all of the following:  generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema) of another area of the body where the sting did not take place, abdominal cramping and pain, wheezing, shortness of breath, chest tightness, coughing, feeling faint, and drop in blood pressure.

If a person has had a large local reaction or a systemic reaction to an insect sting, they should definitely seek a consultation with a board certified allergist like the allergy specialists of Black & Kletz Allergy.  The allergists that Tysons Corner, VA, Falls Church, VA, Gainesville, VA, and Washington, DC residents have trusted for years have had over 50 years’ experience diagnosing and treating insect sting allergies.  A comprehensive history and physical examination is taken and then a decision is made whether to test that individual for allergies to honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  Allergy testing can be done via blood or by skin tests.  The allergist will then decide the preferred method of testing for each specific individual, depending on the history of the reaction that is ascertained at the visit.

Measures in order to help prevent insect stings are discussed with patients, as well as what things should be done, if a future sting occurs.  For example, if stung by a honey bee, a stinger is left in the skin of the victim.  One should never pull out the stinger, as this actually increases the amount of venom that is introduced into the individual by causing contractions of the venom sac which is hidden under the skin of the person.  Instead, one should scrape off the stinger with a finger nail, credit card, etc. in order to prevent the introduction of more venom into the body of the individual.

If a patient has a positive allergy test to any of the stinging insect venoms, it is imperative that he/she go on a course of venom allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) as it is extremely successful in preventing further anaphylactic reactions from insect stings.  The procedure entails giving progressively larger doses and volumes of insect venom to the individual weekly over a period of 10 weeks, then every 2 weeks for 1 dose, then every 3 weeks for 1 dose, then a maintenance dose every 4 weeks for 1 year, and then the maintenance dose can be decreased to every 6 weeks for several years.  The maintenance dose is roughly equivalent to the amount of venom in an actual sting.  Therefore, if someone gets stung while they are on a maintenance dose of venom immunotherapy, they are essentially getting the same dose of venom as they normally get every 6 weeks.  For this reason, they usually do not have a systemic reaction to the stinging insect, because they are protected due to the allergy shots.

All patients with allergic reactions to stinging insects are prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick).  At Black & Kletz Allergy, individuals are taught the correct method on how to use, when to use, and what to do, after using these devices.  We have training devices that we use to show patients the proper way to use them.  As a general rule, if someone is stung by a stinging insect and experiences any systemic sign or symptom, they should use the self-injectable epinephrine device and go immediately to the closest emergency room.

Reach Out To The Allergy Doctors Vienna VA Patients Call For Relief
Insect sting allergies in cities such as Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as others in the Washington, DC, Northern Virginia, and Maryland metropolitan area are not uncommon.  During the Summer and early Fall, there are more insect stings taking place and it is very important to take precautions to reduce the likelihood of getting stung.  The allergy doctors of Black & Kletz Allergy see both adults and children with insect sting allergies, in addition to other allergic disorders such as allergic rhinitis (i.e., hay fever), asthma, hives, swelling episodes, eczema, sinus disease, food allergies, medication allergies, and immune disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all of which offer on-site parking.  The Washington, DC and McLean offices are Metro accessible and the McLean office offers a free shuttle that runs between the office and the Spring Hill metro station on the silver line.  Please call one of our offices to make an appointment or you can click Request an Appointment and we will respond to you within 24 hours by the next business day. Black & Kletz Allergy takes pride in providing excellent quality allergy, asthma, and immunology care to the Washington, DC metro area community in a friendly, convenient, and professional setting.

“Microbiome” and Allergies

Explained By Allergists McLean VA Patients Trust
There has been an increase in the incidence of allergic diseases over the past 20-30 years and this phenomenon is more pronounced in industrialized countries compared to developing countries.  Many researchers believe that environmental and dietary changes play major roles in the development of allergies.  This is true in areas such as Falls Church, VA, Gainesville, VA, and Tysons Corner, VA as well as the rest of the Washington, DC metro area.

The primary role of our immune system is to defend and protect us from infections caused by germs like viruses, bacteria, and parasites.  Exposure of the immune system to infections with germs in early life stimulates the maturation of the immune system in a normal balanced way.  The absence of this stimulation can trigger the immune system to mistake innocuous substances such as dust mites, molds, pollens, and certain foods as potentially harmful and mount a defensive attack on them causing allergic disease.  This “hygiene hypothesis” aims to explain why more people suffer from allergic disorders in the developed, overly hygienic Western world.  An alternative interpretation of the evidence supporting the hygiene hypothesis forms the basis for the “microflora hypothesis,” which says that rather than specifically limiting infection, even the decreased exposure to microbes changes the colonization of bacteria of the infant gut, which has a negative effect in the development of the normal immune system which ultimately leads to allergic disease.

An adult human harbors about 100 billion bacteria in the intestines alone.  These gut bacteria account for 90% of the cells in the human body!  Human cells contain about 21,000 different genes, but the microbes living in the human comprise about 3 million genes.  The composition and function of the bacteria in the gut varies from person to person (i.e., biodiversity) and evolve during the first years of life and stabilize within the first 3 years of life.

The development of the gut microbiome (i.e., all the microorganisms that live in the gut) is influenced by interactions between diet, environment, and host-associated factors.  There is increasing evidence that these bacteria play many helpful roles in the modulation of our immune responses, especially in maintaining a balance between 2 different types of white blood cells called Th1 lymphocytes and Th2 lymphocytes.  The Th1 lymphocytes help protect us from infections, whereas the Th2 lymphocytes help mediate allergic disease.

The emerging hypothesis infers that environment or lifestyle-driven aberrancies in the early-life gut microbial composition and function represent a key mediator of childhood allergies and asthma.  Significant perturbations in the gut bacterial composition, especially reduced diversity, in the Western societies due to frequent antibiotic usage, environmental and lifestyle changes, etc. have disrupted the mechanisms of mucosal tolerance leading to more allergic disease.

Epidemiologic and clinical data supporting this interpretation include:

  1. A positive correlation between increasing risk for asthma and allergies and increasing use of antibiotics in industrialized countries.
  2. Correlations between altered fecal microbial flora and atopic disease
  3. Successful prevention and/or reduction of allergies in some individuals by the use of oral probiotics (live commensal bacteria) and dietary changes.

A recent meta-analysis of 25 studies revealed that the administration of probiotics reduces allergy-causing IgE antibody levels and the risk of atopic sensitization.  An example of dietary factors influencing allergies is the landmark LEAP study which demonstrated that early introduction of peanut products to high risk infants significantly decreased the subsequent development of peanut allergy.

There are a number of ongoing studies which will improve our understanding of the mechanisms underlying allergic disorders and hopefully offer new and exciting options in the management of these conditions in near future.

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

Air Quality and Its Effects on Allergic Individuals

The Washington, DC, Northern, Virginia, and Maryland metropolitan area has its share of pollutants in its air as well as the many allergens that are known to be prevalent. The allergens that are common in the DC metro area include tree and grass pollens in the Spring, ragweed pollen in the Fall, and mold spores which are perennial in nature. The molds are year-round due to the history of Washington, DC being a swamp many years ago. The humidity also tends to be high in the area, which favors the growth of molds. Regarding pollutants, there are many different types of pollutants in the Washington, DC metropolitan area including such cities as Gainesville, VA, Falls Church, VA, and Tysons Corner, VA.. Some of these pollutants include carbon monoxide, ozone, organic dusts and other fine particulate matter, nitrogen dioxide, sulfur dioxide, and lead emissions.

It is not news to anyone that the traffic in the Washington, DC metro area is sometimes horrific. Not only does it play havoc with people’s temperament, but so many motor vehicles produce emissions which contribute greatly to the air pollution and thus the air quality of the area. In the summers, this pollution tends to be worse. The sunny days will produce increased levels of ozone which has been determined to be hazardous to one’s health, particularly people with lung disease such as people with asthma and chronic obstructive pulmonary disease (COPD). Chronic bronchitis and emphysema are the two most common conditions that contribute to COPD.

Almost all patients with allergic rhinitis (i.e., hay fever) and/or asthma know a lot about the pollen count and what it means. The pollen count is the number of pollen grains in one cubic meter of air. For example, if the pollen count for tree pollen is 250, it means that there are 250 grains of tree pollen in a sample of air that is 1 meter X 1 meter X 1 meter. Keep in mind that 1 meter is 39.37 inches. Different locations throughout the U.S. have different guidelines depending on the types of pollens they have and the quantity of the pollen released into the air. As a general rule, the pollen count levels can be interpreted by the following values: Trees – 1-14 is Low; 15-89 is Moderate; 90-1,499 is High; 1,500 and above is Very High. Grasses – 1-4 is Low; 5-19 is Moderate; 20-199 is High; 200 and above is Very High. Weeds – 1-9 is Low; 10-49 is Moderate; 50-499 is High; 500 and above is Very High. Molds – 1-6,499 is Low; 6,500-12,999 is Moderate; 13,000-49,999 is High; 50,000 and above is Very High. In fact, you can always click Today’s Pollen Count at the top of our website to see the latest pollen count for the Washington, DC, Northern Virginia, and Maryland metropolitan area. Many individuals use this knowledge to help them guide when they should avoid certain outdoor activities. Generally, the pollen counts are the highest in the mornings through midday. Planning to do outdoor activities, such as exercising or doing yard work, in the evening is usually recommended to minimize pollen exposure.

In addition to being aware of the pollen count, it is also important to be aware of the Air Quality Index (AQI). The AQI indicates how polluted the air is in your area. The AQI is calculated based on 5 major pollutants which include carbon monoxide, nitrogen dioxide, sulfur dioxide, fine particulate matter, and ground-level ozone. The last two pollutants (fine particulate matter and ground-level ozone) pose the greatest threat to an individual’s health. The AQI is divided into 6 different zones of increasing amounts of pollution and thus health risk. The zones are color-coded and in order from less pollution to more pollution are as follows: Green, Yellow, Orange, Red, Purple, and Maroon. In the Washington, DC area, it is not uncommon to have a few “Code Red” days during the summer, particularly when it is hot, humid, and sunny. “Code Green” is the best air quality and poses little or no risk of any health concern. “Code Yellow” signifies acceptable air quality and may pose a moderate health concern for a very small number of people who are very sensitive to air pollution. “Code Orange” indicates an unhealthy quality of air for some sensitive groups of people. “Code Red” means that the air quality is generally unhealthy for the general public, although usually only sensitive groups will experience more serious health effects. “Code Purple” notifies the general public that the air is very unhealthy and tends to occur in emergency conditions, such as when there is a chemical spill. “Code Maroon” indicates hazardous conditions where everyone will most likely experience untoward health issues. Generally, it is recommended to stay indoors when the level is “Code Red” and above.

The board certified allergists of Black & Kletz Allergy treat patients of all ages including children and the elderly in the Falls Church, VA, Tysons Corner, VA, and Gainesville, VA areas. Children and elderly persons tend to be more sensitive to poor air quality, as well as individuals with lung conditions such as asthma and COPD. 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 Washington, DC and McLean offices are Metro accessible and there is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. If you would like to make an appointment, please call us or you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors of Black & Kletz Allergy have been serving the greater Washington, DC metro area for more than 50 years and we pride ourselves in excellent quality allergy, asthma, and immunology care in a friendly, caring, and professional environment.

Allergist Gainesville VA: Can Allergies Cause Dental Problems?

Dr. Kletz & Dr. Gondi, Trusted Gainesville Allergists, Discuss Dental Problems and Allergies
As allergists that Gainesville, VA calls upon, we know that when one thinks about allergies and allergy symptoms, dental problems usually do not come to mind.  In fact, most people tend to separate dental and medical problems into two distinct categories.  Medical diseases can and do influence your dental health.  Most people know that certain heart defects and murmurs may require premedication with antibiotics in order to prevent subacute bacterial endocarditis.  Patients with GERD (gastroesophageal reflux disease), Sjögren’s syndrome, anorexia, and bulimia are more prone to cavities of the teeth.  There are many more medical conditions which can have profound implications on the health of one’s teeth which will not be discussed.

What about allergies?  Can they cause dental problems?  The simple answer to this question is:  Yes

Many children with hay fever (allergic rhinitis) have nasal congestion as a major feature of their disease.  The nasal congestion frequently causes these children to become “mouth breathers,” since they are unable to breathe through their noses.  As the children grow, they develop a narrow high upper arched palate in their mouths which results in malocclusion (i.e., poor bite) of their teeth.  The teeth grow in crooked usually resulting in the need for costly braces by an Orthodontist.  Seeing a board certified allergist like the ones at Black & Kletz Allergy in the Gainesville, VA, Falls Church, VA , and Tysons Corner, VA areas can prevent this type of dental problem in children if addressed early on.  The allergists at Black & Kletz Allergy would perform a comprehensive history and physical examination and likely do allergy testing to find out if and what the child is allergic to in the environment.  Allergies to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, and cockroaches are very common allergens that can cause chronic nasal congestion.  There are other nasal conditions, such as nasal polyps, which are usually due to an underlying allergy that can also cause chronic nasal congestion.  After fully evaluating the child, a treatment plan would be discussed with the parent(s) which may include measures to avoid the offending allergen, use medications in the forms of syrups, powders, tablets, capsules, nasal sprays, eye drops, and/or begin a course of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization).  Allergy immunotherapy or allergy shots are very effective as they work in 80-85% of the individuals taking them.  They are given to people ranging in age from young children through the elderly.  They have been given in the U.S. for over 100 years.  Treating the hay fever early in its course is very effective in preventing the dental malocclusion that occurs too often in untreated individuals with this condition.

Another problem that people face when it comes to allergies and dentistry is the common “I am allergic to Novocain” response that dentists hear over and over again from patients.  We, as allergists near Gainesville, VA, also hear this common complaint.  Dentists frequently have to use a “numbing medicine” before they can do certain dental procedures such as root canals, pulling teeth, dental implants, putting in crowns, etc. in order to prevent pain from occurring in their patients.  Many times the “allergy” symptoms described are really a side effect of the Epinephrine (adrenaline) that is frequently mixed in with the “numbing medicine” rather than a true allergy to the “numbing medicine” itself.  Epinephrine is usually mixed in with the “numbing medicine” as a way to constrict the small blood vessels in the mouth which helps prevent excessive bleeding.  The most common “numbing medicines” or local anesthetics used are categorized as “Caine drugs.”  (See “Medication Allergies”).  Some examples of “Caine drugs” include Novacain (procaine), Xylocaine (lidocaine), Carbocaine (mepivacaine), Marcaine (bupivacaine), and Pontocaine (tetracaine).  Some individuals are truly allergic to the local anesthetic and some are even allergic to the preservatives found in the local anesthetic.  It turns out, however, that most individuals who think they are allergic to a “Caine drug” usually are not when skin tested by an allergist.  It is important, however, to see a board certified allergist and have skin testing performed to rule out a “Caine drug” allergy, as such an allergy can be very serious and potentially life-threatening.  The allergy doctors in the Gainesville, VA, Falls Church, VA, and Tysons Corner, VA areas at Black & Kletz Allergy routinely see patients with this potential allergy and skin test them to a specific local anesthetic in the “Caine drug” class at one of our 3 office locations in theWashington, DC, Northern Virginia, and Maryland metropolitan area.  If the skin testing to a specific “Caine drug” is negative, then the allergist will let your dentist know that is fine to use that particular medication.  Note that it is possible to be allergic to one specific “Caine drug” but not another specific “Caine drug.” (Example: One can be allergic to Novacain but not Xylocaine).

The board certified allergists at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning local anesthetic allergy testing as well as other medication allergy testing such as penicillin testing.  Black & Kletz Allergy has locations 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 offices are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergist, please call us 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 providing quality allergy care to the DC metro area for more than a half century.