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Is it possible to be allergic to exercise? Well, not really, however, exercise can cause the body to exhibit the signs and symptoms of allergies! We are also not talking about an excuse not to exercise! The mechanism by which exercise causes “allergy” symptoms is not completely understood but it seems to be related to an exaggerated cholinergic response to the warming that occurs with exercise and not due to an allergy at all. There is an increased level of histamine during and or following exercise in many of the conditions associated with this phenomenon. The severity of the “allergic” symptoms can range from mild to severe and in some cases they may be life-threatening. As a general rule, patients should stop exercising at the first sign of an “allergic” or asthmatic reaction. It may be recommended by a board certified allergist that individuals with any of the following conditions carry an epinephrine self-injectable device (i.e., EpiPen,Auvi-Q, Adrenaclick). It should also be noted that if one uses such as device, he or she should go immediately to the closest emergency room. Below are some examples of conditions where exercise causes symptoms that mimic allergies:

Exercise-induced asthma: Many individuals with asthma have external factors which exacerbate their asthma. Some of these triggers may include allergies to environmental allergens such as dust mites, molds, pollens, pets, and cockroaches. Others may include non-allergic triggers such as pollution, organic dusts, strong scents, increased humidity, changes in temperature, cold air, and certain chemicals. Still other asthmatics will complain of increased asthma symptoms when exercising. When an individual develops asthma symptoms (i.e., wheezing, shortness of breath, chest tightness, coughing) with exercise only, that person is said to have exercise-induced asthma. These patients have no other triggers for their asthma other than exercise. To an outsider, this person looks as though they are “allergic” to exercise since they have asthma symptoms whenever they exercise. Most individuals with exercise-induced asthma are given an inhaler that can both be used to treat the asthma as well as be used prophylactically to prevent the asthma symptoms prior to exercise. Leukotriene antagonists may also be utilized to help prevent the symptoms from occurring.

Exercise-induced urticaria (i.e., hives): In this condition, individuals develop hives whenever exercising or immediately following exercise. This is very confusing to the patients that are plagued with this disease. Individuals with this disorder often complain that they are “allergic” to exercise or that they are “allergic” to their own sweat. In reality, it is not an allergy at all. The hives are best controlled by avoiding exercise, but in individuals who want to exercise, there are medications (i.e., antihistamines, leukotrienes antagonists, H2-blockers) that can be given to both treat and prevent such reactions.

Exercise-induced pruritus (i.e., itching): Individuals who have generalized itching without the accompaniment of a rash after exercising have a condition called exercise-induced pruritus. It is very similar to exercise-induced urticaria except that the person gets itching without the hives. These individuals also feel that they are “allergic” to either exercise or their own sweat. In fact, it is not an allergy but rather an exaggerated cholinergic response to the warming of exercise. Avoiding exercise is an option but it does not prevent itching from occurring in exercise that occurs in emergency circumstances where exercise is a must and not an option. Medications used to prevent and treat this malady is the same as with exercise-induced urticaria.

Exercise-induced angioedema (i.e., swelling): In some individuals, exercise may trigger random swelling episodes that can occur anywhere on the body. The swelling can be on the skin or it can be internal. The most common locations for swelling to occur are the face, eyes, lips, throat, tongue, hands, and/or feet. Needless to say, that swelling of the throat can be life-threatening, so it is important to recognize the early signs and symptoms of this type of swelling. There are various medications that can be used to prevent and treat swelling episodes. Again, avoiding exercise is an option but it does not prevent swelling from occurring in exercise that occurs in emergent situations where exercise is a must. The medicines are similar to the ones used for the prevention and treatment of exercise-induced urticaria and pruritus.

Exercise-induced anaphylaxis: Occasionally, exercise can trigger a more serious and exaggerated response whereby an individual may experience life-threatening anaphylaxis. Again, it is very important for the affected individual to understand the signs and symptoms of early anaphylaxis so they are able to treat it appropriately in its early phase. Medications used to prevent and treat exercise-induced urticaria, pruritis, and angioedema are also used to manage exercise-induced anaphylaxis. Avoiding exercise completely is the best option in these individuals. As with all of the above conditions, carrying an epinephrine self-injectable device is very important. Once again, if the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

Food-dependent exercise-induced anaphylaxis: This condition is an off-shoot of exercise-induced anaphylaxis. It is very similar to exercise-induced anaphylaxis except that in these individuals, exercise by itself does not cause anaphylaxis. Approximately 30-50% of patients with exercise-induced anaphylaxis have food-dependent exercise-induced anaphylaxis. Likewise, food itself does not cause anaphylaxis. However, if a person with this condition eats a certain food and then exercises within usually 2 hours after consumption, anaphylaxis will develop. Interestingly, these patients generally are not allergic to that specific food and as mentioned above, do not have anaphylaxis after eating that food. The anaphylaxis only occurs if that person exercises within 2 hours after eating that food. The most common foods that cause this type of reaction include wheat, shellfish, fruit, milk, celery, fish, alcohol, tomato, strawberries, and peach. Avoiding the combination of the trigger food with exercise is the key to preventing the anaphylaxis. As stated above, carrying an epinephrine self-injectable device is very important. If the epinephrine self-injectable device is used, it is important that the individual go immediately to the closest emergency room.

The board certified allergy doctors at Black & Kletz Allergy located in the Washington, DC, Northern Virginia, and Maryland metropolitan area will readily answer any questions you have regarding your exercise-induced asthma and other exercise-induced allergic disorders. We also diagnose and treat allergic rhinitis (i.e., hay fever), asthma, sinus disease, eosinophilic esophagitis, hives (urticaria), swelling (angioedema), generalized itching (i.e., pruritus), eczema (i.e., atopic dermatitis), medication allergies, food allergies, insect sting allergies, and immune disorders. We have 3 offices with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices offer on-site parking. In addition, our Washington, DC and McLean, VA offices are accessible by Metro. There is also a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please make an appointment by calling any one of our 3 offices, or alternatively, you can click Request an Appointment and we will answer you within 24 hours by the next business day. Black & Kletz Allergy diagnoses and treats both adults and children and we are proud to serve the Washington, DC metro area residents for which we have done for more than 5 decades.

Allergy immunotherapy (AIT) (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a time-tested efficacious treatment option for disorders caused by the sensitization to environmental allergens such as dust mites, molds, pollens, pets, and/or cockroaches. It is 80-85% effective in reducing symptoms from allergic rhinitis (i.e., hay fever), asthma, and/or allergic conjunctivitis (i.e., eye allergies). Venom immunotherapy (VIT) on the other hand is 97% effective in preventing serious life-threatening reactions after stinging insect venom allergen exposures to honey bees, wasps, yellow jackets, white-faced hornets, yellow-faced hornets, and/or fire ants). Venom immunotherapy has been the standard of care for individuals allergic to stinging insect venoms for the past several decades.  The term immunotherapy may be used to denote the general concept of both allergy immunotherapy and venom immunotherapy. The process of immunotherapy entails injections with proteins extracted from allergens at regular intervals with increasing incremental doses. The treatment begins with very small doses in order to minimize the risk of adverse reactions. As the treatment continues, the doses are gradually escalated until a maintenance dose is attained.

This process helps allergic individuals develop a tolerance to the allergens they have been previously sensitized to. This procedure is especially useful when dealing with allergens which are usually difficult to avoid such as dust mites, molds, pollens, and/or stinging insects. Patients on maintenance doses of both allergy immunotherapy and venom immunotherapy should be able to resist allergic reactions. The reduction of the severity of symptoms should lead to a reduction of the need for medications. Medications may be effective but only offer temporary relief from allergy symptoms. Unlike immunotherapy, medications do not alter the underlying sensitizations of an individual.

In essence, immunotherapy is a desensitization process that helps the allergic individual develop tolerance to the substance(s) that he or she has been previously sensitized to.  Whereas most allergy medicines mask the symptoms of allergies, allergy injections treat the underlying cause and modulate the immune response.  This results in an increased resistance to the offending allergens.  This process is comparable to vaccinations with bacterial and viral products which help individuals resist infections with those microorganisms.

Allergy shots can cause 2 types of adverse reactions. The more common “local’ reactions generally manifest themselves as redness, itching, and/or swelling at the site of injection. “Systemic” or “generalized” reactions are not common but if they occur, they can result in hives, a drop in blood pressure, wheezing, shortness of breath, swelling of lips, tongue, etc. It is rare however to have life-threatening reactions such as anaphylaxis after allergy injections. Occasionally reactions begin as a local reaction and then progress to systemic reaction. Allergy immunotherapy is currently being researched as a possible treatment option for numerous food allergies.  The preliminary results of studies regarding immunotherapy with peanuts are very promising.  Although there is currently no FDA-approved protocol for immunotherapy for food allergies, it is hoped that we can offer this treatment to individuals with food allergies in the near future. For now, the most effective treatment for food allergies is to avoid the food and any cross-reacting foods. Note that despite there not being any immunotherapy given by injection for the treatment of peanut allergies, there is now a method to undergo peanut desensitization to peanuts by way of an oral route. Palforzia is a peanut allergen powder prescribed by board certified allergists that is used to desensitize patients from ages 4-17 who have a confirmed allergy to peanuts.

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. The board certified allergy doctors at Black & Kletz Allergy are extremely knowledgeable regarding the diagnosis and treatment of environmental allergies (i.e., allergic rhinitis, hay fever), eye allergies (i.e., allergic conjunctivitis), insect sting allergies, asthma, food allergies, eczema (atopic dermatitis), hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), contact dermatitis, eosinophilic esophagitis, medication allergies, and immune disorders. 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 metropolitan area for many years and we look forward to providing you with excellent state-of-the-art allergy care in a welcoming and professional environment.

We love our pets. Pets are very important to humans. They fulfill all types of psychological and social needs that people desire including happiness, self-worth, and companionship. Unfortunately, some individuals cannot experience the joy of owning a pet because they have allergy or asthma symptoms when they are exposed to the pet. Any pet can cause allergy symptoms, but the most common pet allergies in the U.S are due to cats and dogs. Approximately 70% of homes in the U.S. have at least one pet.  It is estimated that about 45% of U.S. households own a dog and about 35% own a cat. Despite this inequity, there are still more cats in the U.S. than dogs (i.e., 86 million cats and 78 million dogs). The U.S. is the number one pet-owning country in the world!

In addition to cats and dogs, there are numerous other pets that can be found in the U.S. These may include fish, birds (e.g., parrots, parakeets), rabbits, pigs, amphibians (e.g., frogs, toads, salamanders), reptiles (e.g., lizards, snakes, turtles, geckos), rodents (e.g., hamsters, guinea pigs, mice, gerbils, rats, chinchillas), ferrets, hedgehogs, hermit crabs, horses, insects, and spiders. Still yet, there are exotic animals that are kept as pets. Some of these animals may include, monkeys, chameleons, raccoons, foxes, bearded dragons, and tigers.

The classic symptoms of a pet allergy are those of either allergic rhinitis (i.e., hay fever), allergic conjunctivitis (i.e., eye allergies), asthma, and/or skin manifestations. The allergic rhinitis symptoms may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, fatigue, sinus congestion, and/or headaches. Eye symptoms typically may include itchy eyes, watery eyes, redness of the eyes, and/or puffy eyes. Some individuals with pet allergies may experience asthma symptoms such as chest tightness, wheezing, coughing, and/or shortness of breath. Known asthmatics may experience a worsening of their asthma when exposed to certain pets. Still others may develop skin manifestations which may include itchiness, redness, and/or hives (i.e., urticaria).

One myth that is widely held as fact by so many is that there are “hypoallergenic” cats and dogs to bring home if one is allergic to such a pet.  There are many pet-allergic individuals who feel that they have reduced allergic symptoms around short-haired cats and/or dogs that do not shed (e.g., poodles, Maltese, Portuguese Water Dog). It should be noted that there are no dogs that are 100% shed-free. Even though many people feel they are better around these non-shedding or short-haired animals, most scientific studies do not support this phenomenon. In addition, it is not the hair that causes the allergies, but rather the dander, saliva, and urine that is responsible for containing the allergens in cats and dogs that cause allergies.

The diagnosis of pet allergies begins with a comprehensive history and physical examination performed by a board certified allergist such as the ones at Black & Kletz Allergy. Next, allergy testing is usually done. The tests can be done either by allergy skin testing or by blood tests, depending on the individual and situation. Once a pet allergy is confirmed, it is important to discuss ways to prevent and/or treat such an allergy.

Prevention is the best option but most people are not willing to get rid of their pets which is very understandable, since they become part of the family. If prevention is not an alternative, there are still ways to minimize one’s exposure to a pet in the confines of one’s home. Despite one’s efforts to minimize their exposure to pets, it is often necessary to treat an individual for pet allergies.

Treatment of pet allergies may include antihistamines, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, asthma inhalers, and other allergy and asthma medications. Allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a very efficacious treatment option in the management of pet allergies. Allergy immunotherapy has been used in the U.S for more than 100 years. Both children and adults respond nicely to this treatment. It is effective 80-85% of the time. Most patients are on allergy immunotherapy for 3-5 years.

The board certified allergy specialists at Black & Kletz Allergy see both pediatric and adult patients and have over 50 years 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 have been servicing the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy, asthma, and immunology care in a friendly and relaxed environment.

The swimming season is in full swing and most public and private swimming pools are attracting swimmers of all ages and of all skill levels. For most individuals, swimming is one of the most pleasurable recreational avenues offered in the summer. For others, swimming offers an effective workout option without putting undue pressure on one’s joints.

Despite the popularity of swimming, a small percentage of individuals may experience adverse reactions while in a pool or after coming out of the pool. Some individuals experience itchy skin and rashes while others notice an increase in upper and lower respiratory symptoms. The question is: Is the chlorine in the water the culprit?

Chlorine is a chemical added to water in swimming pools in order to kill the bacteria that can grow in such water. Chlorine also oxidizes suntan oils, other body oils, cosmetics, leaf mold, bugs, urine, sweat, and other human bodily waste. Chlorine is not an allergen because it does not stimulate the immune system to produce proteins which then cause allergic symptoms. Chlorine is instead considered an irritant. As an irritant, chlorine may cause undesirable side effects on the skin and respiratory system. It is similar to other irritants such as perfumes, colognes, strong scents, pollution, and organic dusts. These irritants may also cause skin and respiratory symptoms that may be confused for allergy symptoms, but when it comes down to it, the symptoms are due to the irritating effect of the chemicals, dusts, or particulates, and not an allergic reaction to them.

In sensitive individuals, chlorine can result in a type of irritant contact dermatitis (ICD), especially if the concentration of chlorine in the pool is high.

Symptoms of irritant contact dermatitis may include:

• Excessive dryness of the skin
• Redness of the skin
• Itching of the skin
• Flakiness, fissuring, and/or scaling of the skin
• Hives (i.e., urticaria) – Raised blotches or “welts” with clear margins

Treatments of irritant contact dermatitis include:

• Washing with fresh water as soon as coming out of the pool
• Liberal application of emollients (i.e., moisturizing lotions)
• Mild topical corticosteroid creams or ointments
• Antihistamines to relieve itching of the skin

Patients with a history of respiratory disorders may experience more of a flare-up of both the upper and lower respiratory symptoms listed below when exposed to chlorine in a pool.

Upper Respiratory Symptoms:

• Sneezing
• Itchy nose
• Runny nose
• Nasal congestion
• Post-nasal drip
• Itchy throat
• Itchy eyes
• Watery eyes
• Redness of the eyes
• Sinus congestion
• Sinus headaches
• Coughing

Lower Respiratory Symptoms:

• Chest tightness
• Coughing
• Shortness of breath
• Wheezing

Even though the above upper and lower respiratory symptoms may be seen in anyone exposed to chlorine, these symptoms are more common and more prominent in patients with inadequately controlled allergic rhinitis (i.e., hay fever) and/or asthma.

Treatment of Upper Respiratory Symptoms: The treatment of the upper respiratory symptoms caused by chlorine exposure may include oral antihistamines, oral decongestants, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular decongestants, and/or ocular mast cell stabilizers.

Treatment of Lower Respiratory Symptoms: The treatment of the lower respiratory symptoms caused by chlorine exposure may include an inhaled bronchodilator and/or an inhaled corticosteroid. The inhaled corticosteroid is used to prevent and control airway inflammation.

Prevention of Chlorine-Induced Symptoms: Choosing a swimming pool with less of a concentration of chlorine may help prevent or mitigate the severity of symptoms that occur in individuals who are sensitive to the effects of chlorine.

The board certified allergy specialists at Black & Kletz Allergy have expertise in diagnosing and treating chlorine sensitivity as well as all types of irritant reactions. In addition, we also treat all types of allergic, asthmatic, and immunologic conditions. The allergists at Black & Kletz Allergy treat both pediatric and adult allergy and immunology patients and have been practicing 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 irritant reactions to chlorine or any other irritant, or have allergies or asthma, we are here to help alleviate or hopefully end these unwanted symptoms that have been so bothersome, so that you can enjoy a better quality of life. Black & Kletz Allergy is dedicated to providing the highest quality allergy, asthma, and immunology care in a compassionate, relaxed, and professional environment.

Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate is steadily changing over the past several decades and is likely to continue into near future. This climate change also has the potential to alter the incidence and severity of allergic and respiratory diseases in humans. Although each individual is different, a general trend towards more allergens and more severe allergic disease seems likely if climate change continues in the direction it is going. While it is already known that the prevalence of both allergic rhinitis (i.e., hay fever) and asthma have increased in the last few decades, it seems likely that these numbers will continue to increase in the near future, at least partially as a result of climate change.

Below are a few ways that climate change may impact allergies:

• The warming of the climate and higher carbon dioxide levels will likely lead to longer pollen seasons.
• More hot summer days will generate more ozone which will probably trigger more flare-ups of breathing difficulties for people with chronic respiratory conditions such as asthma.
• Rising sea levels and changes in rainfall patterns are likely to increase the incidence and severity of mold allergies.
• The warming conditions caused by global warming may lead to the increased prevalence of biting and stinging insects in new areas.
• The effect of fewer cold winter days on respiratory infections from viruses and bacteria is still unpredictable.

We know that having more energy efficient and tighter homes leads to an increase in indoor air pollution. The accumulation of volatile organic compounds (VOC’s), radon gas, smoke particulates, and allergenic proteins will increase the risk of respiratory illnesses. In addition, higher water vapor and moisture levels will increase dust mite and mold growth, leading to an increase in the number of allergy sufferers as well as the severity of allergy symptoms.

“Green” practices such as composting facilities may cause an increase in respiratory diseases through the increased fungal load put into the air by these facilities. Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde. Inhaling particles coated with these chemicals contribute to bronchitis, asthma, and emphysema.

With an increase in temperatures and other features of climate change, ragweed will flower earlier in the season and produce more pollen in urban locations where carbon dioxide concentrations and temperatures are higher. The same effect can be seen on other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures should be noted as a means to help prevent allergy symptoms. Keeping the indoor humidity lower in order to limit dust mite and mold growth is a good thing to do particularly if one is allergic to dust and/or molds. It is also important to use a HEPA filter in one’s house and to change them regularly. Minimizing outdoor activities on high pollen days can also diminish allergic symptoms and reduce the need for allergy medications. One can also take a shower after spending time outdoors so that the pollen is washed off one’s body. Another environmental control measure that helps allergy sufferers is to wash off one’s pet after they spend time outdoors since pet hair attracts pollen.

The allergy doctors at Black & Kletz Allergy are board certified and treat both adult and pediatric patients. We have 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 allergy doctors at Black & Kletz Allergy are eager to help you with any of your allergy or immunology needs. We diagnose and treat a multitude of allergy and immunological conditions including allergic rhinitis (i.e., hay fever), asthma, sinus problems, hives (i.e., urticaria), swelling episodes (i.e., angioedema), generalized itching (i.e., pruritus), food allergies, medication allergies, eczema (i.e., atopic dermatitis), insect sting allergies, poison ivy, poison oak, poison sumac, contact dermatitis, eosinophilic esophagitis, mast cell diseases, and immune disorders. The allergists at Black & Kletz Allergy are knowledgeable about how climate change may affect allergy symptoms and are here to help guide you through these changes. We are dedicated to providing excellent care to you as we have been doing in the Washington, DC metropolitan area for more than 5 decades.

Meat allergy is an increasing problem over the last decade. It is generally not that people have developed a typical food allergy to meat in the classic sense, but this increase has rather occurred because of an entity called alpha-gal syndrome. It is often referred to as mammalian meat allergy, red meat allergy, and tick bite meat allergy. More specifically, alpha-gal syndrome is a food allergy to red meat (i.e., mammalian meat) and any other products made from mammals such as gelatin or milk products. The condition was discovered by researchers at the University of Virginia a little more than a decade ago. The mechanism of why and how the syndrome occurs is quite interesting. Alpha-gal, technically referred to as galactose-alpha-1,3-galactose, is a carbohydrate (i.e., sugar molecule) that is present in most mammals (e.g., cows, pigs, sheep, deer, rabbits, whales). It is not found in humans or non-mammals such as fish, birds, and reptiles. Alpha-gal syndrome is caused by a Lone Star tick bite. After an individual is bitten by a Lone Star tick, the carbohydrate alpha-gal which is present in the tick’s saliva, is transmitted into the person’s blood stream. As a result, the individual will produce IgE antibodies as a defense mechanism against this foreign sugar molecule (i.e., carbohydrate). Because the person now has alpha-gal IgE antibodies present in their blood stream, whenever that individual consumes future mammalian meat which contains alpha-gal, their alpha-gal IgE antibodies will react against the alpha-gal present in the mammalian meat (e.g., beef, pork, lamb, venison, rabbit, whale) causing allergic symptoms.

The symptoms of alpha-gal syndrome or mammalian meat allergy are typically delayed approximately 2-8 hours after the person eats the meat before manifesting. This is in contrast to a “normal” allergic reaction to a food which usually causes symptoms within 30 minutes after ingestion. The symptoms of alpha-gal syndrome can vary in severity from mild to severe and may consist of hives (i.e., urticaria), generalized itching (i.e., pruritus), swelling episodes (i.e., angioedema), runny nose, nasal congestion, wheezing, coughing, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, dizziness, drop in blood pressure, and/or anaphylaxis. Obviously, anaphylaxis is life-threatening and individuals who have a history of anaphylaxis should use an injectable epinephrine device such as an EpiPen, Auvi-Q, or Adrenaclick if anaphylactic symptoms occur. They should also go immediately to the closest emergency room if they use their injectable epinephrine device.

The diagnosis of alpha-gal syndrome is made by performing a comprehensive history and physical examination. A history of a recent tick bite makes the diagnosis more likely, but it is not crucial as not all patients may remember if they had a recent tick bite. Since there is a delay between the ingestion of meat and the onset of symptoms with alpha-gal syndrome, the condition is underdiagnosed. Physicians may not see the connection between the ingestion of the meat and the beginning of allergic symptoms because of this time delay which is not characteristic of a normal allergy. As a result, the syndrome is underdiagnosed. Note: It is therefore important to seek out a board certified allergist like the ones at Black & Kletz Allergy in order to make the correct diagnosis. It is also important to note that since the allergic symptoms of alpha-gal syndrome are very common allergy symptoms, an allergist is often needed to differentiate these symptoms from other allergic conditions that are not tick-induced. Blood tests and/or food prick testing is usually necessary to confirm the diagnosis.

The prevention of alpha-gal syndrome is the prevention of tick bites. One should avoid places where ticks live such as in grassy or wooded areas. Wear long-sleeved shirts and pants. Wear hats and gloves. Use insect repellants, especially containing DEET. Check yourself and your pets for ticks after being outdoors in the grass or woods. Taking a shower after you return from outside may remove unattached ticks. If bitten, remove the tick as soon as possible either by yourself or by a physician in an emergency room. Do not squeeze or squash the tick. Let your physician know if you have been bitten by a tick as there are other diseases that can be caused by tick bites. Some of these diseases may include Lyme disease, Rocky Mountain spotted fever, Tularemia, Babesiosis, Ehrlichiosis, Rickettsiosis, Tick-borne encephalitis, Relapsing fever, Q Fever, Anaplasmosis, and Powassan.

The treatment of alpha-gal syndrome is also simply prevention. It is important to avoid the ingestion of mammalian meat and any other products made from mammals such as gelatin or milk products. Furthermore, one should avoid getting bitten again by ticks as it is thought that subsequent Lone Star tick bites may cause more severe disease if exposure to mammalian meat occurs.

The board certified allergy specialists at Black & Kletz Allergy have been diagnosing and treating alpha-gal syndrome and food allergies in both adults and children for more many years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have 3 office locations, all of which offer on-site parking. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean 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. For an appointment, please call us at one of our locations or 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 have the expertise in alpha-gal syndrome and food allergies. Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless commitment and great pride as we have done for over 50 years.

To the average parent, there is generally no association between Halloween and allergies. For some parents however, Halloween can be a “scary” time, but not because of ghosts and goblins. These “frightened” parents are parents that have a child who has food allergies. To the parent of a food-allergic child, the association between Halloween and food allergies is not only real, but can be downright scary and concerning.

Some food allergy statistics are in order at this point in order to shed light on the seriousness of food allergies. Approximately 8% of children in the U.S have food allergies. Food allergies are increasing and have increased by more than 50% in the last few decades. About one-third of children have food allergies to more than one food. Approximately 4 in 10 food-allergic children have had a severe reaction to a food. Peanut, followed by milk are the number one and two causes of food allergies in children. Tree nuts, shellfish, fish, eggs, wheat, and soy make up the next most common food allergies in children. If you are an observant parent, you can see that 6 of the top 8 food allergies are commonly found in many Halloween candies, assuming fish tacos and crab cakes are not common on your neighborhood block. To make matters worse, it is fairly common for miniaturized Halloween candies not to contain the nutritional information and allergen labeling, which is often found on the larger full-sized versions. This makes it even more difficult for a parent to screen for food allergens that may be in each treat. It should be noted that in order to be extra safe, a parent or child should live by the motto: “when in doubt, throw it out.”

Parents of a food-allergic child who are concerned about their child trick-or-treating on Halloween can go to the website of the Food Allergy Research and Education (FARE) organization and look at their program called the “Teal Pumpkin Project.” The Teal Pumpkin Project has been around since 2014 and its main objective is to increase awareness of the severity of food allergies as well as provide support to families who have food-allergic children. In the world of food allergies, the color teal signifies food allergy awareness. People with and without food-allergic children are encouraged to paint their pumpkins teal and display them by their front doors as a sign that their house is aware of food allergies and that they have alternative non-food containing “treats” for food-allergic children. Some non-food treats may include non-food treats may include stickers, toys, money, crayons, necklaces, bracelets, rings, glow sticks, hair accessories, finger puppets, bookmarks, vampire fangs, spider rings, balls, whistles, balls, etc. The houses with the teal pumpkins may also distribute traditional candies, but they will have separate bowls for food items vs. non-food items. FARE’s website provides a detailed “Teal Pumpkin Project Participation Map” so that participating houses can be easily assessed by the parents of food-allergic children.

In addition to the above Teal Pumpkin Project, other precautions should be adhered to with food-allergic individuals. Food-allergic children should be taught to graciously refuse homemade foods such as cupcakes and cookies that may not be safe for them. Young children should not trick-or-treat without parental supervision. Candies and treats without proper nutritional and allergen labeling should not be eaten in order to prevent a life-threatening allergic reaction. It is advised that one should trick-or-treat with an epinephrine self-injectable device such as an EpiPen, Auvi-Q, or Adenaclick. If an epinephrine self-injectable device is ever used, one should go immediately to the closest emergency room.

The board certified allergists at Black & Kletz Allergy support the efforts of the Teal Pumpkin Project and hope that our patients join in their efforts in order to try to make Halloween a safer holiday. Black & Kletz Allergy has always had a link to FARE. You will find it in the upper portion of our website under the blue “Resources” tab. Please click “LINKS” and then click “Food Allergy Research and Education.” The allergy specialists at Black & Kletz Allergy see both pediatric and adult 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 have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a welcoming and relaxed environment.

Influenza Immunization:

A routine annual influenza (i.e., flu) vaccination is recommended for all individuals equal to and greater than months of age. The recommendations below should always be discussed and approved by an individual’s primary care provider before vaccination occurs.

Children:

• Children from 6 months through 8 years of age who have previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 1 dose of the 2022-2023 influenza vaccine.
• Children from 6 months through 8 years of age who have not previously received 2 or more total doses of trivalent or quadrivalent influenza vaccine 4 or more weeks apart before July 1, 2022 will need 2 doses of the 2022-23 influenza vaccine. These 2 doses should be given at least 4 weeks apart.
• Children who are 9 years old or older only need 1 dose.

Adults 65 Years of Age or Older:

• Adults 65 years or older should receive any one of the following higher dose or adjuvanted influenza vaccines: quadrivalent high-dose inactivated influenza vaccine (HD-IIV4), quadrivalent recombinant influenza vaccine (RIV4), or quadrivalent adjuvanted inactivated influenza vaccine (aIIV4).

Pregnancy:

• Influenza vaccines, except the quadrivalent live attenuated (LAIV4), can be received in any trimester of pregnancy, if approved by one’s Ob/Gyn doctor.
• The quadrivalent live attenuated vaccine (LAIV4) should not be used during pregnancy since it contains a live virus, but it can be used postpartum, if approved by one’s Ob/Gyn doctor.

Chronic Medical Conditions:

The quadrivalent live attenuated vaccine (LAIV4) should not be received in individuals with the following:

• History of severe allergic reaction (i.e., anaphylaxis) to any component of the vaccine
• Concomitant aspirin or salicylate-containing therapy in children and adolescents
• Children between the ages of 2 – 4 years of age who have received a diagnosis of asthma or if a wheezing episode has occurred during the preceding 12 months
• Children and adults who are immunocompromised due to any cause
• Close contacts and caregivers of severely immunosuppressed individuals who require a protected environment

Egg Allergy:

• Individuals who have experienced only hives after exposure to egg may receive any licensed recommended influenza vaccine appropriate for their age.
• Individuals reporting symptoms other than hives after exposure to egg , or who required epinephrine or another emergency medical intervention, may also receive any influenza vaccine that is otherwise appropriate. If a vaccine other than a quadrivalent cell-based influenza vaccine (ccIIV4) such as Flucelvax® or a quadrivalent recombinant influenza vaccine (RIV4) such as Flublok® is selected, it should be administered in an inpatient or outpatient medical setting, supervised by a health care provider who can recognize and manage severe allergic reactions.

Previous Serious Allergic Reaction:

Influenza vaccines are contraindicated for those with a history of a severe allergic reaction to any component of that vaccine.

Travelers:

Travelers who wish to reduce the risk for influenza should consider vaccination, preferably at least 2 weeks before departure.

Vaccination and Influenza Antiviral Medications:

Individuals receiving influenza antiviral medications can take influenza vaccines other than a quadrivalent live attenuated influenza vaccine (LAIV4).

With Other Vaccines:

• The quadrivalent inactivated influenza vaccine (IIV4) and the quadrivalent recombinant influenza vaccines (RIV4) may be administered concurrently or sequentially with other live or inactivated vaccines.
• Injectable vaccines given simultaneously should be administered at separate anatomic sites.
• The quadrivalent live attenuated vaccine (LAIV4) may be administered simultaneously with other inactivated or live vaccines. If not given simultaneously, then at least 4 weeks should pass between the administration of the quadrivalent live attenuated vaccine (LAIV4) and another live vaccine.

Administration of IIV4 and RIV4:

• The quadrivalent inactivated influenza vaccines (IIV4) and quadrivalent recombinant influenza vaccines (RIV4) are administered intramuscularly (IM). For adults and older children, the deltoid muscle in the arm is the preferred site. For infants and younger children, the anterolateral thigh is the preferred site.
• The quadrivalent recombinant influenza vaccine (RIV4) is licensed for individuals 18 years of age and older and should not be used for children and/or adolescents less than 18 years of age.

Administration of LAIV4:

• The quadrivalent live attenuated influenza vaccine (LAIV4) is administered intranasally using the supplied prefilled, single-use sprayer containing 0.2 ml. of vaccine.
• If the vaccine recipient sneezes immediately after administration, the dose should not be repeated.
• If nasal congestion is present which may interfere with the delivery of the vaccine to the nasopharyngeal mucosa, a deferral should be considered, or another age-appropriate vaccine should be administered.

Treatment of Influenza:

The antiviral medications that are used to treat the flu (i.e., influenza) are more efficacious when they are begun within 2 days of the beginning of symptoms. There are 4 FDA-approved antiviral drugs used in the treatment of influenza:

• oseltamivir phosphate (Trade name: Tamiflu®)
• zanamivir (Trade name: Relenza®)
• peramivir (Trade name: Rapivab®)
• baloxavir marboxil (Trade name: Xofluza®)

Oseltamivir (Tamiflu®) is available as a pill or liquid suspension and is FDA-approved for the early treatment of influenza in individuals 14 days of age and older. Zanamivir (Relenza®) is a powder that is inhaled and approved for the early treatment of influenza in individuals 7 years of age and older. Note that zanamivir is administered using an inhaler device and is not recommended for individuals with respiratory problems such as asthma or chronic obstructive pulmonary disease (COPD). Oseltamivir and zanamivir are given twice a day for 5 days. Peramivir (Rapivab®) is given once intravenously by a health care provider and is approved for the early treatment of influenza in individuals 6 months of age and older. Baloxavir (Xofluza®) is a pill given as a single dose by mouth and is approved for the early treatment of influenza in children 5 – 12 years of age who do not have any chronic medical conditions, and for all individuals 12 years of age and older.

The board certified allergists at Black & Kletz Allergy have been advising patients on the treatment and prevention of the flu (i.e., influenza) for many years in both children and adults. 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 allergy specialists of Black & Kletz Allergy are eager to help you with your allergy, asthma, immunological, and vaccination needs. We are dedicated to providing first-rate care to you as we have been doing in the Washington, DC metropolitan area for more than 50 years.

Natural rubber latex is the milky white sap that comes from the Brazilian rubber tree.  The Brazilian rubber tree is scientifically referred to as Hevea brasiliensis.  The tree is mainly found in Southeast Asia and Africa.  The sap is collected from rubber trees much in the same manner that maple syrup is extracted from maple trees.  In order to give latex its elastic characteristic, several chemicals are added to the milky sap during the manufacturing process.  The latex is then further refined into rubber for commercial use.  This natural rubber should not be confused with synthetic rubber which is made from chemicals.  Synthetic rubber products are not made with natural rubber latex and do not cause allergic reactions in individuals who are allergic to natural rubber latex.

Latex allergy is a condition in which a sensitive individual develops an immunological reaction against the allergenic proteins found in natural rubber latex.  This allergic reaction usually begins within 30 minutes, but can develop later, and can range in severity from mild to life-threatening.  Approximately 1-2% of the U.S. population has a latex allergy.  Latex allergies are much more common in certain groups of individuals such as children with spina bifida, rubber industry workers, patients who have had multiple surgeries, patients who have had recurrent catheterizations of their bladder, and health care workers.

Approximately 70% of children with spina bifida have latex allergies because they have not one but 2 risk factors for latex allergies:  multiple surgical procedures and the use rubber urinary catheters.  Both of these factors make these children more susceptible to latex allergy mainly because they come in contact with natural rubber latex more than most individuals.  Since they are exposed to latex more than the average person, they are more likely to develop an allergy to latex.

The allergic reaction that occurs in an individual due to a latex allergy can be different in each person.  The allergic reaction can be either an immediate-type (i.e., Type I) hypersensitivity reaction or a delayed-type (i.e., Type IV) hypersensitivity reaction.  In addition to a true allergic reaction, a non-allergic irritant contact dermatitis may also occur.  In an immediate-type or Type I allergic reaction, the allergic individual usually has allergy symptoms within 30 minutes after exposure to the allergen (i.e., mold, dust mite, pollen, food, bee venom).  The allergic reactions to latex usually occur after a number of exposures to latex, however, the severity of the reactions can worsen with repeated exposures.  The symptoms of an immediate-type (Type I) allergic reaction due to a latex allergy may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy eyes, watery eyes, redness of the eyes, wheezing, shortness of breath, chest tightness, coughing, generalized itching, hives (i.e., urticaria), abdominal cramping, throat tightening (i.e., angioedema), nausea, dizziness, rapid heart rate, feeling faint, and/or drop in blood pressure.  In severe cases, anaphylaxis can occur which can be life-threatening.  A self-injectable epinephrine device may be prescribed to an individual with a history of a systemic reaction to latex.  If such a device is used, they are to go immediately to the closest emergency room.

Physical contact with latex can also cause soreness and blistering of the skin which usually begins 2 to 3 days of exposure.  This type of reaction is a delayed-type (Type IV) reaction and is called allergic contact dermatitis.  It is similar to the reaction that is caused by poison ivy, poison oak, and poison sumac.  As mentioned above, a non-allergic irritant contact dermatitis may also occur.  Patients with this type of reaction may develop itchy, red, dry, flaky, peeling, and/or cracked skin after topical exposure to latex.  Blisters may also develop in certain individuals.

The diagnosis of latex allergy is made by a comprehensive history and physical examination.  Blood tests can be done to confirm a diagnosis.  Allergy skin testing can also be performed in individuals where the blood test is negative but there is a high index of suspicion for latex allergy.

The treatment of latex allergy is to avoid exposure to natural rubber latex.  Individuals should avoid all products containing latex, some of which may include: latex gloves, condoms, dental dams, balloons, rubber bands, select toys, tires, erasers, elastic clothing waistbands, nipples used on baby bottles, pacifiers, baby bottles, soles of shoes, athletic shoes, certain fruits and vegetables (see below).  Many medical and dental devices (e.g., gloves, stethoscopes, dental dams, catheters, and airway and IV tubing.  It should be noted that synthetic rubber products such as house paint are not made with natural latex.  Patients who are allergic to latex should wear a medical alert bracelet and carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) and know when to use it.  As mentioned above, if the self-injectable epinephrine device is used, the individual should go immediately to the closest emergency room.

It should also be noted that certain fruits and vegetables cross-react with latex as they share similar proteins and should be avoided in individuals who have a latex allergy.  Approximately 30-50% of people with latex allergy have reactions to these fruits and vegetables.  Some of the more common cross-reacting fruits and vegetables may include apples, avocados, bananas, chestnuts, carrots, celery, kiwi, melons, papayas, potatoes, and tomatoes.

The board certified allergists at Black and Kletz Allergy have over 50 years of experience in diagnosing and treating latex allergies.  We treat both pediatric and adult patients.  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 have been servicing the greater Washington, DC metropolitan area for many decades and we look forward to providing you with the utmost state-of-the-art allergy care in a warm and pleasant environment.

Egg allergy is second only to milk allergy in prevalence among infants and young children.  It affects about 1 to 2 % of young children overall.  It is also the most common food allergy in children with eczema.

Proteins found in egg whites are generally responsible for causing allergic reactions in egg-allergic individuals.  Although the ovalbumin is the most abundant protein in egg white, it is the protein ovomucoid that is generally responsible for egg allergy in most children.  Ovalbumin is heat labile.  The heating process denatures the protein ovalbumin and as a result of heating, the new heated protein is structurally different.  Since the heated proteins are structurally different, the majority of egg-allergic children will not react to baked egg products that have been heated during the baking process. This suggests that children who have specific IgE antibodies primarily to ovalbumin are likely to tolerate heated forms of egg.  On the other hand, the protein ovomucoid, which is also found in egg white, is not altered by extensive heating and thus is responsible for most of the egg allergies in children.

Clinical Manifestations:

• Immediate hypersensitivity (Type I or IgE antibody mediated) reactions are the most common type of allergic reaction that occurs in egg-allergic individuals. Symptoms usually begin within minutes of egg exposure.  Skin manifestations such as itching, rashes, hives, and/or soft tissue swellings are the most common symptoms.  Respiratory symptoms such as chest tightness, coughing, wheezing and/or shortness of breath can rapidly progress in severity.  Allergic reactions to eggs can also result in gastrointestinal symptoms such as abdominal pain, abdominal bloating, nausea, vomiting, and/or diarrhea.
• Egg allergy most commonly manifests itself in the second half of infancy.
• Egg allergy can be potentially life-threatening (e.g., vocal cord swelling can rapidly lead to difficulty in breathing and loss of consciousness)
• Food-dependent, exercise-induced anaphylaxis with egg as the trigger has been reported. In other words, an individual can eat an egg and then exercise within a certain period of time (i.e., usually within 2 hours) and then develop anaphylaxis as a result of the combination of egg plus exercise.  It is interesting to note that this individual may be fine just eating an egg or just exercising, but when done sequentially, anaphylaxis may occur.
• Bird-egg syndrome is a condition where the primary sensitization is to airborne bird allergens and there is secondary sensitization or cross reactivity with the protein albumin in egg yolk. These patients experience respiratory symptoms (i.e., runny nose, nasal congestion, post-nasal drip, sneezing, itchy eyes, watery eyes, puffy eyes, redness of the eyes, chest tightness, coughing, wheezing, shortness of breath) with bird exposure and allergic symptoms with egg ingestion.
• Egg allergy can present as infantile atopic dermatitis (i.e., eczema). Children with eczema and asthma are at increased risk for more severe reactions.
• Egg allergy is one of the common triggers of symptoms in certain gastrointestinal disorders such as eosinophilic esophagitis (EoE) and food protein induced enterocolitis (FPIES).

Diagnosis:

• A comprehensive history of one’s exposure to egg products (both cutaneous and oral), time of onset of specific symptoms after exposure, rapidity of progression, duration of the reaction, and resolution of symptoms are all necessary to help make the diagnosis of an egg allergy.
• Skin prick tests (SPT) with egg white and egg yolk antigens
• Laboratory tests for blood levels of specific IgE antibodies to egg
• Oral food challenge (OFC), a gold-standard for the confirmation of the diagnosis of food allergy.

Treatment:

• The most straightforward approach in managing any food allergy is the complete avoidance of the culprit food. Eliminating egg white and egg yolk from the diet can be difficult and can pose nutritional as well as quality-of-life concerns.
• The evaluation of the allergy followed by an oral food challenge to extensively heated egg is an option since a majority of those with egg allergy will tolerate egg in extensively heated (baked) products, such as a muffin.
• Oral immunotherapy (OIT) is a promising treatment method, though not yet FDA-approved.
• Epinephrine auto-injectors are prescribed for use in the case of a reaction following inadvertent exposure to egg products. Some of the more common names of epinephrine auto-injectors may include EpiPen, Auvi-Q, and Adrenaclick. It should be noted that if an individual uses their auto-injector, that person should go immediately to the closest emergency room.
• Children with egg allergy should be monitored for the resolution of the allergy since most will outgrow the allergy in childhood. Monitoring for resolution includes assessing the history of any accidental exposures and reactions and serial testing for sensitization using laboratory tests, skin prick testing, and/or oral food challenges.

Immunizations:

• Children with egg allergy should not receive yellow fever vaccinations due to an increased risk of allergic reactions since the vaccine is produced using chicken embryos.
• Egg-allergic children can safely receive the influenza and MMR (mumps, measles, rubella) vaccinations despite the use of egg-based technology since the amount of egg protein is incredibly small. It is recommended however that the vaccination be given in a doctor’s office and observed for 30 minutes after the injection.  There are also a couple of influenza vaccines that do not contain any egg protein that are available.

Prevention:

The early introduction of egg can provide protection against egg allergy for at least some children who are at high risk for developing an egg allergy.  Children at risk may need to undergo a comprehensive evaluation to see if the early introduction of eggs in the diet is appropriate.

The board certified allergy doctors at Black & Kletz Allergy have been diagnosing egg allergy and other food allergies in both adults and children in patients in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Black & Kletz Allergy has 3 offices in the Washington, DC metro area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible.  We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you think or know you have a food allergy, please call us to make an appointment at one of our conveniently located offices.  Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day.  The allergy specialists at Black & Kletz Allergy are confident that we will be able to help you identify your food allergies and any other allergy you may have.  The allergists at Black & Kletz Allergy are dedicated to providing you with the best quality allergy, asthma, and immunology care in a professional and caring environment.

Now that it is turning cold in the Washington, DC, Northern Virginia, and Maryland metropolitan area, some allergic individuals are happy because they have a respite from their pollen (e.g., trees, grasses, weeds) allergies which tend to bother them in the Spring, Summer, and/or Fall.   Others however, are not as happy, as they either continue to have their allergy symptoms or develop their allergy symptoms only in the colder weather.  These individuals are allergic to other allergens such as dust mites, molds, pets, or cockroaches, to name a few.

Dust mites, molds, pets, and cockroaches are allergens that are generally considered “indoor” allergens; however, molds are found both indoors and outdoors.  Molds are particularly a problem in the Washington, DC metro area as Washington, DC was built on a swamp and the mold counts tend to be high in the area throughout the year.  The 2 most common conditions caused by these allergens are allergic rhinitis (i.e., hay fever) and allergic conjunctivitis (i.e., eye allergies).  The classic symptoms of allergic rhinitis may include sneezing, runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, sinus congestion, sinus headaches, and/or snoring.  The typical symptoms of allergic conjunctivitis may include itchy eyes, watery eyes, puffy eyes, and/or redness of the eyes.  Another common malady that can arise from these allergens is asthma.  Asthmatics typically complain of wheezing, chest tightness, coughing, and/or shortness of breath.  Reducing one’s exposure to dust mites, molds, pets, and/or cockroaches is generally the first step in managing allergic rhinitis, allergic conjunctivitis, or asthma in most individuals.  It should be noted that exposure to cockroaches is a fairly common cause of asthma exacerbations in inner city asthmatic children.  Medications are also frequently utilized in order to better control the unwanted allergy or asthma symptoms.  Allergy immunotherapy (allergy shots, allergy injections, allergy desensitization, allergy hyposensitization) is a staple in the treatment of all 3 conditions.  Allergy immunotherapy has been around for more than 100 years and it is effective in 80-85% of individuals who take allergy shots.

There is a subset of individuals who are bothered just by the cold air and not the allergens associated with the Winter.  These patients have vasomotor rhinitis and may experience hay fever-like symptoms (i.e., runny nose, nasal, congestion, post-nasal drip) with just the exposure to cold air.  Vasomotor rhinitis is a nonallergic condition that is caused by irritants such as cold air, strong scents, chemicals, pollutants, etc.  In addition to these hay fever-like symptoms, the cold air may contribute to nose bleeds (i.e., epistaxis), watery eyes, and redness of the eyes.

The cold air does not only affect the eyes, nose and lungs when it comes to allergic and nonallergic conditions that are diagnosed and treated by board certified allergists like the ones at Black & Kletz Allergy.  The skin is affected by the cold quite often and can be extremely annoying and even serious for some individuals.  There are 4 cold-related conditions that fall under a similar category that affect the skin.   These diseases are similar, but differ mainly by their severity.  These 4 disorders include cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis.  In cold-induced pruritus, the cold air will cause an individual to have itchy skin.  A person with cold-induced urticaria will develop hives with cold exposure.  People with cold-induced angioedema will develop swelling episodes when exposed to the cold.  Lastly and most seriously, some individuals may develop life-threatening anaphylaxis when they are exposed to the cold.  It is important that a patient be prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) for patients with cold-induced angioedema and/or cold-induced anaphylaxis.  It is also important to note that any individual who needs to use a self-injectable epinephrine device should go immediately to the closest emergency room after using the device.

In addition to the 4 cold-related conditions mentioned above that affect the skin, some individuals may experience a change in the color of their skin with associated coldness, numbness, and stinging sensation.  The color change is typically a whitish or bluish color.  These individuals may have either Raynaud’s disease (i.e., primary Raynaud’s) or Raynaud’s phenomenon (i.e., secondary Raynaud’s) depending on whether there is an underlying medical problem.  Raynaud’s disease is not associated with an underlying medical disorder and is more common than Raynaud’s phenomenon, which is associated with an underlying medical condition.  The medical conditions most commonly associated with Raynaud’s phenomenon include connective tissue diseases (e.g., systemic lupus erythematosus, Sjögren’s syndrome, scleroderma, rheumatoid arthritis), smoking, injuries to the hands and/or feet, carpal tunnel syndrome, atherosclerosis, and certain medications (e.g., beta blockers, ADHD medications, migraine headache medications).

The board certified allergy doctors at Black & Kletz Allergy will promptly respond to any questions regarding cold-induced disorders and any other allergic or immunologic disorders.  We have been treating cold-indued disorders for over 50 years and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We 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 Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  If you are concerned that you may have a cold-induced condition or any other allergy, asthma, sinus, skin, or immunology problem, 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 welcoming setting.

Most of the medications used for treating diseases are chemically synthesized in a laboratory. Some newer medications, however, are derived from a variety of natural sources such as humans, animals, or microorganisms. These newer medications, often referred to as “biologicals,” are typically produced by using biotechnology and/or other cutting-edge methodologies. Biologicals represent a breakthrough advance in therapeutics as they may offer the most effective means to treat a variety of medical illnesses and conditions that presently have no other treatments available. Most allergic and immunological disorders have chronic uncontrolled inflammation as the primary underlying mechanism of the disease. This chronic inflammation often leads to organ dysfunction and the unwanted symptoms associated with such inflammation. The inflammatory process is mediated by various chemical substances such as antibodies and cytokines. The biological medications (i.e., biologicals) target these inflammatory mediators and suppress or block their actions resulting in better control of the disease.

• XOLAIR (i.e., omalizumab) was the first biological approved by the FDA for the treatment of asthma. It was initially approved for adults in 2003 and later approved for children in 2006. Xolair acts by blocking the “allergy” antibody, commonly called IgE, which acts as a mediator of many disorders of immediate hypersensitivity. Xolair is used for adult and pediatric patients who are 6 years of age and older with moderate to severe persistent asthma, whose symptoms are inadequately controlled with inhaled corticosteroids, who have a positive allergy skin test or an in vitro (i.e., in the test tube) reactivity to a perennial aeroallergen such as dust mites. It is administered by subcutaneous (SQ) injections on a regular basis (i.e., every 4 weeks). The dose and frequency of administration depend on the IgE level and the weight of the patient. The IgE level is determined by a blood test. After getting the approval for the treatment of moderate to severe persistent asthma, Xolair subsequently was also approved for the treatment of chronic idiopathic urticaria (i.e., chronic hives) in patients ≥ 12 years of age who remain symptomatic despite H1 antihistamine (e.g., Clarinex, Claritin, Allegra, Zyrtec, Xyzal, Benadryl) treatment. Xolair has helped numerous individuals suffering from chronic hives. More recently, Xolair has received an additional indication for the add-on maintenance treatment of nasal polyps in adult patients ≥ 18 years of age who have an inadequate response to nasal corticosteroids (e.g., Flonase, Nasonex, Nasacort AQ, Rhinocort AQ, Qnasl) .
• NUCALA (i.e., mepolizumab) is a biological drug that blocks a cytokine called IL-5. It was approved in 2015 as an add-on maintenance treatment for patients with severe eosinophilic asthma aged 6 years and older. The approved recommended dosage is 100 mg once every 4 weeks given as a subcutaneous (SQ) injection. Later, Nucala also was approved for:
  • Add-on maintenance treatment of chronic rhinosinusitis with nasal polyps (i.e., CRSwNP) in adult patients 18 years of age and older with an inadequate response to nasal corticosteroids
  • Treatment of adult patients with eosinophilic granulomatosis with polyangiitis (i.e., EGPA)
  • Treatment of adult and pediatric patients aged 12 years and older with hypereosinophilic syndrome (i.e., HES)
• FASENRA (i.e., benralizumab) is indicated for the add-on maintenance treatment in patients with severe eosinophilic asthma aged 12 years and older. It acts by rapidly depleting eosinophils which cause tissue damage when excessively activated and accumulated. The maintenance dose is 30 mg. injected subcutaneously (SQ) under the skin every 8 weeks.
• DUPIXENT (i.e., dupilumab) acts by blocking 2 pro-inflammatory cytokines called IL-4 and IL-13. It is administered every 2 weeks as a subcutaneous (SQ) injection under the skin.

It is used to treat:

• Adults and children 6 months of age and older with moderate to severe eczema (i.e., atopic dermatitis) that is not well controlled with prescription therapies used on the skin (i.e., topical), or who cannot use topical therapies
• With other asthma medications for the maintenance treatment of moderate to severe eosinophilic or oral steroid-dependent asthma in adults and children 6 years of age and older whose asthma is not controlled with their current asthma medications
• With other medications for the maintenance treatment of chronic rhinosinusitis with nasal polyposis (CRSwNP) in adults whose disease is not controlled
• Adults and children 12 years of age and older, who weigh at least 88 pounds (i.e., 40 kg), with eosinophilic esophagitis (EoE)
• Adults with prurigo nodularis (PN)

• TEZSPIRE (i.e., tezepelumab) is the most recent biological medication that was approved by the FDA for treatment of asthma. It is a medication that blocks the cytokine TSLP, a cytokine which plays a prominent role at the top of the inflammatory pathway. It is indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older with severe asthma. Tezspire can be used without checking for any biomarker levels such as IgE. It can also be used in most phenotypes of asthma and is not restricted to only be used in eosinophilic asthma as with some other biologicals. It is administered as an injection subcutaneously (SQ) under the skin in a single dose of 210 mg. every 4 weeks.

The board certified allergy doctors at Black & Kletz Allergy see both adult and pediatric patients and have over 50 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 have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a friendly and approachable environment.

In the U.S., dogs are the most common pets. According to the American Veterinary Medical Association, approximately 77 million pet dogs are living in the country spread around roughly 49 million homes. This means that each dog-owning household has an average of 1.5 dogs. The most common breed of dog is the Labrador Retriever. The second most common pets are cats. According to the American Veterinary Medical Association, there are about 32 million homes in the U.S. with cats comprising of approximately 59 million cats in total. Thus, the average cat-owning home has an average of 1.8 cats. The most common breed of cat is the Ragdoll. Fish, birds (e.g., parakeets, cockatiels, parrots), reptiles (e.g., lizards, turtles, snakes, geckos), rabbits, poultry (e.g., chickens, ducks, turkeys, geese), hamsters, guinea pigs, and ferrets round off the top 10 most common pets in the U.S. in that order. Overall, about 70% of homes have at least one pet. The number of pet-owning households continues to rise compared with ownership in the past.

It should also be noted that approximately 4 million households’ own horses. Horses do not normally live in people’s homes, but they still may be rather allergenic. In recent years, it has become fashionable to own miniature horses, which in some cases, do live in their owner’s home. Living with a horse in one’s house is probably not a good idea, but for those who are allergic to horses, it is especially ill-advised.

Whereas Wyoming is the top state for pet ownership at 71%, Idaho residents have the greatest number of dogs owners at approximately 59%. In contrast, Washington, DC has the least number of pet-owning households at 39%. Of note, 46% of Vermont residents have cats in their home making it the highest in the nation.

In general, a pet allergy is caused by an allergic reaction to specific proteins that are only found on the pet in question. The classic symptoms of pet allergies may include sneezing, runny nose, nasal congestion, post-nasal drip, sinus congestion, itchy nose, itchy throat, itchy eyes, watery eyes, red eyes, chest tightness, coughing, wheezing, and/or shortness of breath. The diagnosis of a pet allergy is done by taking a comprehensive history and physical examination of the patient in combination with allergy testing (i.e., blood tests, skin tests). Once the diagnosis is made, the best approach is prevention. If an individual can avoid being exposed to the pet, no other treatment is generally needed. If they must be exposed or refuse to avoid the animal, then the treatment may consist of oral antihistamines, oral, decongestants, leukotriene antagonists, nasal corticosteroids, nasal antihistamines, nasal anticholinergics, ocular antihistamines, ocular mast cell stabilizers, inhaled bronchodilators, inhaled mast cell stabilizers, and/or inhaled corticosteroids. For those who decide to live with their pet, allergy shots (allergy immunotherapy, allergy injections, allergy desensitization, allergy hyposensitization) may be indicated. Allergy injections are very effective as they work in 80-85% of individuals who take them. They have been given to patients for over 100 years and they are generally given for a period of 3-5 years.

People who are allergic to dogs usually have a reaction to the major protein called “Can f 1,” which is found on dogs. Specifically, the dander of dogs contains this major dog protein, Can f 1. It should be noted that the furry hair of a dog, which is not allergenic, may also transport other allergens (i.e., dust, pollens) to sensitive allergic individuals causing them to be exposed to more dust and pollens.  The dander of a dog can stick to an individual’s clothing, bedding, carpeting, etc., but with less affinity.  In addition to the dog’s dander, the Can f 1 protein is also found in a dog’s saliva and urine.  It is important to note that a dog allergy will cause perennial symptoms, unlike pollen allergies which generally affects individuals in certain seasons.

Individuals with cat allergies have a very similar situation to those with dog allergies, however, the major proteins responsible for the allergic reaction are named “Fel d 1” and “Fel d 4.” These proteins are found in the sebaceous glands of the skin (i.e., dander), the saliva, and the urine of cats. The dander of a cat tends to “stick” to things such as walls, bedding, carpeting, clothes, etc. Even with professional cleaning, it still takes a long time (i.e., up to several months) for the levels of cat protein to decrease to tolerable levels. Thus, removing a cat from one’s home for a few weeks is not long enough to determine if the cat is the problem. One misconception that is quite common is that there are “hypoallergenic cats.”  All cats have the capacity to induce allergic symptoms to cat-sensitive individuals. Some patients feel that they can tolerate short-haired cats better than long-haired cats, but studies do not support this theory. Brushing and bathing your cat regularly will however reduce the cat protein levels that cause allergic symptoms and of course is advisable.

Bird and rodent allergies are similar to other pet allergies except that in addition to the dander, the proteins responsible for the allergic reaction are also found in the urine, fecal, and feather particulates in birds and in the urine, saliva, and fecal droppings in rodents (e.g., hamsters, guinea pigs, mice, rats, gerbils, chinchillas). It is important to point out that in addition to allergies, both birds and rodents pose another threat to one’s health. Exposure to birds can cause more than 60 infections and diseases. Some of these may include avian flu, avian tuberculosis, psittacosis, salmonellosis, allergic alveolitis, campylobacteriosis, giardiasis, Newcastle disease, histoplasmosis, and cryptosporidiosis. Exposure to rodents (e.g., mice, rats) can cause many diseases as well such as the hantavirus pulmonary syndrome (HPS), tularemia, leptospirosis, salmonellosis, bubonic plague, rat-bite fever (RBF), Lassa fever, and lymphocytic choriomeningitis.

Allergies to reptiles are not common.  There have been reports of allergies to snakes, and of course there is always the possibility of an allergic reaction to the venom of certain snakes. There have also been reported cases of allergies to various reptiles, particularly iguanas. In addition to the typical allergy symptoms that occur with other pets, there seems to be more skin irritation with reptiles than with other pets.

Horse allergies are not that uncommon.  Individuals that are allergic to horses typically have similar symptoms as people with cat and/or dog allergies. The dander is the most common way in which horses cause allergic symptoms in humans.  The horse’s saliva, urine, and the fecal material dropped by horse mites are other ways that people are exposed to the allergenic proteins of horses. There is an increased incidence of horse allergy in some individuals that have cat and/or dog allergies due to a common protein that is shared between all 3 animals.

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating pet allergies in both adults and children in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. Black & Kletz Allergy has 3 offices in the Washington, DC metropolitan area with locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our offices have on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. We offer a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. If you suffer from a pet allergy or are not sure if you do, please call us to and make an appointment at one of our conveniently located offices. Alternatively, you may click Request an Appointment and we will respond within 24 hours by the next business day. The allergy specialists at Black & Kletz Allergy are confident that we will be able to help you with your furry friends.

Many fruits and vegetables contain substances called lipid transfer proteins (LPT’s). They are usually present in the skin and seeds of these foods. Lipid transfer proteins are also found in various nuts and some cereals. In the plant, the purpose of the lipid transfer proteins is to move the lipid molecules so the plants develop and maintain their internal and external structures.

Individuals can become sensitized to the lipid transfer proteins. As a result, people can have allergic reactions to them when exposed in the foods we consume. When this occurs, it is called lipid transfer protein allergy. When an individual is allergic to many foods containing lipid transfer proteins, it can be said that that person has lipid transfer protein syndrome.  The most common plant foods triggering these reactions include apples, grapes, peanuts, almonds, hazelnuts, walnuts, tomatoes, and dried fruit. Other foods that may also cause symptoms may include mustard seeds, sunflower seeds, chestnut, peaches, strawberry, kiwi, orange, tangerine, pear, banana, lemon, apricot, plum, raspberry, pomegranate, cherry, barley, lettuce, cabbage, corn, mulberry, asparagus, green beans, pea, celery, wheat, durum wheat, lentils, and lupin. Other foods that are known to contain lipid transfer proteins include broccoli, onion, beetroot, parsley, eggplant, parsnip, butter beans, fennel, millet, goji berry, quinces, grapefruit, blueberry, and figs.

Lipid transfer proteins are resistant to heat and to the acid in our digestive tract. This heat and acid resistance make it so that individuals can react to even well-cooked, dried, raw, and/or canned foods. For example, if someone is sensitized to the lipid transfer proteins in a grape, that person should avoid all grape-containing foods such as grape juice, wine, and raisins.

This condition is more common in adults as well as people living in Mediterranean countries. In fact, lipid transfer protein allergy is the most frequent cause of food allergy in southern Europe. It is however interesting to note that lipid transfer protein allergy has been increasingly recognized in other parts of the world.

SYMPTOMS: The symptoms of lipid transfer protein allergy usually begin within 10 to 30 minutes after eating the offending food. The symptoms may include the following:

• Itching of the mouth and/or throat
• Runny nose
• Nasal congestion
• Sneezing
• Abdominal pain
• Nausea and/or vomiting
• Skin rashes
• Swelling of the lips, tongue, and/or throat (i.e., angioedema)
• Wheezing
• Shortness of breath
• Drop in blood pressure
• Dizziness/Lightheadedness
• Anaphylaxis

Some contributing factors of an allergic reaction due to eating a suspected food with lipid transfer proteins may include physical exertion, alcohol consumption, and certain medications . These factors also may delay the onset of the allergic symptoms where the allergic reaction begins after the typical 10 to 30 minute window. Exercise, alcohol, and NSAID’s can also increase the severity of the allergic reaction. There are even cases where someone can eat a plant-based food that contains lipid transfer proteins and has no allergic reaction but when combined with exercise, alcohol consumption, and/or NSAID exposure, that individual may experience an allergic reaction.

DIAGNOSIS: The diagnosis of this condition involves a comprehensive history and physical examination. Special emphasis should be targeted towards getting a detailed record of the patient’s food intake. Maintaining food and symptom diaries are extremely useful in helping to establish the diagnosis. The food and symptom diaries should be supplemented with allergy skin prick testing with suspected food antigens and/or laboratory evaluation when needed.

DIFFERENTIAL DIAGNOSIS: The differential diagnosis includes other food-induced allergic reactions such as pollen-food allergy syndrome (i.e., oral allergy syndrome) and food-dependent exercise-induced urticaria/anaphylaxis (FDEIA).

TREATMENT: Once the diagnosis is confirmed, avoidance of all forms of the plant food including raw, cooked, and processed forms of the food is essential in order to minimize the risk of severe reactions.

Individuals diagnosed with lipid transfer protein allergy will also be prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick) which is to be used in the case of a systemic reaction following an inadvertent exposure to the offending food. It should be stressed that if an individual uses a self-injectable epinephrine device, that person should go immediately to the closest emergency room.

The board certified allergy specialists at Black & Kletz Allergy will promptly respond to any questions you may have regarding food allergies or any other allergic or immunologic disorder. Black & Kletz Allergy has been treating food allergies for many years and we 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 pediatric and adult patients. All 3 offices at Black & Kletz Allergy offer on-site parking and 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. If you are concerned that you may have a food allergy or sensitivity or any other allergic or immunologic condition such as allergic rhinitis (i.e., hay fever), asthma, sinus disease, medication allergies, flying insect allergies, or hives (i.e., urticaria), please call us to schedule an appointment. You may also click Request an Appointment and we will respond within 24 hours by the next business day. At Black & Kletz Allergy, we strive to improve the quality of life in allergic individuals using state-of-the-art medicine in a professional and compassionate setting.

Nearly all children get infected with respiratory syncytial virus (RSV), a highly contagious virus, by their second birthday. RSV has a seasonal predilection, usually from December to March every year. In most instances, it causes mild “cold-like” symptoms and resolves without complications in approximately 1-2 weeks.

Although most cases get better and resolve on their own, respiratory syncytial virus can sometimes lead to severe illness requiring visits to the emergency room. In some cases, hospitalization may be required. The incidence of severe illness due to RSV is especially high during the Winters in the U.S. Surging RSV infections in conjunction with the rise in flu and COVID-19 infections has been termed the “tripledemic.”

RSV is especially severe in very young children and adults over 65 years of age. Predisposing factors to severe RSV infections may also include underlying chronic lung and/or heart conditions as well as having a compromised immune system.

Respiratory syncytial virus is the most common cause of bronchiolitis (i.e., inflammation of the small airways in the lungs) in children younger than 1 year of age. RSV causes approximately 60,000 hospitalizations among children under the age of 5 annually. RSV infection is estimated to cause approximately 15,000 annual deaths in the U.S. in adults over the age of 65. Respiratory syncytial virus is the leading cause of lower respiratory tract infection in children and is a common cause of wheezing in infants and young children. Studies suggest that a severe RSV infection early in childhood is linked to development of asthma later in life.

The infection of respiratory syncytial virus spreads from person to person primarily by contact with respiratory secretions and to a lesser extent by aerosol and droplets. RSV can survive for many hours on hard surfaces such as tables and door handles and lives on soft surfaces such as tissues and hands for shorter amounts of time.

Symptoms: The symptoms of respiratory syncytial virus usually begin 2 to 3 days after contact with the virus. The initial symptoms usually include nasal congestion and runny nose with clear mucus secretions, an itchy throat and a dry cough. Children can also experience mild fevers, poor appetite, and reduced physical activity.

For babies, thick mucus can clog up the nose and small air passages in the lungs, making it difficult for them to breathe. Narrowed bronchial tubes may also cause wheezing in addition to a severe cough. Respiratory distress requires hospitalization where supplemental oxygen and inhaled medications can be administered.

Older adults, especially those with asthma, chronic obstructive pulmonary disease (COPD), heart diseases, and/or diabetes mellitus can develop pneumonia from an RSV infection. The virus can also aggravate their underlying lung conditions requiring emergency treatment.

Diagnosis: The diagnosis of RSV is suspected by clinical presentation and can be confirmed by laboratory tests using a nasal mucus swab. Imaging of the lungs may also be needed in order to evaluate the severity of the condition.

Treatment: The treatment of respiratory syncytial virus is only supportive care in most instances as there is no specific medication available. For young children, nasal saline with gentle suctioning and a cool-mist humidifier may help with their breathing.

In severe cases, intravenous (IV) fluids may need to be given in order to treat dehydration. Oxygen supplementation may be needed to relieve any breathing difficulty.

A medication known as Synagis (palivizumab) is sometimes prescribed in order to minimize or prevent serious RSV disease among high-risk infants and children less than 2 years of age. This drug does not improve symptoms for children already suffering from RSV, nor does it prevent infection with RSV.

Prevention: People infected with RSV are usually contagious for 3 to 8 days and may become contagious 1 to 2 days before they begin showing signs of the illness.

One of the most effective ways to prevent an RSV infection is to practice good hand hygiene. Frequent hand washing, covering sneezes and coughs, and avoiding direct contact with unclean surfaces are very helpful in minimizing the spread of respiratory syncytial virus.

Effective vaccines and therapeutics to prevent and treat RSV infections are in active development. The research into developing an RSV vaccine began in the 1960’s and this year (2023) RSV vaccines should be on the market. The pharmaceutical companies Pfizer, GSK, and Moderna have been working on such a vaccine and are all close to the final product. Pfizer and GSK announced promising Phase III results in 2022 and they are now both awaiting regulatory approval for the vaccine.

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 have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a friendly and relaxed environment.