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This is a very relevant subject now as we have had very cold temperatures so far over this last month in the Washington, DC, Northern, VA, and Maryland metropolitan area.  And yes, you read it correctly.  Individuals can be “allergic” to the cold.  There is a condition known as “cold-induced urticarial” in which exposure to the cold will cause hives (i.e., urticaria).  The annoying hives can be triggered by cold weather or cold water.  Being exposed to the cold weather, swimming in cold water, drinking a cold beverage, and/or being in an air conditioned room may all cause certain individuals to develop hives and other symptoms.  In addition to the hives, these other symptoms usually present as swelling (i.e., angioedema), itching (i.e., pruritus), redness of the skin or other rashes, dizziness, fatigue, wheezing, headaches, anxiety, and/or shortness of breath.

It is not uncommon to experience “cold” allergies and in some families, there is a genetic linkage.  Many people are perplexed with the notion that the cold environment can cause such symptoms.  Keep in mind that it is not unusual for anyone to experience minor symptoms when exposed to the cold weather.  These “normal” responses generally consist of a little red flushing of the exposed part of the body (usually the face).  One may also experience a minor burning sensation, especially upon re-warming of the involved skin.  Obviously, individuals that are exposed to very cold temperatures or cold temperatures over a prolonged period of time run the risk of frostbite which can be very serious, as it may result in gangrene and thus loss of limbs and other body parts.

Individuals with Raynaud’s phenomenon or Raynaud’s disease also have cold intolerance.  People with these conditions have cold fingers or toes, skin color changes, and/or numbness/prickly feeling upon re-warming of the skin when they are exposed to the cold.  Although the exact cause is not completely understood, the blood vessels in individuals with Raynaud’s overact to cold temperatures and/or stress.  Often people with Raynaud’s phenomenon will have an accompanying autoimmune disorder such as systemic lupus erythematosus, scleroderma, Sjögren’s syndrome, vasculitis, or rheumatoid arthritis.  Others still have increased symptoms if they smoke, develop carpal tunnel syndrome, acquire a disease of the arteries, partake in repetitive actions such as playing the piano, texting, typing, etc., injure their hands or feet, and/or are exposed to certain medications (e.g., ADHD medications, certain over the counter “cold” medications, migraine medications, certain chemotherapy medications, beta blockers).

Regardless of the condition, the cold can play havoc with one’s body.  Luckily, we do not live in the far north of the U.S. where cold is more of an issue for longer periods of time.  However, since we live in a more temperate climate, allergies to pollens (i.e., allergic rhinitis/hay fever) in the Spring and Fall tend to be worse in the Washington, DC, Northern Virginia, and Maryland metropolitan area.

If you suffer from cold-induced symptoms of any kind, the board certified allergists at Black & Kletz Allergy have the expertise in order to diagnose and treat this condition.  We treat both adult and pediatric patients and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and both the Washington, DC and McLean, VA offices are Metro accessible.  Please either call us for an appointment or you may 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 treating allergy and asthma patients in the Washington, DC metro area for more than 50 years and we strive to provide state of the art allergy care to its residents and visitors.

Exercise-induced anaphylaxis (EIA) is defined as the onset of allergic symptoms during, or immediately after, exercise.  The manifestations may include hives (i.e., urticaria), swelling of the soft tissues (i.e., angioedema), generalized itching (i.e., pruritus), wheezing, shortness of breath, nausea, dizziness, fainting, and/or a drop in blood pressure.  In some individuals, these reactions occur only if exercise is undertaken after eating certain specific foods!  When the food intake and the exercise are independent of each other, there are no symptoms.  This condition is termed “food-dependent exercise Induced anaphylaxis” (i.e., FDEIA).

Symptoms of FDEIA may begin at any stage of exercise and occasionally occur just after exercise.  The offending food is usually ingested within 4 hours preceding exercise, or rarely just after exercise.  The frequency with which symptoms occur varies among patients with FDEIA and can be very unpredictable, even for a given patient.  Early signs and symptoms may include fatigue, diffuse warmth, flushing, and/or generalized itching.  These symptoms usually subside after some time if the person stops exercising.  If the exercise is continued however, it can lead to swelling of the throat, breathing difficulty, drop in blood pressure, and vascular collapse which can potentially be fatal.

Though a wide variety of foods are known to play a role, the most common foods which have been observed to cause this condition are grains (especially wheat) and nuts in Western populations and shellfish in Asians.  Most patients develop symptoms only after eating a specific food, although a few have attacks if any food (usually solids rather than liquids) has been ingested.  Patients have been described where symptoms occurred only if 2 foods were eaten together before exercise.  The processing of the food(s) may also be critical in some cases, such as a patient who developed FDEIA with tofu but could tolerate soy milk.

The exact mechanism of how food plus exercise triggers life-threatening reactions is not clearly known.  A leading theory suggests that physical exertion enhances the absorption of the food from the gut. Ingestion of alcohol can also facilitate this condition, probably by the same mechanism.  Another hypothesis suggests that exercise stimulates the mast cells (which are previously sensitized to specific food proteins) to release chemical mediators responsible for the reaction.  In some instances, taking medications such as aspirin or nonsteroidal anti-inflammatory drugs can also contribute to the reaction, supporting the hypothesis of mast cell activation.

As mentioned above, wheat is the most commonly reported allergen in FDEIA overall.  Gliadin, a protein component of gluten, is an important allergen in this disorder, as well as in wheat allergy causing anaphylaxis independent of exercise.

DIAGNOSIS:

The following criteria are needed to establish the diagnosis of FDEIA:

If a specific food is implicated, there should be:

A serum tryptase level should be measured in all patients and should be normal in individuals with FDEIA when the patients are in their usual state of health.  Elevated levels at baseline should prompt an evaluation for a mast cell disorder.

Skin testing or blood testing for environmental allergens is sometimes useful if the patient is more susceptible to attacks during certain pollen seasons or in a patient with concomitant allergic respiratory disease such as asthma.

A positive food plus exercise challenge confirms the diagnosis, but a negative challenge does not reliably exclude the diagnosis because symptoms can be difficult to induce in a laboratory setting and the procedure is not standardized.

TREATMENT:

Avoidance of ingesting the suspected food before exercising is critical.  Identification of aggravating factors such as alcohol, aspirin, and/or nonsteroidal anti-inflammatory drugs and their avoidance is also important.

In some individuals with this condition, pre-treatment with certain medications such as first generation antihistamines and/or cromolyn may provide some preventive benefit.  It should be noted that this is not a substitute for avoidance of eating the allergic food and then exercising.

The board certified allergists at Black & Kletz Allergy will promptly respond to any questions regarding FDEIA and other allergic or immunologic disorders.  We have been treating this condition for many years and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and treat both adult and pediatric patients.  All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metroaccessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you are concerned that you may have FDEIA or any other allergy, asthma, sinus, skin, or immunology problem(s), please call us to schedule an appointment.  You may also click Request an Appointment and we will reply within 24 hours by the next business day.  At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals in a professional and caring setting.

As we approach the festive holiday season, many individuals will be plagued with increased allergy and/or asthma symptoms.  While most of us will not experience allergic symptoms this holiday season, there are a lot of people who have allergies that will be affected by various allergens during the Christmas, Hanukkah, and Kwanzaa holidays.

During the holidays, individuals may be exposed to decorations that are stored in closets or basements for a long period of time.  These decorations regularly attract dust and/or molds which to many will cause allergic rhinitis, allergic conjunctivitis, and/or asthma symptoms.  The typical symptoms that occur may include runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy eyes, watery eyes, redness of the eyes, sore throat, sinus congestion, sinus headaches, snoring, fatigue, wheezing, coughing, chest tightness, and/or shortness of breath.

Christmas trees may also cause allergy and/or asthma symptoms.  Both natural and artificial trees may be to blame.  Natural Christmas trees are known to harbor many varieties of mold.  A study published in the Annals of Allergy, Asthma, and Immunology found that there were about 50 varieties of mold isolated from some natural Christmas trees.  About 75% of these molds were known to cause allergic rhinitis (i.e., hay fever) symptoms.  In addition, having a real Christmas tree in a home can increase the amount of indoor mold.  Mold counts in a room with a live Christmas tree are higher than the same room once the tree is removed.  Artificial Christmas trees often introduce dust and molds to individuals especially in the case where they have been stored in dusty and/or moldy environments.  Occasionally, the materials used to make the tree is the offending agent as it can cause nasal, sinus, ocular, and pulmonary symptoms.  Usually this is due to an irritant (e.g., chemical) in the materials, and thereby not an actual allergy in the classical sense, however, allergy-like symptoms may ensue.  It is recommended to clean the tree by shaking the tree, hosing it off with water, and/or blowing the dust off using an air compressor regardless if it is natural or artificial in order to minimize the allergens and irritants.

Regardless whether you celebrate Kwanzaa, Hanukkah, Christmas, or merely just get together with family or friends for a non-religious occasion, the winter holiday season can be a problem for some allergic individuals because of food allergies.  The most common food allergies are milk, wheat, soy, eggs, peanuts, tree nuts, fish, and shellfish.  In sensitive individuals, a food allergy can be very severe and life-threatening.  It is very important for the host(s), as well as other people who bring dishes from their homes to be extremely careful when cooking food to know exactly what is in the food so that they can warn the food-allergic individual(s).  More and more, people will prepare dishes without the offending food for the sensitive individual, so he or she can eat without concerns.

The board certified allergists at Black & Kletz Allergy hope that everyone enjoys the upcoming holiday season.  We are here to meet your allergy and asthma needs for the people of the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We treat both adults and pediatricpatients.  We have offices on K Street, N.W. in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at each of the 3 offices.  Our Washington, DC and McLean, VA locations are Metro accessible.  Black & Kletz Allergy offers a free shuttle service between our McLean, VA office and the Spring Hill metro station on the silver line.  If you suffer from allergies, asthma, sinus problems, hives, or immunological disorders, please call us to make an appointment.  You may also click Request an Appointment and we will get back to you within 24 hours by the next business day.  Again, we wish you a happy holiday season.

Asthma is a chronic inflammatory disorder of the lungs.  Genetics play a major role in the causation of the disease process.  It is a characteristically variable disease with the severity varying from person to person.  It also varies at different stages in one’s lifetime of an affected individual.  Environmental factors such as exposure to allergens, irritants, and infections are the usual factors that trigger exacerbations of asthma.

Even when symptoms are not present, low-grade inflammation is believed to exist in affected individuals.  In patients who are susceptible to frequent flare-ups of asthma, it has been well established that adequately controlling the ongoing inflammation will substantially reduce the frequency and severity of exacerbations.  Uncontrolled inflammation can also adversely affect the lung function in the long term.

Corticosteroids are global anti-inflammatory agents and have been the mainstay of maintenance therapy for several decades.  They are proven to suppress the inflammatory cascade at multiple points in a dose-dependent fashion.  They are very reliable in preventing flare-ups of asthma as well as preserving lung function.  However, long-term use of corticosteroids (especially in high doses) unfortunately is not without risks.  The potential side effects may include increased susceptibility to infections, thinning of bones, cataracts, glaucoma, increased appetite, weight gain, mood swings, glucose intolerance as well as many other adverse effects.  These side effects can be minimized by using these agents in the lowest effective dosage and for the shortest possible time.

Over the past several years, scientists have focused on developing alternatives to corticosteroids with fewer side effects.  Research has been fruitful in delineating various “pathways” in the causation and progression of inflammation.  Different chemical mediators mediate the process at different stages.  Blocking these mediators by specific drugs has proven to be effective in controlling the resulting inflammatory damage to tissues.

Leukotrienes were one of the earliest identified mediators for which blocking drugs were developed. Zileuton (i.e., Zyflo), zafirlukast (i.e., Accolate) and montelukast (i.e., Singulair) were approved by the U.S. Food & Drug Administration (i.e., FDA) for maintenance treatment of asthma in the late 1990’s.  These are oral medications used daily in patients with persistent asthma.  Zyflo works by inhibiting leukotriene formation whereas both Accolate and Singulair block the action of specific leukotrienes.  Though these drugs do not help everyone, they are very effective in asthmatics in which leukotrienes play a major role in perpetuating inflammation.  These agents do not have the steroid related side effects, however, a very small percentage of people using Singulair were noted to experience emotional disturbances such as depression.  In addition, patients taking Zyflo must have their liver function tests monitored while on the medication.

Immunoglobulin E (i.e., IgE) is the antibody that mediates allergic reactions and contributes to the disease frequency and severity of asthma exacerbations.  Omalizumab (i.e., Xolair) is a monoclonal antibody that depletes IgE in the blood and has been shown to reduce the frequency of symptoms and exacerbations in patients with asthma.  Note that it is also helpful in the treatment of recalcitrant chronic idiopathic urticaria (i.e., hives).  For asthma, it is given as an injection under the skin (i.e., subcutaneously) at a dose of 75 to 375 mg. every 2 or 4 weeks to patients 6 years of age and older.  The dose is calculated based on the serum IgE level and the weight of the patient and is given to patients with moderate to severe persistent asthma.  This medication is however unlikely to be helpful in patients with non-allergic asthma.  In the treatment of chronic idiopathic urticarial, Xolair is given subcutaneously at a dose of 150 or 300 mg. every 4 weeks to patients 12 years of age and older and is not dependent on the serum IgE level or body weight.

Eosinophils, on the other hand, are a type of white blood cell, long known to cause tissue damage when present in excessive numbers.  In a subtype of asthma, these cells play a predominant role in the inflammatory pathway.  Three “biological” medications were recently approved by the FDA for maintenance treatment of “eosinophilic” asthma.  These medications are effective in controlling asthma in patients who have high levels of eosinophils in their peripheral blood, detected in a commonly done test called a CBC (i.e., complete blood count).

Mepolizumab (i.e., Nucala) was approved in November of 2015.  It is a monoclonal antibody that blocks a molecule called IL-5 (i.e., interleukin-5) which is essential for growth and survival of eosinophils.  It is given as a subcutaneous injection at a fixed dose of 100 mg. every 4 weeks in patients 12 years of age and older who have severe persistent asthma.

Reslizumab (i.e., Cinqair) is another monoclonal antibody that received FDA approval in March of 2016. This medication is administered intravenously in a dose of 3mg. per kg. of body weight, every 4 weeks, infused over 20 to 50 minutes for patients with severe persistent asthma aged 18 years and older.

The most recent medication receiving approval for maintenance treatment of severe persistent asthma was benralizumab (i.e., Fasenra).  It was approved in November of 2017 for patients 12 years of age and older with the eosinophilic asthma phenotype.  It is injected subcutaneously in a fixed dose of 30 mg. The frequency of administration is once every 4 weeks for the first 3 doses and then once every 8 weeks thereafter.

The board certified allergy doctors at Black & Kletz Allergy have 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.  The allergists at Black & Kletz Allergy are extremely knowledgeable about the most current treatment options for patients with asthma and related disorders and can promptly answer any of your questions.  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 have been servicing the greater Washington, DC area for more than 50 years and we look forward to providing you with excellent state of the art allergy and asthma care in a friendly and pleasant environment.

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.

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:

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:

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.

“Flu” season is almost here and it is time to get prepared for its onslaught.

Influenza is a highly contagious viral infection which is the cause of the “flu.”  It impacts people of all ages.  Though it can occur any time of the year, most cases are reported from October through March, with peaks between December and February of each year.  It affects between 5 to 20% of the U.S. population annually.  It accounts for thousands of lost school and work days.  It can be especially serious in the very young and the elderly.  Each year, more than 200,000 individuals are hospitalized and several thousand people die from the complications of influenza.

Symptoms:

Influenza usually presents initially as “cold-like” symptoms with runny nose, nasal congestion, itchy and/ or burning eyes, sore throat, and a dry cough.  Fever (usually 100°F – 102 degrees° F) is usually present and can be associated with chills.  Muscle aches (e.g., body aches) and fatigue are extremely common.  Joint pains, joint stiffness, gastrointestinal manifestations (e.g., diarrhea, nausea, vomiting) may also occur, but are not as common.

The symptoms usually lasts for approximately 7 to 10 days, but the malaise can continue for several weeks. Pneumonia is not an uncommon complication of the influenza virus and can substantially prolong the duration of illness.  Like other viral infections, influenza can also trigger acute flare-ups of asthma and chronic obstructive pulmonary disease (COPD) in susceptible individuals.

The influenza virus spreads from human to human via aerosols created by coughs and/or sneezes of infected individuals.  The incubation period ranges from 18 – 72 hours.  Shedding of the virus continues for 5 – 10 days in most individuals, however the duration of the shedding is longer in young children and immunocompromised persons.

Diagnosis:

There are rapid diagnostic tests that can directly detect influenza A or B virus-associated antigens or enzymes within 30 minutes by testing material obtained from throat swabs or nasal swabs.  Due to the cost, availability, and sensitivity of these tests, however, most physicians diagnose influenza based on clinical criteria alone.

Treatment:

Most patients with influenza benefit from rest and increased fluid intake and generally recover in a few days, though the fatigue may persist for weeks.  Antiviral medications can reduce the duration and severity of illness.  To be effective, these drugs must be started within 40 hours of the onset of symptoms.  There are two common antiviral medications used in the treatment and prevention of influenza A and B.  The first medication is oseltamivir (i.e., Tamiflu) which is taken orally 75 mg. twice a day for 5 days for individuals over the age of 12.  If using oseltamivir for prophylaxis for individuals 5 years of age and over, the dose is 10 mg. once a day for 10 days, but can be used in adults and adolescents (13 years of age and older) for up to 6 weeks for a community outbreak.  Smaller doses are given to children between the ages of 1 and 12.  The second medication is called zanamivir (Relenza) and is taken by inhalation using a Diskhaler (i.e., a device similar to an asthma inhaler) 10 mg. twice a day for 5 days for individuals 7 years of age and over.  If using zanamivir for prophylaxis for individuals 5 years of age and over, the dose is 10 mg. once a day for 10 days, but can be used in adults and adolescents for up to 28 days for a community outbreak.  Zanamivir should not be used by anyone who has respiratory problems such as asthma or other lung diseases.

Prevention:

Avoiding exposure to infected individuals and maximizing personal hygiene (e.g., frequent hand-washing with soap and water, not touching one’s nose and eyes) are the first line of defense in preventing the spread of the influenza virus.

Each year in U.S., vaccines that contain antigens from the strains most likely to cause infection during the winter flu season are produced.  These vaccines become effective 10 – 14 days after administration. It is recommended that all persons 6 months of age and above receive a routine annual influenza vaccination.

Only injectable vaccines are recommended for use during the 2017 – 2018 season.  The live nasal spray vaccine (e.g., FluMist) is not recommended due to concerns about its effectiveness against the H1N1 strains of the viruses.  A number of inactivated as well as recombinant vaccines are available for this season. Trivalent vaccines are designed to protect against three different influenza viruses (2 influenza A viruses and 1 influenza B virus). Quadrivalent vaccines protect against the same three viruses as the trivalent vaccine plus an additional influenza B virus.

In 2016, only about 50% if children ages 6 months to 17 years of age received the vaccine.  In adults 65 years of age and above, approximately 66% received the vaccine.  In individuals from ages 18 through 64, the percentage of people vaccinated for influenza was less than the two cohorts mentioned above.  Needless to say, there is great room for improvement in vaccinating the population against such a potentially virulent illness.

Special Populations:

Pregnant women can receive any licensed inactivated or recombinant trivalent or quadrivalent vaccine.  It is always advisable to check with your Obstetrician/Gynecologist physician and get his or her approval before receiving a flu vaccination.

Children between 6 months and 8 years of age who have never been vaccinated will require two doses of influenza vaccine administered at least 4 weeks apart.  If a child received two or more doses before July 1, 2017, only one dose of 2017 – 2018 flu vaccine is recommended.

As per the Centers of Disease Control and Prevention (CDC), children and adults with a history of severe allergic reaction to egg (i.e., any symptom other than hives) should receive the influenza vaccine in a medical setting under the supervision of a healthcare provider who is able to recognize and manage severe allergic conditions.  A previous severe allergic reaction to the flu vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.

The board certified allergy doctors at Black and Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We diagnose and treat both adult and pediatric patients.  The allergists at Black & Kletz Allergy are extremely knowledgeable about vaccinations as we specialize in immunological conditions. In addition, we also specialize in allergies (environmental, foods, insect stings, medications), asthma, sinus problems, eczema, generalized itching (pruritus), hives (urticaria), swelling episodes (angioedema), and eosinophilic disorders (e.g., eosinophilic esophagitis).  Each one of our offices offers on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  There is a free shuttle service that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

If you would like to make an appointment to see one of our board certified allergists, please call us today.  Alternatively, you may click Request an Appointment and we will respond to your inquiry within 24 hours by the next business day.  Black & Kletz Allergy has been serving the Washington, DC and Northern Virginia metro area for more than 50 years and we look forward to helping you with you allergy, asthma, and immunologic needs.

Halloween is just around the corner and most individuals do not think of allergies when thinking of Halloween.  They more aptly think of costumes, trick-or-treating, candy, bobbing for apples, skeletons and skulls, and Halloween parties.  It is a festive time of the year and both adults and children enjoy the holiday.  Even though adults enjoy the event, it is the children that really become excited!

You may have never pondered about the connection between Halloween and allergies and you would not be alone.  Unfortunately, approximately 8% of all children in the U.S. have some type of food allergy.  These kids and their families are generally the only ones who connect this cheerful holiday with food allergies.  There is a good reason for this as food allergies can be very serious and in some cases fatal.  Almost 40% of children with food allergies have had a severe reaction to a food.  About 30% of children with food allergies have multiple food allergies.  According to Centers for Disease Control and Prevention (CDC), food allergies in children have increased by 50% between the years 1997 and 2011.  Peanut is the most common food allergy in children followed by milk.  The other 6 foods that are in the top 8 most allergic foods, (in addition to peanut and milk mentioned above) include shellfish, tree nuts, soy, wheat, eggs, and fish.  These 8 foods account for 90% of all food allergy reactions.  It is not surprising that Halloween candy often contains 6 of the 8 most common food allergens.  You guessed it, fish and shellfish are generally not a problem in Halloween candy, however, peanuts, tree nuts, milk products, soy, eggs, and/or wheat are found in a multitude of Halloween candy.  It is important to note that in some cases, miniaturized candies often given out during Halloween may contain different ingredients than their full-sized versions.  In addition, many miniaturized candies do not have labels which make it nearly impossible for the parents to deem the candy safe for their child.

What can be done to insure that a “food allergic” child can participate in Halloween and have as much fun as the next child?  Nothing is guaranteed, however, there is a program run by the Food Allergy Research and Education (FARE) organization called the “Teal Pumpkin Project”.  This FARE-sponsored international program has been around since 2014.   It began in Tennessee, however, as a local crusade in 2012 by the mother of a severely food allergic child.  She also created a food allergy support group called the Food Allergy Community of East Tennessee (FACET).

The Teal Pumpkin Project’s aim is to raise awareness of the severity of food allergies and show support to families who have a food allergic child.  This is accomplished by painting a pumpkin teal and placing it on one’s front porch to signify that non-food treats are available at that location on Halloween night.  The color teal was used because it represents food allergy awareness.  Typically, non-food treats may include toys, stickers, crayons, glow sticks, hair accessories, rings, bracelets, necklaces, coins, bookmarks, spider rings, vampire fangs, whistles, balls, finger puppets, etc.

Another important point is to clarify that the Teal Pumpkin Project is not exclusionary and it still promotes the option of giving out normal trick-or-treat candy to children without food allergies.  It recommends that the non-food items be kept in a different bowl than the traditional candy bowl.  FARE provides a “Teal Pumpkin Project Participation Map” on its website so that participating houses can be easily assessed by the parents of food allergic children.

The board certified allergists at Black & Kletz Allergy support the efforts of FARE’s Teal Pumpkin Project and hope that our patients will continue to expand this endeavor.  We have always had a link, on the upper portion of our website under the blue “Resources” tab, to the Food Allergy Research Education (FARE) organization.   If you or your child suffer from food allergies, food intolerances, or eosinophilic esophagitis, please call us to make an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas with on-site parking all 3 locations.  Our Washington, DC and McLean, VA locations are Metro accessible and we offer a free shuttle between our McLean, VA office and the Spring Hill metro station on the silver line.  We look forward to helping you with all your allergy, asthma, and immunology needs as we have been doing in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than a half century.

The most common type of food allergy is an “immediate hypersensitivity” reaction (i.e., Type I reaction), where the symptoms usually begin within a few minutes of exposure to the offending food.  These reactions are mediated by an antibody called IgE which interacts with the protein (i.e., antigen, allergen) in the food.  This interaction causes a release of chemicals which are responsible for the undesirable allergic symptoms.  The most common foods that cause these types of reactions are nuts and shellfish, though any food can theoretically trigger IgE.

Food Protein-Induced Enterocolitis Syndrome (FPIES), though not as common, can also cause serious and potentially life-threatening adverse effects.  IgE is not involved in these reactions, because FPIES is likely to be caused by a “cell-mediated hypersensitivity” reaction (i.e., Type IV reaction), where a specific type of white blood cell called a T-lymphocyte (i.e., T-cell) is thought to play a role.

Clinically, the most distinguishing feature of FPIES is that the symptoms typically begin a few hours after the ingestion of the food.  Though it can affect people at any age, it most commonly involves infants and young children.

50 to 60% of patients with FPIES have a family history of allergic disorders such as asthma, hay fever (i.e., allergic rhinitis) or eczema (i.e., atopic dermatitis) and approximately 20% have a family history of other food allergies.

Although any food can be a trigger for FPIES, the most common culprits are milk, soy, and grains.  Breast milk is not known to be a trigger and most infants develop symptoms when they are first introduced to formula or solid food.

Symptoms of FPIES (may include any or all of the following):

Note:  Unlike traditional IgE-mediated allergies, FPIES reactions do not manifest with itching, hives, swelling, coughing, and/or wheezing.

Diagnosis and Testing of FPIES

FPIES is occasionally mistaken for a bacterial or viral infection.  Although it is a type of allergy, prick skin tests and blood tests are not helpful in the detection of this condition.  The diagnosis primarily rests on a detailed history of ingestion of specific foods, nature and severity of the symptoms in conjunction with their temporal relationship with exposure, and a detailed physical examination.  Rarely oral food challenges under controlled conditions and clinical supervision are necessary to confirm the diagnosis.

Atopy patch testing is being studied for its effectiveness in diagnosing FPIES, as well as predicting if the problem food is no longer a trigger.  At this time, however, it is not considered a valid test to make the diagnosis.

Management of FPIES

The only option in the management of FPIES is strict avoidance of the triggering food(s).  A severe reaction might necessitate emergent intravenous fluids and rarely corticosteroid agents to control inflammation in the intestines. Occasionally, children may require hospitalization if the symptoms are very severe.

Epinephrine is usually not helpful in the treatment of FPIES and is not routinely prescribed, since this condition is a non-IgE-mediated reaction.

Most children with sensitivity to milk and soy can be well managed by switching to hypoallergenic formulas, such as a casein hydrolysate or amino acid based elemental formulas.  Many children sensitive to cereal grains can tolerate yellow fruits and vegetable based age-appropriate foods.  New foods are usually introduced very slowly, one food at a time, for an extended period of time per food.  In protracted cases, dietary advice from a certified nutritionist can be very helpful.

Prognosis of FPIES

In most instances, FPIES resolves spontaneously with time.  The affected children need to be closely monitored by a board certified allergist to determine if the condition has resolved.

With proper medical care and a personalized dietary plan to ensure proper nutrition, children with FPIES usually grow and develop normally.

We Can Help You

The board certified allergy doctors at Black & Kletz Allergy will promptly answer any questions you may have regarding FPIES or any related disorders.  Our allergists have been diagnosing and treating FPIES and other food allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  We have 3 convenient locations in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at each location and both the Washington, DC and McLean, VA 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.  To schedule an appointment, please call us at any one of our 3 locations.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated in providing the most up-to-date diagnostic and treatment modalities in the field of allergy, asthma, and immunology.

Recurrent infections occur in many individuals in the U.S., as well as around the world.  In the U.S., malnutrition is not a common cause as it is in many undeveloped third-world countries.  Parasitic infections are also not very common in the U.S. unless an individual travels to a developing country, consumes uncooked meat/fish, drinks tainted water, or has an immune deficiency.  The most common types of infections found in the U.S. are numerous and include sinus infections, pneumonias, bronchial infections (i.e., bronchitis), skin infections (e.g., cellulitis, boils, abscesses), ear infections, throat infections, eye infections, gastrointestinal infections, urinary tract infections, and surgical site infections.  Nosocomial infections are a subset of infections specific to those infections that are acquired in a hospital setting.

The causative agents of most infections include bacteria, viruses, parasites, fungi, and prions.  These microbes or infectious agents can be transmitted in many ways such as person to person, mother to child, animal to person, and by food contamination.  Infections can be spread by direct contact, indirect contact, bug bites, and food contamination.

What about allergies?  Can they cause infections?  The answer is that having allergies predisposes an individual to the development of some types of infections.  The typical types of infections found more in allergic individuals may include sinus infections, ear infections, bronchitis, and pneumonia.  As a caveat to this, people with immune problems (i.e., immunodeficiencies) are more likely to develop infections.  In fact, most immunodeficiencies are found because the individual complains of recurrent infections.  People with immunodeficiencies can be stricken with infections from bacteria, viruses, fungi, and/or parasites.  These immune defects may involve B cells, T cells, NK cells (i.e., natural killer cells), phagocytic cells, and/or complement deficiencies.  The cells mentioned above are types of white blood cells in one’s body. Immunodeficiencies can be hereditary (i.e., genetic) or acquired (i.e., developed as a result of diseases, cancers, infections, malnutrition, or side effects of medications)

Some examples of hereditary immunodeficiencies include:

Some examples of acquired immunodeficiencies include acquired immunodeficiency syndrome (AIDS), severe acute respiratory syndrome (SARS), cancers of the immune system (e.g., leukemia, multiple myeloma), and immune complex diseases (e.g., viral hepatitis).

In summary, many individuals suffer from recurrent infections and many can be attributed to allergy and/or immunology problems.  Allergic rhinitis, asthma, and immune disorders predispose individuals to the increase risk of various types of infections.  The allergists at Black & Kletz Allergy have been diagnosing and treating both adults and children with all types of infections for many decades in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We are board certified in both adult and pediatric allergy and immunology.  If you or someone you know suffers from recurrent infections (e.g., sinus, ears, lungs, skin), please call us to make an appointment at one of our 3 convenient offices.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of the offices have on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line.  You may also click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been a fixture in the greater Washington, DC and Northern Virginia community for over 50 years for our exceptional services for the diagnosis and treatment of allergic, asthmatic, and immunological conditions.

Definition:

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition caused by the abnormal accumulation of eosinophils (a type of white blood cell) in the lining of the tube carrying food from the throat to the stomach (i.e., esophagus).

Cause:

EoE is a relatively newly discovered condition and is being diagnosed with increasing frequency in the past decade in all age groups.  Though the exact cause of the condition is still being investigated, food and environmental allergies are suspected to play a role as it is often associated with other atopic disorders like seasonal allergies (i.e., allergic rhinitis), asthma, and eczema (i.e., atopic dermatitis).  Both genetic and environmental factors are theorized to contribute to this condition.

Mechanism:

Eosinophils release various proteins that cause damage to the structure of the esophagus resulting in ridges, furrows, scarring, and narrowing of the lumen of the tube.

Symptoms:

Children:

Adults:

Diagnosis:

Management:

EoE is a complex immune system disorder with a chronic and relapsing course that has no known cure at this time.  Optimal management of the condition requires coordinated care by an experience board certified allergist, gastroenterologist, and nutritionist/dietician.

The board certified allergists at Black & Kletz Allergy will readily respond to your needs for further information and services in dealing with EoE and other allergic and immunologic disorders.  The allergy specialists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We offer on-site parking at all of our offices and our Washington, DC and McLean, VA 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.  To make an appointment, please call our office or alternatively, you can click Request an Appointment and we will respond to your inquiry within 24 hours by the next business day.  Black & Kletz Allergy treats both children and adults and we strive to provide the best and most current diagnostic and treatment modalities in the Washington, DC metro area, as we have done for more than 50 years.

It is August in the Washington, DC metropolitan area and to many allergy sufferers, that means ragweed pollen is in the air.  Ragweed is a flowering plant that releases its pollen into the air in the Washington, DC, Northern Virginia, and Maryland metro area usually beginning in mid-August and lasting until the end of October when the first frost occurs.  Recent studies show that with the rising temperatures and rising carbon dioxide (CO₂) levels, the ragweed season is now longer and may begin as early as early August.  Ragweed pollen is a major allergen to many allergic individuals that suffer from hay fever (i.e., allergic rhinitis) and is the number one cause of pollen-induced allergic rhinitis in North America.  Each ragweed plant can generate approximately 1 billion grains of ragweed pollen each season.  The ragweed pollen, like other pollens, is transported by the wind.  The wind causes the ragweed to become airborne for days which provides individuals an easy way to become exposed and thus sensitized to the ragweed pollen.  Ragweed pollen, like other pollens, can travel hundreds of miles due to its light weight.  The ragweed pollen count is lowest in the early morning and tends to peak in the midday.  Once sensitized, a person may exhibit the typical hay fever symptoms when exposed during the ragweed season.

What are the symptoms of ragweed allergy?

The classic symptoms of ragweed allergy may include all or any of the following:  runny nose, itchy nose, sneezing, post-nasal drip, nasal congestion, itchy throat, snoring, itchy ears, clogged ears, itchy eyes, watery eyes, red eyes, puffy eyes, sinus congestion, sinus headaches, fatigue, wheezing, coughing, chest tightness, and/or shortness of breath.  Complications of ragweed allergies may include sinus infections, asthma exacerbations, ear infections, nasal polyps, Eustachian tube dysfunction, inability to concentrate, and sleep disturbances.

What can be done to avoid exposure to ragweed pollen?

Unfortunately, it is almost impossible to avoid exposure to ragweed pollen if you live in the Washington, DC metro area.  In fact, it is almost impossible to avoid no matter where you live in the U.S.  That being said, there are some measures that can be followed to minimize one’s exposure to ragweed pollen.  They are as follows:

What medications can be used to alleviate symptoms?

There are a wide variety of over the counter (OTC) medications that can be utilized to help treat the symptoms of allergic rhinitis caused by ragweed.  Using nasal irrigation with saline can be very beneficial for most individuals to help reduce the nasal symptoms of ragweed allergy.  Oral antihistamines, nasal corticosteroids, nasal antihistamines, oral decongestants, anticholinergic agents, eye drops, and/or leukotriene antagonists are frequently used by board certified allergists like the ones at Black & Kletz Allergy to help prevent and manage hay fever symptoms.  For asthma symptoms that are caused by ragweed, a variety of medications are commonly used.  Some of these include inhaled corticosteroids, long-acting beta₂-agonists (in combination with inhaled corticosteroids), leukotriene antagonists, inhaled beta₂-adrenergic agonists, oral beta₂-adrenergic agonists, and xanthine derivatives.  Xolair (i.e., (omalizumab) and Nucala (i.e., mepolizumab) are injectable medications that are used to treat more difficult cases of perennial asthma, where the asthma is more chronic.

Are allergy shots helpful?

Absolutely yes.  Allergy shots (i.e., allergy immunotherapy, allergy injections, allergy desensitization) are very helpful.  Allergy shots have been around for more than 100 years in the U.S.  They are generally given to individuals of any age above the age of 2, and they can be continued in pregnant individuals, as long as it is approved by the individual’s Ob/Gyn doctor.  They are effective in 80-85% of individuals and the average length of time on allergy shots is 3-5 years.  They work by making the individual tolerant to whatever is put into their allergy serum (e.g., ragweed, trees, grasses, dust mites, molds, cats, dogs).

Where can I get help with my allergies?

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating ragweed allergy for more than 50 years in the Washington, DC, Northern, VA, and Maryland metropolitan area.  Black & Kletz Allergy also treats allergies to other environmental triggers (e.g., trees, grasses, dust mites, cats, dogs, horses, rodents, cockroaches), medications, foods, insect stings, poison ivy, poison sumac, and poison oak.  We also treat hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), immunological disorders, mammalian meat allergy, sinus disorders (e.g., sinus infections), eosinophilic esophagitis, eczema (i.e., atopic dermatitis), contact dermatitis, nasal polyps, latex allergies, and anaphylaxis.

Black & Kletz Allergy has 3 convenient office locations:  Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking.  The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy is dedicated to providing quality cutting edge allergy, asthma, and immunologic care to the residents and visitors of the Washington, DC metro area, as we have done for more than a half century.

Sunscreen is something that you need to wear to protect your skin from the sun’s harmful UV rays, but not all sunscreen is created equal. Some people might have no problem wearing it, but it’s also possible for your skin to have a bad reaction to the common ingredients in most sunscreen formulas. You might not be aware that sunscreen chemicals are added to some other cosmetic or lotion products, which can cause you to have an allergic reaction.

Understanding Sunscreen Sensitivities

Contact dermatitis is a rash on your skin due to contact with an irritating substance, such as those used in common sunscreen formulas. Your skin could be irritated or having an allergic reaction which is more prominent on areas that have direct exposure to the sun, such as your face or where clothing isn’t protecting you. This is a known as photo-contact dermatitis and may also be a reaction to preservatives or fragrances used.

Those Prone to Allergies

Certain groups of people or individuals are more prone to developing an allergy to sunscreen. Females are more affected particularly because they are more prone to using cosmetics that can contain potentially irritating substances. Those with sun-damaged skin, sunscreen being applied to areas of damaged skin and people who work outdoors on a regular basis such as construction workers. The American Academy of Dermatology advises that everyone wear sunscreen because one in five Americans will eventually develop skin cancer due to the sun’s harmful UV rays.

Understanding How Sunscreen Works

There are two ways sunscreen works to protect your skin. The chemical absorbers in sunscreen absorb the energy from the sun as it hits your skin and turns it into less dangerous and damaging radiation. Physical blockers reflect the sun’s rays to prevent radiation from being absorbed and are commonly found in products used by people who spend significant time at the beach.

Chemicals That Can Cause Allergies

Everyone has a different reaction to chemicals and to the active ingredients found in many sunscreen products. It can be hard to pinpoint which ingredient is causing a reaction since some have multiple active ingredients. These are some of the ingredients found in many popular sunscreen products:

• Benzophenone – This has been used in sunscreen for quite some time and is one of the most common irritants in sunscreen formulas. Other names for it are eusolex, methanone, and diphenyl ketone.
• Dibenzoylmethane – This has been commonly used in sunscreen since 1997 in the United States and acts as a chemical absorber.
• Octocrylene – This is a newer chemical used in many sunscreen products and has the potential to cause contact dermatitis for individuals who have sensitive skin. It is typically used to enhance a product’s scent.

It’s important to protect your skin from the harmful rays of the sun, but experiencing an allergic reaction is less than desirable and can be very serious. Be careful when selecting sunscreen, and maybe even consider the answer to the question, “What is the best all natural sunscreen?” to avoid those common allergenic chemicals.

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Allergens (i.e., antigens) that are commonly found in the Washington, DC, Northern Virginia, and Maryland metropolitan area in the Summer may include:  pollens, molds, dust mites, pets, cockroaches, stinging insects (e.g., bees, wasps, yellow jackets, white-faced hornets, yellow-faced hornets), and non-stinging insects (e.g., mosquitoes, gnats).

Non-allergens (i.e., irritants) that cause allergy-like symptoms and/or asthma, that are found in the Summer in the Washington, DC metro area may include:  smog, smoke, ozone, diesel fuel, dust particulates, and automobile exhaust.

Grass pollens are more prevalent in the early Summer, whereas ragweed pollen generally begins to pollinate in the middle of August and typically ends in late October with the arrival of the first frost.  There are also small amounts of tree pollens that linger in the air during the beginning of the Summer in the Washington, DC metro area, although characteristically, tree pollens wreak havoc mostly in the Spring.

Molds are omnipresent in the greater Washington, DC metropolitan area since Washington, DC was built on a swamp.  In the Summer, there is higher humidity, along with warmer temperatures which provides the perfect condition for mold growth.  Molds are also found indoors and tend to gravitate to places such as basements, kitchens, and bathrooms where moisture may be worse.

Dust mites (e.g., Dermatophagoides farinae, Dermatophagoides pteronyssinus) are microscopic bugs that tend to live in carpeting, fabrics, and bedding.  They live off of dead skin that naturally sloughs off of humans and animals.  They will also eat molds.  Dust mites reach their peak concentrations during the Summer and thrive in the warm, humid environment that Washington, DC is famous for in the Summer.

Cats, dogs, horses, and furry pets (i.e., hamsters, guinea pigs, rats, mice, ferrets) are a source of allergens throughout the year, because they are generally kept indoors, except for horses.  As the weather warms up, people tend to go horseback riding more often, so people tend to complain of allergies to horses more often during the warmer months of Summer.  In addition to the actual pet allergy itself, cats and dogs often transfer pollens on their furry coats from the outside to the inside of one’s home which may add to the misery of a particular allergic individual.

Cockroaches are very common in homes, restaurants, and stores especially in inner city locations such as Washington, DC.  They are highly allergenic and are responsible for exacerbating asthma, particularly in asthmatic children who live in the inner cities.

Stinging insects are also more common in the Summer.  Bees, wasps, yellow jackets, white-faces hornets, and yellow-faced hornets are always around during this time of year.  They tend to like being around food and tend to be found quite often at picnic grounds, barbeques, swimming pools.  They also are found near gardens, lawns, and parks.  Note that stinging insects can be anywhere and sensitive individuals should always practice avoidance measures and carry an epinephrine auto-injector (e.g., EpiPen, Auvi-Q, Adrenaclick), if prescribed by an allergist such as the board certified allergists at Black & Kletz Allergy.  If an individual uses their epinephrine auto-injector, they should immediately go to the closest emergency room.  Life-threatening anaphylactic reactions (i.e., anaphylaxis) to stinging insects do occur and anyone who has had any type of systemic reaction in the past to a stinging insect should definitely see a board certified allergist for venom testing and possible venom immunotherapy (i.e. “bee shots”), since venom immunotherapy is highly effective in preventing anaphylactic reactions with future stings.

Non-stinging insects such as mosquitoes are more prevalent in the Summer and tend to migrate near standing fresh water.  Even a small puddle is enough standing water to act as a reservoir for the breeding of mosquitoes.  Most of the reactions to non-stinging insects involve a local redness and/or swelling of the skin.  There may be pain and/or itching associated with the bites.  In rarer situations, an individual may experience an anaphylactic reaction.  If this occurs it is important to use an epinephrine auto-injector and immediately go to the closest emergency room.

Non-allergens (i.e., irritants) such as smog, smoke, ozone, diesel fuel, dust particulates, and automobile exhaust also may cause allergy-like and/or asthma symptoms in many susceptible individuals.  Automobile exhaust in combination with the heat of summer and ultraviolet (UV) rays of the sun contribute greatly to increased levels of ozone and smog.  In addition to ozone and smog, dust particulates and smoke are two more non-allergic irritants that contribute to air pollution.  Air pollution is unhealthy to human life when the pollution level or air quality index (i.e., AQI) rises to above 150.  Note that the AQI ranges from 0 to 500.  AQI’s above 100 are unhealthy for certain sensitive groups of people (e.g., people with lung disease).  AQI’s above 300 are hazardous to everyone.

The board certified allergy specialists at Black & Kletz Allergy have over 50 years’ experience in the diagnosis and treatment of environmental allergies and insect sting and bite allergies.  Although these conditions may be more prevalent in the Summer, environmental allergies are a perennial problem and most sensitive individuals have year-round symptoms.  Black & Kletz Allergy specializes in both adults and children who have allergies and/or asthma.  We have 3 locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at each location and the Washington, DC and McLean offices are Metro accessible.  There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.

If you would like us to help you with your allergies and/or asthma, please call us at one of our office locations that are convenient for you.  Alternatively, you can click Request an Appointment and we respond within 24 hours by the next business day.  We are here in order for us to make your Summers more enjoyable by eliminating or markedly reducing your allergy and/or asthma symptoms.

The onset of summer brings with it the menace of mosquitoes.  Though we are more concerned about diseases transmitted by mosquitoes such as malaria, encephalitis, dengue fever, chikungunya, West Nile virus, yellow fever, filariasis (elephantiasis), Western equine encephalitis, Eastern equine encephalitis, Japanese encephalitis, Venezuelan equine encephalitis, St. Louis encephalitis, La Crosse encephalitis, Ross River fever, Rift Valley fever, and most recently Zika virus-related illnesses, adverse reactions to mosquito bites can be very severe in susceptible individuals.

Mosquitoes inject their saliva into the tiny blood vessels in our skin, before sucking the blood. Immunological reactions to the chemicals in the saliva of the mosquito are usually responsible for the untoward reactions.  The chemicals can also interfere with the clotting mechanism in individuals resulting in local bleeding.

Three types of reactions can occur:

The typical clinical course of sensitization and natural desensitization usually proceeds in five stages:

Treatments:

Avoidance:

The board certified allergists of Black & Kletz Allergy have had over 50 years of experience dealing with mosquito bite reactions.  Black & Kletz Allergy has 3 office locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergy doctors at Black & Kletz Allergy diagnose and treat both adults and children with allergies (e.g., hay fever, food allergies, medication allergies), asthma, hives, swelling episodes, eczema, contact dermatitis, insect bites, bee sting allergies, sinus disease, and immunologic problems.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have on-site parking at each location.  The Washington, DC and McLean, VA offices are Metro accessible and 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 to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy has been striving to provide high quality allergy and asthma care to the residents of the Washington, DC metro area for more than a half a century and we are dedicated to continue delivering state of the art allergy and asthma care in the future.