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Month: February 2016

New Treatments For Asthma

More than 22 million people in the U.S. suffer from asthma. As Centreville allergists, we know there are many options for treating your
allergies. Though several effective medications are available, many asthmatics frequently experience severe flare-ups of their asthma causing shortness of breath, wheezing, and/or cough.  About 400, 000 people end up getting hospitalized every year in the U.S. for management of their acute exacerbations.

As asthma is a chronic inflammatory condition involving the lungs, most currently available preventive maintenance medications are in the form of anti-inflammatory drugs inhaled directly into the lungs.  A few oral medications are also frequently employed, though they are usually less effective.

A third class of medications consists of injectable agents given every few weeks on a regular basis.  These are called monoclonal antibodies which target and reduce the numbers of certain specific mediators which contribute to the severity of asthma.

One of them, Xolair (omalizumab), has been available for the past several years.  It reduces the numbers of IgE antibodies which play a crucial role in causing exacerbations of asthma.  In selective patients who meet certain criteria, it has been found to be very useful in reducing the frequency of asthma symptoms and the need for emergency treatments.

A second drug in this class, called Nucala (mepolizumab), was recently approved by the FDA for the treatment of severe asthma.  It is a monoclonal antibody produced by recombinant DNA technology which targets and blocks a protein mediator called IL-5 (interleukin 5).  IL-5 causes an increase in the number of a particular type of white blood cell called an eosinophil which contributes to tissue damage in the lungs.  Since Nucala blocks the effect of IL-5, the resulting number of eosinophils decreases which reduces the tissue damage in the lungs of asthmatics.

In clinical trials, Nucala has shown to decrease the numbers of asthma exacerbations, emergency room visits and hospitalizations compared to a placebo.  It has been approved to treat severe and persistent asthma in adolescents above 12 years of age and adults who are still symptomatic despite the regular use of other controller medications.

While the dose and the frequency of administration of Xolair is determined by the weight of the patient and the serum IgE level, Nucala is given in a standard dose of 100 mg. every 4 weeks.  It can be injected under the skin in the arms, thighs, or abdomen.  The only criterion for the use of Nucala is a blood eosinophil count of more than 150 cells/mcL (which can be measured in a routine CBC) in patients with uncontrolled asthma.  The most common side effects of Nucala include headache, injection site reactions (pain, redness, swelling, itching, and/or a burning feeling at the injection site), back pain, and/or fatigue.

This new medication is a welcome addition to our armamentarium in our battle with uncontrolled asthma. It has the potential to greatly benefit certain selective patients whose asthma is predominantly mediated by harmful eosinophils. Being allergists in Centerville, we are happy to see additional alternative therapeutic options for the treatment of asthma.

In addition to the above treatment modalities for asthma, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective in the treatment of asthma.  It should be noted that Xolair as well as Nucala can be given in combination with allergy shots.

The board certified allergists at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about this new treatment modality. Dr. Michael Kletz and Dr. Appaji Gondi, Centreville allergists at Black and Kletz Allergy, have been treating both adults and children with hay fever, with hay fever, asthma, sinus problems, insect sting allergies, eczema, hives, swelling episodes, food and medication allergies, and  immunological problems for more than 50 years.  We have an office in Washington, DC and 2 offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA.  All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations 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.  For an immediate appointment, please call us or you may click Request an Appointment and we will respond within 24 hours by the next business day.

Allergies and Sinus Infections

People who have allergies are more prone to developing acute, chronic, and recurrent sinus infections (i.e., acute sinusitis, chronic sinusitis, recurrent sinusitis).  Allergic rhinitis (hay fever) is a condition in which allergens such as dust mites, molds, pollens, cats, dogs, and/or cockroaches will cause classic allergy symptoms in individuals that are sensitized to these allergens.  Some of the typical symptoms may include:  runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, snoring, sinus pressure, and/or sinus headaches.  The allergens cause inflammation and swelling in the nasal passages and sinus cavities.  These allergies can also lead to the development of nasal polys which further aggravate nasal congestion.  In the month of February, in the areas surrounding our Washington, DC, Manassas and McLean allergist offices, like Arlington, Centreville and Vienna, the allergens primarily responsible for causing allergic rhinitis symptoms include:  dust mites, molds, cats, dogs, cockroaches, and tree pollens.  The trees in the Washington, DC area usually begin to pollinate in mid to late February.  If the month is on the warmer side, the trees pollinate earlier.

When an allergic individual is exposed to an allergen to which they are sensitized, they exhibit the symptoms as mentioned above.  This predisposes the allergic person to develop sinus infections.  When someone develops nasal congestion or has nasal polyps due to allergies, the capability for the sinuses to drain properly diminishes.  As a result, the mucus becomes stagnant in the nasal passages and accumulates in the sinuses.  When the mucus “sits” in the sinuses, it is more likely to become infected with bacteria.  The dark, moist, stagnant environment in the sinuses is a perfect breeding ground for bacteria; much like a stagnant pond is much more likely to develop algae than a free flowing river.  Hence, if allergies are treated or prevented, then one is less likely to develop a sinus infection.

Allergic rhinitis can be treated with a multitude of medications which may include antihistamines, decongestants, expectorants, nasal sprays, saline irrigation of the nose, and/or leukotriene antagonists.  Allergic rhinitis symptoms can be prevented by avoiding the offending allergen, although this is difficult to accomplish in many cases.  Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy injections) are another way to minimize or prevent allergic rhinitis symptoms from occurring.  They are 80 – 85% effective and have been used in the U.S. for over 100 years.  Patients on allergy shots often realize a decrease in both the number and the severity of sinus infections.

Note that in addition to allergies, February is a time of the year that has other nonallergic factors which increase the likelihood of developing sinus infections.  In the Winter, there tends to be more “colds,” (which are due to viruses), as well as other viruses in circulation that cause upper respiratory tract infections.  Notwithstanding, people tend to stay indoors more often during the Winter, resulting in individuals being in closer contact with each other than at other times of the year.  This further increases the chance of spreading these viral upper respiratory tract infections.  In addition, the flu season occurs during the Winter which affects the nose and sinuses in most individuals.  The flu, which is caused by the influenza virus, also predisposes individuals to sinus infections.

Sinus infections can also exacerbate both allergy-induced and nonallergy-induced asthma.  When an asthmatic develops an upper respiratory tract infection such as a sinus infection, it also commonly aggravates their asthma symptoms which generally include wheezing, shortness of breath, coughing, and/or chest tightness.  This can be very serious and the asthmatic should see their allergist so their sinus infection can be treated effectively and without delay.  In addition to the asthma symptoms, acute sinus infections typically present with sinus headaches, nasal congestion, post-nasal drip, purulent discolored nasal discharge, and possibly a low grade fever.  Recurrent sinus infections may indicate an additional immunological defect and an immune system evaluation should be performed by the allergist.  Chronic sinus infections usually indicate that antibiotic therapy needs to be given to the patient for a much longer course than the typical 10-14 days given with acute sinus infections.  Another interesting fact about chronic sinus infections is that they can cause exacerbations of someone’s asthma without any sinus-related symptoms present.  Patients with chronic sinusitis may not have any symptoms at all.

If you suffer from allergies and/or sinus infections, please call Black & Kletz Allergy to schedule an appointment with one of our board certified allergists.  We treat both adults and children, and have 3 offices in the Washington, DC, Northern VA, and Maryland metro area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible, with a free shuttle between the McLean 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 DC metro area for over 50 years.  Please call us for an appointment today or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.