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Month: November 2017

Allergies and Thanksgiving

It is that time of the year again when families and friends gather together for the highly anticipated Thanksgiving Day holiday.  Most people do not think about how Thanksgiving may affect one’s allergies, however, the holiday is full of potential triggers for many individuals prone to various allergies.

The most obvious allergies in relationship to Thanksgiving would be food allergies.  This relationship stems from the fact that when the average person thinks of Thanksgiving, they immediately associate the holiday with food and gluttony.  There are individuals who are allergic to turkey, the staple food of Thanksgiving, but turkey allergy is not very common.  More commonly, many individuals will experience sleepiness after eating turkey meat.  This phenomenon is explained due to the fact that turkey contains higher levels of the amino acid “L-tryptophan.”  L-tryptophan will enter the bloodstream from the digestive tract and travel to the brain where it gets converted to the chemical “serotonin.”  It is the serotonin that is responsible for causing this sleepiness.  In addition to turkey which helps fill the plates on a Thanksgiving Day dinner, there are lots of other foods that accompany this holiday favorite.  Common food allergens such as wheat, soy, egg, milk, nuts, and peanuts are often found around the table.  Gravy used for turkey and mashed potatoes frequently contains soy, wheat, and/or dairy.  Nuts are commonly found on string beans and in some types of stuffing.  Nuts and peanuts are common in many desserts such as pecan pie and brownies.  Eggs and milk (dairy) are also used in many baked goods.  Although pumpkin allergies are not common, pumpkin pie may contain an array of ingredients that may trigger a food allergy in susceptible individuals.  It is also important to note that among various cultures, many families incorporate many ethnic foods in their celebrations.  These foods may not be traditional but they increase the likelihood of other allergenic foods such as fish, shellfish, etc. to be the causative agent of an impending food allergy.  If someone has a serious food allergy, it is advisable for that person to bring their own food.

In addition to food allergies, one always is exposed to the typical environmental allergens such as dust mites, pets, molds, and to a lesser extent pollens.  By Thanksgiving, the pollen count in most places in the U.S. is low or non-existent, except in the southern states.  It is the molds, dust mites, and pets that tend to bother individuals during the end of November in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  These allergens can cause the typical symptoms of hay fever (I.e., allergic rhinitis and/or allergic conjunctivitis) and/or asthma which may include runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, sinus headaches, itchy eyes, watery eyes, redness of the eyes, wheezing, coughing, chest tightness, and shortness of breath.  One must keep in mind that many of these symptoms may mimic the symptoms of the common cold or flu (i.e., influenza) which tend to become more prevalent during this time of the year.

Other irritants that can cause allergic-like symptoms at a Thanksgiving Day event may include perfumes, colognes, cigarette smoke, smoke from a fireplace or wood-burning oven, and cleaning fluids.  Unfamiliar soaps may cause contact dermatitis to individuals with eczema (i.e., atopic dermatitis) and sensitive skin.

Thanksgiving is a festive time and loved by almost everyone.  It is a time to congregate with family and friends and an excuse to eat too much!  Given the positives about the Thanksgiving holiday, it is crucial to remember that there can be potentially serious complications from this seemly innocuous occasion.  With this in mind, have a very happy Thanksgiving!

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating allergies, asthma, sinus conditions, and immunological disorders for more than 50 years.  Black & Kletz Allergy has 3 convenient locations in the Washington, DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at each location and the Washington, DC and McLean 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.  Please call us today to make an appointment at the office of your choice.  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 pride themselves in delivering the highest quality allergy care in the Washington, DC metropolitan area in conjunction with providing excellent customer service in a friendly and affable environment.

Allergic to Penicillin?

Adverse reactions to medications are very common.  Among the drugs associated with immediate hypersensitivity reactions (i.e., Type I allergy, IgE antibody-mediated allergy), penicillins are the most commonly observed.

Penicillin allergy is reported in approximately 7 to 10% of community populations and up to 20% of hospitalized patients.  What is amazing is that more than 90% of these patients do not actually have true penicillin allergy!

There are three common causes for this high rate of false positive penicillin allergy reports:

  1. Mislabeling of a side effect (e.g., gastrointestinal upset) as an “allergy”
  2. Coincidental event (e.g., headache or rash due to an underlying infection)
  3. Loss of true allergy sensitivity over time with avoidance of penicillins.

Penicillin allergy can be ruled out with the help of a standardized testing procedure which is routinely done in our office at Black & Kletz Allergy.  Skin testing was introduced as a diagnostic intervention for the evaluation and management of patients with a history of penicillin allergy in 1960’s.  This procedure is commonly performed with minimal risk.  Penicillin skin testing can be done safely in properly selected patients with suspected penicillin allergy and can even be performed in pregnant women with Streptococcal infections.

The procedure for testing involves three stages:

  1. Skin prick testing with a small amount of diluted penicillin “antigens” (commercially prepared testing reagents) with negative and positive controls.
  2. If the prick tests are negative after 20 minutes, a tiny quantity of the antigen in injected into the superficial layers of the skin (i.e., intradermal skin test).
  3. If the intradermal skin test in in this second stage is also negative after 20 minutes, the patient will be given 250 mg. of amoxicillin by mouth (i.e., oral challenge) and will be closely monitored for 90 minutes.

If the patient tolerates all three stages without any adverse effects, the patient may receive penicillins if needed, without increased risk of immediate allergic reactions.  The negative predictive value of penicillin allergy testing is more than 99%.

Penicillin allergy testing should be performed in a healthcare setting only by clinicians with the knowledge, training, and experience to select appropriate patients for this procedure, interpret test results, and manage a systemic allergic reaction should it occur.

Unverified penicillin allergy in hospitalized patients is associated with longer hospital stays and increased rates of serious drug-resistant infections.  The alternative antibiotics to penicillin can be associated with higher cost and/or greater risk for untoward side effects.

For this reason, the “Choosing Wisely” program of the American Board of Internal Medicine Foundation recommended in 2014 that clinicians not overuse non-penicillin antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.  The National Quality Partners’ Antibiotic Stewardship Action Team recommends penicillin allergy skin testing as a component of a comprehensive antibiotic stewardship program.

Penicillin allergy testing is associated with an unrealized potential:  this procedure can accurately identify the approximately 9 of 10 patients who despite reporting a history of penicillin allergy can receive penicillins safely.

On the basis of current evidence, the American Academy of Allergy, Asthma and Immunology (AAAAI) believes that more frequent and routine performance of penicillin allergy testing will result in reduced costs of care, enhanced patient safety, and improved outcomes.

The board certified allergy doctors at Black & Kletz Allergy have been performing penicillin skin testing routinely for many years on both adults and children.  Black &Kletz Allergy has 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking.  The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day.  The allergists of Black & Kletz Allergy are eager to help you with your allergy, asthma, sinus, and immunology needs.  We are dedicated to providing excellent care and service to you as we have been doing in the Washington, DC metro area for more than 5 decades.