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Month: April 2024

Asthma Triggers

Asthma is a chronic inflammatory disorder affecting the lower respiratory tract. The lower respiratory tract includes the muscular tubes that carry air in and out ofthe lungs as well as the tissues in the lungs where gas exchange takes place. The inflammation found in individuals with asthma is usually associated with inflammation of the upper respiratory tract, which includes the nose and the sinuses.

The symptoms of asthma may include a feeling of chest tightness or heaviness in the chest, wheezing (i.e., high-pitched whistling type of noise during breathing), coughing, and/or shortness of breath/difficulty in breathing. The frequency of these symptoms varies depending on the severity of the asthma. The symptoms can be intermittent or persistent. The severity is also classified as either mild, moderate, or severe.

Asthma usually begins in childhood, although it can also be diagnosed for the first time in adulthood. The course of asthma is variable. The symptoms can be mild, moderate, severe, frequent, infrequent, intermittent, and/or persistent at various times throughout one’s life.

The underlying cause for most cases of asthma is a genetic predisposition. However, several factors in the environment play a role in determining the frequency and severity of asthma symptoms. These external factors “trigger” flare-ups or exacerbations of the condition in most individuals.

Common triggers of asthma:

1. Infections: Both upper and lower respiratory infections, especially the ones caused by viruses, are notorious for triggering and aggravating asthma leading individuals to visit emergency departments. In some cases, hospitalizations are required in order to treat the patient effectively. Several viruses such as rhinoviruses, adenoviruses, myxoviruses, and coronaviruses are well-known to exacerbate asthma. Frequent hand washing, avoiding exposure to “sick” people, and timely immunizations to viruses and bacteria (e.g., influenza, coronavirus, respiratory syncytial virus (RSV,) shingles, pneumococcus) can minimize the risk of asthma flare-ups.

2. Allergens: In sensitized individuals, exposure to indoor allergens (i.e., molds, dust mite, animal dander, cockroaches), and outdoor allergens (i.e., tree pollen, grass pollen, weed pollen) could set off more frequent and more severe asthma symptoms. Environmental controls and allergy desensitization with allergen injection therapy (i.e., allergy shots, allergy immunotherapy, allergy hyposensitization) is very helpful to better control and prevent asthma symptoms, as they are effective in 80-85% of the patients that take them.

3. Irritants: Dry air, cold air, excessive humidity, smoke, pollution, chemical aerosol sprays, fragrances, colognes, and other strong odors may irritate the airways of the lungs and result in exacerbations of asthma. As these irritants cannot be “desensitized” by traditional allergy immunotherapy, avoidance is the key to reducing the risks of more severe asthma when irritants are the trigger.

4. Physical Exertion: Exercise can trigger acute attacks of asthma in certain individuals. Proper conditioning, regular use of preventive maintenance medications, and receiving bronchodilator inhaled medications prior to exercise can all help to reduce asthma exacerbations that are caused by physical exertion.

5. Occupational Asthma: Hairstylists, bakers, farmers, welders, seafood processors, textile workers, carpenters, pharmaceutical workers, chemical manufacturers, food processors, animal handlers, metal workers, painters, and adhesive handlers are at increased risk for asthma flare-ups as they may inhale harmful gases, fumes, chemicals, dyes, plastics, metals, enzymes, dust, animal proteins, and/or other particulates. These substances are known to cause wheezing, coughing, and/or shortness of breath in certain occupations, as well as exacerbations in asthmatics in individuals who work there.

The diagnosis and treatment of asthma begins with the allergist performing a comprehensive history and physical examination. The diagnosis is further enhanced by obtaining a pulmonary function test. Occasionally a chest X-ray may be needed to rule out other respiratory diseases. Allergy skin testing or blood testing is often done since both indoor and outdoor aeroallergens are often a trigger in many asthmatics. The treatment of asthma begins with prevention. It is advisable for an asthmatic individual to try to avoid triggers that are known to cause or exacerbate their asthma symptoms. Medications are utilized in the management of asthma in most asthmatics. Every asthma patient should have a short-acting beta2 agonist rescue inhaler rescue medication (e.g., albuterol, ProAir, Proventil, Ventolin, Xopenex, levalbuterol, pirbuterol, Maxair, AirSupra) on hand to use if symptoms develop or to use prophylactically before exposure to a known trigger such as exercise. In addition, many patients will need other medications in order to control their asthma symptoms. Some other medications used to treat asthma may include, inhaled corticosteroids, inhaled long-acting beta2 agonists, oral leukotrienes, oral phosphodiesterase inhibitors, oral beta2 agonists, and biologicals [e.g., Xolair (omalizumab), Nucala (mepolizumab), Fasenra (benralizumab), Dupixent (dupilumab), Tezpire (tezepelumab)]. Allergy injections, as mentioned above may also be beneficial in the treatment of asthma as it helps reduce and prevent allergic triggers such as dust mites, molds, pollens, pets, and cockroaches. It is important to note that the treatment of asthma is individualized as it differs with each individual depending on the patient’s symptoms, frequency of symptoms, severity of symptoms, triggers, medications tried in the past, and the patient’s underlying conditions.

The board certified specialists 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 doctors of Black & Kletz Allergy see both children and adults in the Tysons Corner, VA, McLean, VA, and Manassas, VA areas and we have been serving the greater Washington metropolitan area for over 50 decades. 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.

Insect Sting Allergies Update

As we enter into Spring, not only should allergy-sensitive individuals be on the lookout for those annoying pollen allergy symptoms, but they should be aware of their surroundings for venomous flying insects. In the Washington, DC, Maryland, and Northern Virginia metropolitan area, the most common venomous flying insects are honey bees, wasps, yellow jackets, white-faced hornets, and yellow-faced hornets. The summer months are the peak months that insect stings occur. In the U.S., about 3% of the population experience allergic reactions to the venom of flying insect stings. Approximately a half a million individuals seek emergency room care every year for insect sting reactions in the U.S. Unfortunately, there are roughly 50 deaths reported each year from these insect sting reactions.

Honey bees live in “honeycombs” or colonies that are found in crevices of buildings or in hollow trees. Yellow jackets, on the other hand, generally nest underground and are rarely seen in the cracks in buildings or in trees. Hornets produce brown or grey oval-shaped nests above the ground which are typically located in the branches of trees or in shrubs. Wasps make nests that are made up of a paper-like material which may also be found in shrubs, but are also common under eaves and behind window shutters.

Honey bees, wasps, yellow jackets, white-faced hornets, and yellow-faced hornets all inject their venom into their subjects when they sting their prey. If a sensitive individual has an allergic reaction to a sting, they may develop either a local reaction or they may develop a more serious systemic reaction. A local reaction usually entails redness, itching, and/or swelling at the site of the sting. A systemic reaction, on the other hand, may include generalized itching, hives, swelling, chest tightness, shortness of breath, wheezing, throat tightening, abdominal cramping, fainting, and/or a drop in blood pressure. Patients with reactions are prescribed self-injectable epinephrine devices (e.g. EpiPen, Auvi-Q, Adrenaclick) so that they can be used immediately. A person who has used a self-injectable epinephrine device should immediately go to the closest emergency room.

After a sting, in some instances, an individual may have toxic (i.e., non-allergic) reaction instead of an allergic reaction, particularly if stung by several insects at once. In a toxic reaction, the body reacts to the venom as if it was a poison. This typically occurs because the individual is exposed to an over-abundance of venom at one time. A toxic reaction may cause symptoms similar to those of an allergic reaction, but in addition, may cause non-allergic symptoms such as nausea, fever, and/or seizures.

It is interesting to note that of all the venomous flying insects mentioned above, only the honey bee leaves the sting in the victim. If you are stung by a honey bee and notice the stinger stuck in your skin, you should not pull it out, as doing so may cause more of the venom to be introduced into your body. The recommended way to remove the stinger is to scrape it off with something like your fingernails, a credit card, or other flat surface. It should also be noted that honey bees will die after stinging their victims because their stingers have barbs. After stinging, as the bees try to withdraw their stingers from their prey, their abdomens rupture causing a large hole which causes the demise of the bees. It is also interesting to be aware that, in general, bumblebees do not sting. They can sting but it is uncommon. They tend to sting only when the feel threatened. Since a bumblebee’s stinger has no barbs and is therefore smooth, it does not die after stinging its prey, since their abdomens are not ruptured after stinging. Another interesting fact is that only female bumblebees can sting, as their stingers are used as a modified egg-laying device which is only present in females.

One other well-known venomous insect to bring up is the fire ant. Fire ants bite their victims. The typical reaction to a fire ant is that of a local burning pain with an accompanying red bump that can turn into a white fluid-filled pustule within a day or two. Occasionally individuals are very sensitive to the venom and will manifest systemic symptoms such as generalized itching, hives, swelling, chest tightness, shortness of breath, wheezing, throat tightening, abdominal cramping, fainting, and/or a drop in blood pressure, just like with venomous flying insects. Fire ants of course do not fly. In addition, they do not pose a large threat to residents of the Washington, DC metro area because they live in the warmer climates of the southern U.S., although they have been found in Virginia and Maryland. At least for now, fire ants are not prevalent as far north as Washington, DC, but who knows what will happen in the future, especially if global warming takes more of a stronghold.

The diagnosis of a venomous insect sting allergy is performed by board certified allergy specialist like the ones at Black & Kletz Allergy. The allergy doctor will complete a comprehensive history and physical examination. Depending on the patient’s history, allergy testing to flying insects is usually the next recommended step. Allergy testing is usually performed by allergy skin testing, although blood testing is occasionally done depending on the patient’s history.

The treatment of venomous flying insect sting allergy consists of venom immunotherapy (i.e., allergy desensitization, allergy shots, allergy injections). If the results of the skin testing are positive to any of the stinging insect venoms, it is highly recommended that the patient complete a course of venom allergy immunotherapy as it is extremely effective in preventing further anaphylactic reactions from venomous flying insect stings. Venom allergy immunotherapy involves receiving increasingly greater doses and volumes of insect venom to the patient 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 reduced to every 6 weeks for several more years. This maintenance dose is roughly equivalent to the amount of venom in an actual sting of a flying insect. In addition to venom immunotherapy, all patients who are allergic to any of the venomous flying insects should carry a self-injectable epinephrine devices (e.g. EpiPen, Auvi-Q, Adrenaclick) as mentioned above. A patient who has used a self-injectable epinephrine device should immediately go to the closest emergency room.

The board certified allergists at Black & Kletz Allergy have expertise in diagnosing and treating venomous flying insect allergies. 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 50 years. 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 insect sting allergies, Black & Kletz Allergy is dedicated to providing the highest quality allergy care in a comfortable, thoughtful, and professional environment.