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Month: November 2018

Vaccines for Adults with Lung Disease

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.

  1. 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.

  1. 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.

  1. 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

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.