Month: August 2024

New Treatment for Anaphylaxis

• August 21, 2024
• Black & Kletz Allergy

Anaphylaxis is an acute, severe, and life-threatening allergic reaction.  The most common triggers for anaphylaxis include allergenic foods, medications, and insect stings.  Symptoms usually begin within a few minutes of exposure of the triggering agents.  Initially, the symptoms characteristically involve the skin which typically causes itching and hives followed by swelling of the soft tissues.  Unless treated, the reaction may rapidly progress and may involve other organ systems (e.g., respiratory, gastrointestinal, cardiovascular) resulting in symptoms such as shortness of breath, wheezing, coughing, nausea, vomiting, abdominal pain, dizziness, drop in blood pressure, and/or loss of consciousness.

The only effective treatment for anaphylaxis is epinephrine.  If given early in the process, it can stop the reaction from progressing and can be life-saving.  As anaphylactic reactions can occur after accidental exposures anywhere and at any time, it is recommended to have epinephrine readily available at all times for those at risk for anaphylaxis.

Until now, the only form of epinephrine available was an injectable form.  The epinephrine is injected into a muscle either with a syringe and a needle or with an autoinjector device.  There are a few autoinjectors available in different shapes and sizes and dome of the brand names include EpiPen, Auvi-Q, and Adrenaclick.  Autoinjectors are preloaded with different doses of epinephrine suitable for adults and children.  One problem with autoinjectors is that some patients and parents of children at risk for anaphylaxis are not comfortable in using them because they are squeamish about needles.  As a result, a hesitancy in the use of epinephrine can lead to a delay in administering the needed treatment in a life-threatening situation which can be detrimental.

On August 9, 2024, the Food and Drug Administration FDA) approved a new form of epinephrine that is delivered into the nostrils by way of a nasal spray device.  It is called Neffy and it uses the same delivery device used to administer other medications into the nasal cavity such as Narcan, a drug useful in reversing the effects of opiates.

Neffy delivers 2 mg. of epinephrine into the nasal cavity. (Epipen is available in 0.3mg. and 0.15mg. dosage strengths).  In clinical trials, Neffy resulted in comparable blood levels of epinephrine to injectable forms, with a shorter onset of action.  It also showed that it can increase the blood pressure and heart rate rapidly, which are indicators for the reversal of the reaction.

This nasal epinephrine formulation is approved for adults and children weighing 30 kg. (66 lbs.) and above.  Neffy is a single dose nasal spray administered into one nostril.  It is available as a 2-pack, which is similar to injectable forms.  It is recommended to administer the second dose on Neffy from a different device into the same nostril if the anaphylactic symptoms persist 5 minutes after the initial dose.

It is hoped that the nasal spray would remove some barriers for early usage of epinephrine (i.e.  the fear of injections) and thus would meet an unmet need.  The manufacturer says that most commercially insured patients will pay approximately $25 as copay for a 2-pack, while also offering assistance for patients who are not insured.  The medication has a shelf-life of about 30 months and is stable at wide temperature ranges.

Neffy was also studied in patients with nasal congestion due to allergies and infections and it was shown to be well absorbed from the nasal cavity without losing its efficacy.  Note however that Neffy was not studied in patients with nasal polyps and in patients after nasal surgeries, so its efficacy in these patients is currently unknown.

The side effects observed in clinical trial participants included throat irritation, tingling sensation in the nose, runny nose, nasal congestion, headaches, jitteriness, and dizziness. Neffy should also be used with caution in patients with a history of allergic sensitivity to sulfites.

Neffy is expected to be available in the pharmacies in October 2024.

The board certified allergists at Black & Kletz Allergy see both adult and pediatric patients and have over 5 decades of experience in the field of allergy, asthma, and immunology.  Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line.  To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day.  We look forward to providing you with the newest cutting edge allergy care in a welcoming and relaxed environment.

Ragweed Allergy Update

• August 2, 2024
• Black & Kletz Allergy

As the Summer marches on and we are now in the month of August, many allergy sufferers are about to get ready for another foe, namely ragweed. Usually about August 15th of every year, ragweed pollen begins to blanket the Washington, DC, Northern Virginia, and Maryland metropolitan area like clockwork. The dissemination of ragweed pollen generally comes to an end in our region in late October during the first frost. With the rising temperatures and rising carbon dioxide (CO₂) levels, the ragweed season is now longer than it has been historically and it now may begin as early as early August. Ragweed is a flowering plant and considered a weed. Ragweed is widespread in the U.S., particularly in the Midwestern and Eastern and regions of the U.S. Though many weeds (e.g., cocklebur, mugwort/sagebrush, pigweed, Russian thistle) pollinate in the Fall, ragweed is the most common and predominant allergen in our geographical area. The only state without ragweed is Alaska.  It is typically found in fields, on the side of roads, in vacant lots, and near riverbanks. There are at least 17 species of ragweed in North America. Even though each ragweed plant lives only 1 season, it can produce approximately 1 billion pollen grains, plenty enough to cause havoc amongst allergy sufferers. Increased humidity in conjunction with warm weather and wind enhances the release of ragweed pollen. The ragweed pollen, like other pollens, is transported by the wind and can travel hundreds of miles due to its light weight. The wind causes the ragweed to become airborne for days which provides an easy way for individuals to become sensitized to the ragweed pollen. The ragweed pollen count is typically lowest in the early morning and it tends to reach its highest in the midday.

When a previously sensitized individual has been is exposed to ragweed again in the air, the ragweed proteins trigger specialized cells in the immune system to release increased levels of histamine and other chemical mediators which are responsible for numerous allergic symptoms which is known by the names allergic rhinitis (i.e., hay fever) and/or allergic conjunctivitis (i.e., eye allergies). Some of these symptoms may include runny nose, sneezing, nasal congestion, post-nasal drip, itchy nose, sinus congestion, headaches, itchy throat, fatigue, snoring, itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes. In asthmatics, coughing, chest tightness, wheezing, and/or shortness of breath may also occur.

In some ragweed-sensitive individuals, consuming certain fresh fruits or vegetables [e.g., bananas, melons (watermelon, cantaloupe, honeydew), cucumber, zucchini, artichokes, sunflower seeds, white potato, chamomile tea, dandelion] may cause itching and tingling of mouth, tongue, and throat. This condition is called “oral allergy syndrome” or “pollen-food allergy syndrome” and is a result of the cross-reacting proteins in the pollen and fresh fruits or vegetables. The syndrome is caused by allergens in foods that are derived from plants. Thus, only foods that come from plants can cause the syndrome.  Ironically, when the fruit or vegetable is canned or cooked, the protein is denatured and destroyed which usually prevents the allergic reaction from happening. Most of the time, individuals can tolerate canned and/or cooked fruits or vegetables.

Avoidance is the key to combatting ragweed, if at all possible. Some avoidance measures may include the following:

• Keeping the windows and doors at home as well as the windows in automobiles closed and use air-conditioning.
• Decreasing outdoor activities, especially in the early morning hours when the pollen counts tend to be at their highest.
• Showering to remove ragweed pollen from the skin and hair after coming indoors.
• Washing clothes upon returning from outdoors.
• Nasal irrigation can wash the ragweed pollen from the nasal passages.
• Washing the fur and coats of one’s pets after being outside.

If it is impossible to avoid ragweed using the avoidance measures listed above or one still develops those annoying allergy symptoms, there are some medications available in order to prevent or minimize the symptoms of ragweed allergy. They include oral antihistamines, oral decongestants, leukotriene antagonists, nasal antihistamines, nasal decongestants, nasal anticholinergics, nasal corticosteroids, ocular antihistamines, ocular decongestants, ocular anti-inflammatory agents, and/or ocular mast cell stabilizers. For those patients who have asthma, the treatment may include short-acting beta 2 agonists, long-acting beta 2 agonists, inhaled corticosteroids, leukotriene antagonists, monoclonal antibody injections, and/or oral corticosteroids in more severe cases. In addition to the medications listed above, allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) are a very effective tool in the treatment of allergic rhinitis, allergic conjunctivitis, and asthma. They have been given to patients in the U.S. for more than 100 years. Allergy shots work in 80-85% of patients who undergo them. They are typically given for 3-5 years. Allergy immunotherapy will offer the most effective long-term relief of symptoms and can reduce or eliminate the need for medications.

The board certified allergists at Black & Kletz Allergy have 3 office locations in the Washington, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. The McLean office has a complementary shuttle that runs between our office and the Spring Hill metro station on the silver line. The allergy specialists at Black & Kletz Allergy diagnose and treat both pediatric and adult patients. For an appointment, please call one of our offices or alternatively, click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors at Black & Kletz Allergy have been helping patients with hay fever, asthma, sinus disease, hives, eczema, insect sting allergies, food allergies, medication allergies, and immunological disorders for more than 5 decades. If you suffer from allergies, it is our mission to improve your quality of life by reducing or preventing your unwelcome and irritating allergy symptoms.