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As we enter into the ragweed season, some of us with seasonal allergies may experience a flare-up of symptoms.

Ragweed is one of the several weeds that pollinate in late Summer and the early Fall.  Seventeen different species of ragweed grow in the United States.  Common ragweed grows up to five feet tall.  It has hairy stems and light green leaves, up to four inches long.  Ragweed grows in fields, gardens, and along roadsides.  It is an annual plant, which means it only lives for one season.

Ragweed flowers are yellowish-green in color and small in size.  They grow in clusters of up to six inches long near the top of the plant.  Ragweed flowers produce large amounts of pollen. The pollen is transferred from one plant to another by the wind as well as insects.

Ragweed allergy occurs when an individual’s immune system produces a forceful response to a foreign substance (i.e., ragweed pollen) that is actually harmless in most circumstances.  As a result, the individual experiences hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthmasymptoms (see below).

Certain cells of the body begin releasing antibodies to proteins in the ragweed pollen.  This results in the production of several chemicals (e.g., histamine) that cause these allergy symptoms.  Some individuals with ragweed allergy may also get local itching of the mouth and throat areas when they eat fresh melons, bananas, kiwi, cucumbers, zucchini, and/or avocados.  This condition is called oral allergy syndrome, which is also known as pollen-food allergy syndrome.

Each ragweed plant can release approximately one billion grains of ragweed pollen in one ragweed season.  The grains are so light that the wind easily carries them into the air where individuals inhale the grains.  The result is that these individuals may become sensitized and allergic to the ragweed pollen.  The pollen travels very far by the wind and pollen has been detected hundreds of miles away.  Some studies suggest that rising temperatures and carbon dioxide (CO2) levels are extending the ragweed season.  In Northern Virginia and Washington, DC, ragweed begins to pollinate in mid-August, peaks after the Labor Day weekend in September, and lasts until the end of October when the first frost ultimately kills the plant.

What are the Symptoms?

The allergic reaction to all plants that produce pollen is commonly known as hay fever (allergic rhinitis).  Symptoms can include itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, runny nose, stuffy nose, post-nasal drip, itchy throat, and sneezing.  In those with severe allergies, asthma symptoms (i.e., wheezing, shortness of breath, cough, chest tightness), sinusitis, headaches, fatigue, and impaired sleep may also occur.

What Methods of Prevention are Recommended?

A few simple suggestions can dramatically diminish one’s exposure to pollen:

• It is preferable to stay inside when the pollen counts are at their highest.  In the Washington, DC area, this is in the mid-morning and the mid-afternoon.  One can track the pollen count in our area by clicking Today’s Pollen Count at the top of our website.
• After being outdoors, change your clothes after returning indoors and take a shower to remove the pollen.  Do not hang clothes outdoors to dry, as the pollen will collect on them.  Use a clothes dryer instead.
• Keep the windows closed in your car and home.   Turn on the air conditioner.  Make sure to change the air filters every 1-2 months.
• Shower before bed to remove pollen, especially from your face and hair.
• Use HEPA air filters in your home.

Diagnosing and Treating Ragweed Allergies: When avoidance and prevention do not work, try over-the-counter medications.  If symptoms continue, or complications arise, it may be time to seek the advice of a physician.  The board certified allergists at Black & Kletz Allergy treat both adults and children with ragweed allergies and have done so for more than fifty years.  A thorough history and physical examination will be performed and allergy skin testing and/or allergy blood testing can be done in order to diagnose your condition.  Once a diagnosis of ragweed allergy is established, there are a multitude of medications available by prescription that can be tried in order to help alleviate your symptoms.  These medications come in the form of pills, capsules, syrups, powders, nasal sprays, eye drops, and inhalers.  Allergy shots (allergy immunotherapy, allergy injections) are an extremely effective means to treat not only ragweed allergy, but allergies (i.e., allergic rhinitis, allergic conjunctivitis, allergic asthma) in general.  They work in approximately 80-85% of individuals, but take about 4-6 months before they are effective for most individuals.  They have been around for over 100 years and can be given in children, adults, pregnant women, and the elderly with great success.

Black and Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, Virginia (Tysons Corner, Virginia), and Manassas, Virginia.  The Washington, DC and McLean, VA offices are Metro accessible and all 3 locations offer on-site parking.  The allergists and staff at Black and Kletz Allergy will gladly answer any of your questions or concerns. We strive to offer individualized treatment plans in order to alleviate your unwanted allergy symptoms in a caring and professional setting.

Outdoor activities in the summer can result in skin irritation and itching due to a variety of causes.

The board certified allergists and trained staff at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area can answer your questions and concerns regarding many skin conditions and will provide time tested and scientifically validated advice.  Our allergists specialize in both adult and pediatric patients.  We have 3 convenient office locations which all offer on-site parking.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are also Metro accessible.  Please click Request an Appointment and we will answer you within 24 hours on the next business day.  For faster service, please call our office directly.  Black & Kletz Allergy prides itself in providing prompt quality care to the community in a caring professional setting.

There are many cause of a cough.  Coughing is usually caused by a viral upper respiratory infection (URI), asthma, post-nasal drip, and/or gastroesophageal reflux disease (GERD).  There are however many other conditions which may cause a cough, some of which include other infectious types of upper respiratory infections (i.e., bacterial, fungal, parasitic), occult sinus infection, vocal cord dysfunction, cystic fibrosis, laryngopharyngeal reflux, pneumonia, bronchitis, bronchiectasis, pertussis (whooping cough), croup, foreign body (which can get stuck in one’s airways), pulmonary embolism, neurogenic cough, post-infectious cough, hypersensitivity pneumonitis, sarcoidosis, psychogenic cough (due to a habit or tic), Tourette’s Syndrome, aspiration, cigarette smoking, chronic obstructive pulmonary disease (COPD) (i.e., chronic bronchitis, and/or emphysema), interstitial lung disease, tumors, congestive heart failure, exposure to air pollutants, and the side effects of certain medications such as angiotensin-converting enzyme inhibitors .

So can allergies play a role in causing a cough?  Yes.  Since asthma is a leading cause of cough and about 80% of individuals with asthma also have allergies, one can see right away that allergies play a large role in causing a cough.  In addition, there is a sub-group of asthmatics who have a condition called cough-variant asthma where sufferers only cough as a result of their asthma.  They do not have the accompanying wheezing, shortness of breath or chest tightness that most other asthmatics experience.  As if this wasn’t bad enough, it is estimated that 75-80% of asthmatics have gastroesophageal reflux disease (GERD), which is also one of the most common causes of a cough.  Allergies also play a major role in predisposing a person to develop a sinus infection (sinusitis) which again often causes a cough.  Immunodeficiency disorders (which are diagnosed and treated by allergists/immunologists) such as hypogammaglobulinemia also predispose people with these disorders to acute sinus infections.  Hypersensitivity pneumonitis is a condition where there is an inflammation of the air sacs (alveoli) of the lungs caused by an allergic reaction to inhaled antigens such as dusts, molds, and chemicals.  Individuals with this condition commonly have certain hobbies and/or occupations that expose them to these antigens.  Once again, cough is a primary symptom of this disease.

In individuals with a persistent cough, many tests can be done in order to diagnose the reason behind the cough.  Some of these tests include blood work, chest X-rays, CT scans of the chest and/or sinuses, allergy testing, pulmonary function tests (PFT’s; breathing tests), rhinoscopy, upper endoscopy (with or without biopsy), esophageal manometry (assesses the function of the lower esophageal sphincter and esophagus), barium swallow, pH monitoring (measures the acidity in the stomach), and bronchoscopy (with or without lung biopsy).  In most cases, the workup usually does not require the last six tests listed above which are generally reserved for difficult cases.  After diagnosing the problem, there are a variety of medications that can be used to treat an individual’s cough.

The board certified allergists at Black & Kletz Allergy have been diagnosing the underlying conditions of coughs and treating individuals with coughs for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We treat both adult and pediatric patients and have 3 convenient locations in the DC metro area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA) and Manassas, VA, each with on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible.  Black and Kletz Allergy is committed to providing excellent allergy, asthma, and immunology care to the greater Washington, DC and Northern Virginia community.

Allergic Fungal Sinusitis (AFS) is a chronic inflammatory condition involving the nose and sinuses caused by an allergic sensitivity to environmental fungi.  It is usually seen in people with normal immune systems as opposed to invasive fungal infections which usually affect people with compromised immune systems caused by conditions which may include diabetes mellitus, certain cancers, HIV infection, and patients receiving chemotherapy or radiation treatment.  It is similar to a condition that affects the lung called Allergic Bronchopulmonary Aspergillosis (ABPA).

Many patients with AFS are atopic, meaning they have a tendency to develop allergic sensitization when exposed to common harmless substances like pollens, dust mites, cats, dogs, and certain foods.  About two-thirds of patients with AFS also have allergic rhinitis and up to half of them also have allergic asthma.  AFS is most commonly seen in young adults with an average age of 22 years.

CAUSE:

When an atopic person breathes in air containing the fungus, it triggers an allergic inflammation of the mucus lining inside the nostrils and sinuses resulting in swelling of the tissues.  This swelling leads to blockage of the sinus drainage pathways causing the mucus secretions (mucin) to accumulate within the sinus cavities.  This, in turn, creates an ideal environment for further reproduction of the fungus.  The sinuses are eventually filled with a viscous and tenacious fungal mucin which has the consistency and appearance of peanut butter.

SYMPTOMS:

In advanced stages, facial disfigurement and vision disturbances may also be encountered due to extension of the disease to the surrounding areas.

DIAGNOSIS:

TREATMENT:

A comprehensive management plan incorporating medical, surgical, and immunologic care remains the most likely means of providing long-term disease control for allergic fungal sinusitis (AFS).

The board certified allergists at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area have been treating sinus disease for more than 5 decades.  We have expertise in recognizing and managing individuals with allergic fungal sinusitis.  Black & Kletz Allergy has 3 convenient locations in the Washington, DC area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location.  In addition, the Washington, DC and McLean, VA offices are accessible by the Metro.  If you suffer from any of the above symptoms, please contact one of our offices to make an appointment.  Alternatively, you can click Request an Appointment and we will contact you within 24 hours of the next business day.  We strive to serve the community in a professional, friendly, and caring manner.

There is a surprising connection between asthma and acid reflux.  Anywhere from 75-80% of asthmatics suffer from acid reflux.  Acid reflux is also known by the name of gastroesophageal reflux disease (GERD).   Acid reflux is a condition where the acidic stomach contents travel in the wrong direction and enter the esophagus (swallowing tube).  This causes a variety of symptoms of which the main one is heartburn.  People with acid reflux commonly feel a burning sensation in the chest and/or throat.  They often complain of a bitter or sour taste in their mouth.  Other symptoms can include wheezing, coughing, belching, abdominal bloating, sore throat, nausea, and/or the feeling that something is stuck in one’s throat.  It is the wheezing and coughing symptoms that cam mimic asthma or in fact be triggered in an asthmatic who has acid reflux or GERD.

Acid reflux occurs because the lower esophageal sphincter, a muscle at the lower part of the esophagus near the entrance to the stomach, becomes too relaxed.  This allows the stomach acid to go backwards into the esophagus which can cause damage to the esophagus and cause a burning sensation, commonly referred to as heartburn.  In addition to causing heartburn, it also can aggravate a person’s asthma in a couple of different manners.  The first way this occurs is a result of small amounts of this acid irritating the airways (like a chemical burn) which can trigger asthma symptoms.  The second way may involve triggering a reflex in the airways to become narrower in order to prevent more acid from entering the airways.  It is this narrowing of the airways which causes an asthmatic to wheeze, cough, and/or feel short of breath.  In addition, some asthma medications can decrease the lower esophageal sphincter pressure thereby relaxing this muscle which subsequently will increase the severity of acid reflux.  Asthma medications in the bronchodilator family such as Albuterol (i.e., Proventil, Ventolin, ProAir, AccuNeb), Levalbuterol (Xopenex), Terbutaline, (i.e., Brethine, Brethaire), Salmeterol (Serevent), Formoterol, (Foradil), Vilanterol, Ipatroprium (Atrovent), and Tiotropium (Spiriva) fall into this category.  There are also asthma medications that are combinations of two medications, one of which is a bronchodilator, which can therefore increase acid reflux disease.  The names of some of these medications include Advair, Symbicort, Dulera, Breo Ellipta, Combivent, and DuoNeb.  Theophylline (i.e., Theo-Dur, Uniphyl, Theo-24, Slo-Bid), an older but still useful oral bronchodilator asthma medication, has also been linked with increasing acid reflux in individuals by causing the relaxation of the lower esophageal sphincter as well.  Interestingly, the chemical structure of Theophylline is similar to caffeine which is another trigger of acid reflux.

The cause of acid reflux disease is a failure of the lower esophageal sphincter to function properly.  There are several risk factors that can contribute to acid reflux disease and some of them include:

• Hiatal hernia – the protrusion of part of the stomach through the diaphragm (a muscle separating the abdomen from the chest) into the chest
• Obesity
• Pregnancy
• Use of certain medications (i.e., bronchodilators, calcium channel blockers, aspirin, prednisone)
• Alcohol use
• Smoking
• Certain foods – caffeine, fatty foods, garlic, onions, spicy foods, and acidic foods (i.e., tomatoes, soda, citrus fruits)
• Diabetes
• Eating before bed
• Eating large meals
• Certain connective tissue disorders – Scleroderma or systemic sclerosis

The diagnosis can be made with a combination of a good history from the individual along with observing relief when prescribed medications to control reflux such as antacids and/or acid-blocking medications.  If there is no improvement in symptoms of acid reflux, there are several procedures that can be performed to help diagnose acid reflux disease.  Some of these procedures include upper endoscopy with or without biopsy, barium swallow, esophageal manometry (checks the function of the lower esophageal sphincter and esophagus), and pH monitoring (checks the acidity in the stomach).

The treatment of acid reflux disease is aimed at minimizing the risk factors mentioned above in addition to prescribing antacids and acid-blocking medications.  By treating the underlying acid reflux disease in the asthmatics that have this condition, the symptoms of asthma (i.e., wheezing, coughing, shortness of breath, and chest tightness) may also be diminished)

The board certified allergists at Black & Kletz Allergy recognize the association between asthma and acid reflux (GERD) and we treat our asthmatics accordingly after a thorough history and physical examination.  Black & Kletz Allergy has 3 offices and has been serving the Washington, DC, Northern, Virginia, and Maryland metropolitan area for more than 50 years.  We have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have parking at each location and the Washington, DC and McLean, VA (Tysons Corner, VA) offices are Metro accessible.  If you have asthma, think you have asthma, or have symptoms of wheezing, coughing, shortness of breath, and/or chest tightness, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.

Many people think that they are “allergic” to penicillin, when they may not really be truly allergic.

Penicillin is a very effective and relatively inexpensive antibiotic, used in the treatment of many bacterial infections.  About 1 in 10, 000 people who receive penicillin may have a true allergic reaction, where the immune system considers the antibiotic as a harmful foreign agent and mounts a defensive attack.  The chemical mediators that are released during this process can cause itchy rashes, hives, and/or swelling of the tissues.  In rare cases, life threatening reactions can occur in which difficulty in breathing (i.e., wheezing, shortness of breath), cardiovascular manifestations (i.e., drop in blood pressure, shock) and other serious organ system damage can ensue.

However, two recent studies proved that most people who consider themselves allergic to penicillin can safely receive penicillin.  In one study, 94 percent of 384 people who believed they were allergic to penicillin tested negative for penicillin allergy.  In the second study, penicillin skin testing was performed on 38 people who believed they were allergic to the antibiotic, and all of them tested negative.

Most people with a presumptive history of sensitivity to penicillin are given alternate antibiotics to treat infections.  In some instances, the replacement antibiotic may not be as effective as the preferred penicillin and in addition, the substitute antibiotic is also more expensive.  Such use may also result in some bacteria developing resistance to antibiotics, harming the community at large.  Hence it is important to distinguish between false and true allergy to penicillin and related antibiotics.

A standardized skin testing procedure can differentiate people who are likely to adversely react to penicillin from those who can safely tolerate it.  It involves injecting small amounts of chemical determinants (reagents) of penicillin sensitivity into the layers of the skin, with appropriate positive and negative controls.  A positive test manifests as an itchy, red, raised bump after 15 minutes and confirms true allergy to penicillin and the need to permanently avoid penicillin and related antibiotics.

If the skin test is negative, a related drug, amoxicillin is given by mouth at a standard dose and the person is monitored in a board certified allergist’s office for 1 to 2 hours for any adverse reactions.  If the oral dose is also tolerated, he/she can safely receive penicillin and related antibiotics to treat infections in the future.

The board certified allergists at Black & Kletz Allergy can administer the penicillin skin testing and oral challenge, if needed, and can offer recommendations for appropriate antibiotic use based on the test results.  Please call any of our 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with questions or concerns related to antibiotic or other medication allergies.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have been serving this area for more than 50 years.  There is parking at each one of our 3 office locations.  In addition, the Washington, DC and McLean, VA offices are also accessible by the Metro.  If you have wondered if your “penicillin allergy” was correct, please call us today or click Request an Appointment and we will contact you within 24 hours of the next business day.  We would be happy to test you for a penicillin allergy, so that you can clarify if you are truly allergic to penicillin.

In the Washington, DC, Northern Virginia, and Maryland metropolitan area (DMV area), grass begins to pollinate in late-April to early-May, peak in late-May or early-June, and end in August.  In addition to the grass pollen during this time period, molds spore counts are also highly elevated which further complicates one’s allergies.  There is also an overlapping with tree pollens in the early Spring, meaning that all three allergens (trees, grasses, and molds) are in the environment at the same time during some periods in the Spring.

The most common types of grasses include Timothy, Sweet vernal, Bermuda, Rye, Kentucky blue, Orchard, Meadow fescue, Red top, Bahia, and Johnson.  Grass pollens, unlike other environmental allergens, are very similar in their microscopic appearance.  This fact is the reason why an individual who is sensitized with one type of grass may have allergy and/or asthma symptoms when exposed to many other types of grasses.  The one major exception to this rule is Bermuda grass, which does not cross react with many other grasses.

As with the other allergens that cause hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthma, it is the wind disbursement of the grass pollen into the air that sensitizes individuals.  Since the grass pollen is very light in weight, the wind causes the pollen to be carried in the air where people inhale the pollen and have direct contact with the pollen and their eyes.  It is this interaction that causes some people to develop allergies to the grass pollen which in turn causes the classic symptoms of hay fever, allergic conjunctivitis, and/or asthma. These symptoms may include some or all of the following:  sneezing, itchy nose, runny nose, nasal congestion, post-nasal drip, sore throat, hoarseness, itchy eyes, watery eyes, puffy eyes, sinus congestion, sinus pain, wheezing, coughing, shortness of breath, and/or fatigue.

Grasses tend to pollinate more the longer they grow.  Therefore, keeping one’s lawn mowed reduces the grass pollen that enters the air.  It is the tall grasses found in empty lots and by the sides of the roads, etc. that is the primary cause of the high grass pollen counts found in the Spring in the Washington, DC area.  Warm, windy, and dry days tend to increase the grass pollen counts.  The grass pollen counts also tend to be the highest in the early mornings.

There are preventive measures that should be practiced by all grass allergy sufferers and include the following:

The board certified allergists at Black & Kletz Allergy have been diagnosing and treating grass pollen allergies in children and adults in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than half a century.  If you experience any of the above symptoms in the late Spring and Summer, you may suffer from grass allergies.  It is important for a board certified allergist to perform a detailed history and physical examination.  Allergy testing can be performed via the skin or blood to determine if one has an allergy to grass or other environmental allergen such as trees, molds, etc.  Treatment begins with prevention.  It may not be possible to completely avoid exposure to grass pollen, however, certain preventive measures can still help alleviate some of the suffering.  There a wide array of medications that can be tried which may include tablets, capsules, syrups, powders, nasal sprays, eye drops, and/or asthma inhalers.  Allergy immunotherapy (also referred to as allergy shots or allergy desensitization) is a very effective means to treat grass and other environmental allergies.  It is effective in about 80-85% of patients.  They have been around for over 100 years.  They can be given to almost anyone, including children and pregnant women.

If you would like to be seen at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA, please call us to make an appointment.  Alternatively, you can click Request an Appointment and we will get back to you within 24 hours by the next business day.  We have parking at each office location and we are Metro accessible at our Washington, DC and McLean, VA locations.  Black & Kletz Allergy provides a friendly and caring environment for you to get the top quality allergy, asthma, and immunology treatment that we have been providing the community for more than 50 years and that you deserve.

Over the past decade, more people are interested in gluten-free diets in order to get relief from a variety of symptoms.  It is therefore important to know a little about the differences between celiac disease, gluten sensitivity, and true wheat allergy.

CELIAC DISEASE (CELIAC SPRUE; NONTROPICAL SPRUE; GLUTEN ENTEROPATHY):

Gluten is a protein normally present in wheat, rye, and barley.  Gluten is what gives dough its elasticity, ability to rise, and contributes to the dough’s chewiness.  It is found mainly in foods, but may also be found in everyday products such as medicines, hair products, vitamins, cosmetics, lipsticks and lip balms, and other dermatologic preparations.  Gluten is found in so many unexpected foods as additives and can be found in unsuspecting foods such as beer, ketchup, ice cream, soy sauce, processed lunch meats, to name a few.  Celiac disease is a hereditary (runs in families) autoimmune disorder of the small intestine found in all age groups (infancy through adulthood) that occurs in approximately as many as 3 million Americans.  It occurs when people with celiac disease eat gluten.   Their body’s immune system reacts to the gluten by attacking the lining of their small intestine.  The immune system’s reaction to gluten damages small, fingerlike growths called villi.  When the villi are damaged, the body cannot get the nutrients it needs.

Symptoms of celiac disease can include:

• Abdominal pain/cramping
• Flatulence/bloating
• Diarrhea/constipation
• Extreme tiredness/fatigue
• Change in mood/depression/irritability
• Weight loss/decreased appetite
• Joint pains
• Iron deficiency anemia
• Osteoporosis due to decreased absorption of calcium
• Very itchy skin rash with blisters (Dermatitis herpetiformis)
• Delayed growth in children

The diagnosis is suspected when blood tests detect elevated levels of certain antibodies to gluten.  An upper endoscopy is needed to confirm the diagnosis, as one needs a biopsy that shows the abnormal villi of the small intestine.

The only treatment for celiac disease at this time is avoidance of gluten in diet.  When it is no longer exposed to gluten, the villi of the small intestine heal and can absorb nutrients again.

NON-CELIAC GLUTEN SENSITIVITY (NCGS) (GLUTEN SENSITIVITY; GLUTEN INTOLERANCE):

“Non-celiac gluten sensitivity” (NCGS) is used to describe individuals who cannot tolerate gluten as they experience the same symptoms as those with celiac disease.   The main difference is that individuals with NCGS do not have the gluten antibodies in the blood and there is no villi damage in the small intestine as is seen in celiac disease.  Research suggests that non-celiac gluten sensitivity is an innate immune response (nonspecific first line of defense), as opposed to an adaptive immune response (or “learned” response such as an autoimmune reaction) or allergic reaction.  As many as 18 million Americans may have NCGS.

People with NCGS can also have other symptoms such as headache, “foggy” feeling in the head, lack of concentration, and numbness in the legs, arms, and/ or fingers.  Symptoms typically appear hours or days after gluten has been ingested, a response typical for innate immune conditions.

New research shows that it is possible that gluten may not even be responsible for the symptoms produced by NCGS.  FODMAP’s (fermentable oligo-, di-, and monosaccharides and polyols), a group of poorly digested carbohydrates, may be the cause of the symptoms instead.  It is also interesting to note that wheat, rye and barley – the 3 grains that contain gluten – are all high in FODMAP’s.  Even though wheat, rye, and barley contain high amounts of FODMAP carbohydrates, many other foods such as peaches, apples, beets, garlic, onion, asparagus, kidney beans, soybeans, milk, ice cream, and many sweeteners (fructose, mannitol, agave, sorbitol, etc.) also contain high amounts of FODMAP’s.

There are currently no confirmatory tests for NCGS and the diagnosis is by ruling out other conditions that may cause similar symptoms.  As stated above, blood tests and biopsies that are positive with celiac disease are normal in these individuals.  Improvement of one’s symptoms when gluten is removed from the diet makes NCGS more likely.  However, there is a risk of self-diagnosis and starting oneself on a gluten-free diet.   The risk is that there may be a serious gastrointestinal and/or other disorder that will be missed without the proper work-up.  It is therefore important for individuals with these symptoms to see their physicians so that serious disorders can be ruled out by using proper testing to exclude them.  Assuming there is no other disorder, a gluten-free diet and a FODMAP-free diet may be beneficial.

WHEAT ALLERGY:

One or more of the wheat proteins, albumin, globulin, gliadin, or gluten, can cause an allergic reaction involving IgE antibodies.  The reactions usually take place within a few minutes to several hours after exposure to the allergen.  The symptoms may include some or all of the following:  itching in the mouth, swelling of lips and/or tongue, hives, eczema, runny or stuffy nose, itchy or watery eyes, tightening of the throat and/or trouble breathing, wheezing, drop in blood pressure, vomiting, diarrhea, abdominal cramps, abdominal pain, and/or anaphylaxis.

A thorough medical history and physical examination in conjunction with skin prick tests and/or allergen-specific IgE blood testing are useful in the diagnosis of wheat allergy.  A food challenge may be necessary in some individuals.  For wheat allergy, strict avoidance of wheat and wheat products is necessary.

Although classic IgE-mediated allergic reactions are most common with wheat, non-IgE-mediated reactions to wheat may occur, usually with a slower onset of symptoms and these symptoms are generally confined to the gastrointestinal tract.

The board certified allergists at Black & Kletz Allergy can provide answers to your questions and offer evidence based diagnostic and treatment options.  We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for many years.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Each of our 3 convenient office locations has on-site parking and the Washington, DC and McLean, VA locations are easily accessible by the Metro.  Black & Kletz Allergy has been diagnosing and treating wheat and other food allergies for over 50 years.  We also have the expertise to help diagnose and treat many gastrointestinal diseases associated with allergies and autoimmune disorders as well as rule out food allergies as a source of your gastrointestinal problems.  Please call our office for an appointment if you have any of the above symptoms or alternatively, you can click Request an Appointment and we will be in touch with you within 24 hours of the next business day.

Black & Kletz Allergy provides expert allergy and clinical immunology services from an allergy doctor Vienna VA residents have long trusted as the board certified allergists have more than 50 years of experience.

Our allergy doctor Vienna VA inhabitants trust is a specially trained physician with expertise in the treatment of allergic and immunological diseases. After successfully completing internship and residency training in either pediatrics or internal medicine, our allergy doctor Vienna VA residents desire underwent further training for 2 to 3 years in an accredited allergy and immunology fellowship training program. During training, our allergy doctor Vienna VA residents trust learned to diagnose and treat various disorders affecting the immune system.

The disorders affecting the immune system may include allergic sensitivity to environmental allergens (e.g., dust mites, molds, pollens, pets, cockroaches), foods, medications, insect sting venoms, etc. Environmental allergies usually affect the respiratory system causing conditions such as allergic rhinitis (hay fever), allergic conjunctivitis, and asthma.

The most common allergens affecting the respiratory system are aeroallergens that are inhaled such as the aforementioned dust mites and their droppings, mold spores, pollens (e.g., trees, grasses, weeds), animal dander, and cockroaches. The allergy doctor Vienna VA inhabitants respect is trained in identifying the specific allergens that cause allergic rhinitis, allergic conjunctivitis, and asthma. Our allergist is able to identify the specific allergies by performing diagnostic allergy tests such as skin tests and/or blood tests. The allergy doctor Vienna VA residents trust then provides detailed information to the patient about the various ways of avoiding exposure to these specific substances by way of environmental controls. The symptoms of respiratory allergies may include nasal congestion, runny nose, post-nasal drip, itchy nose, itchy throat, itchy eyes, watery eyes, redness of the eyes, puffy eyes, sneezing, facial pressure, headaches, sinus pain, sinus congestion, throat irritation, coughing, wheezing, chest tightness and/or shortness of breath. The allergy doctor Vienna VA inhabitants have confidence in will prescribe medications in order to relieve these symptoms. Our allergist will also explain the medications to the patient as well as their potential side effects. In addition, our allergy doctor Vienna VA residents respect may offer a desensitization treatment (i.e., allergy shots, allergy injections, allergy immunotherapy, allergy hyposensitization) protocol, which will build up tolerance to these allergens and help prevent future allergy and/or asthma symptoms. This process is especially useful when the environmental controls are not feasible and/or when medications are not helping enough or causing undesirable side effects. The allergy doctor Vienna VA inhabitants admire will give detailed information to the patient about allergy shots including possible benefits and risks from the procedure. It should be noted that allergy shots are efficacious in about 80-85% of patients receiving them. Allergy shots have also been given to allergy sufferers for more than 100 years and are generally taken for 3-5 years.

Food allergens may cause generalized itching (i.e., pruritus), hives (i.e., urticarial), swelling (i.e., angioedema) and rarely life-threatening allergic reactions (i.e., anaphylaxis). The most common foods that cause allergic reactions in children and adults include peanuts, tree nuts, wheat, milk, eggs, soy, fish, and shellfish. The allergy doctor Vienna VA residents trust will perform diagnostic tests in order to identify the specific food allergens that a person is sensitized to and the allergist will then educate the patient in methods of avoidance. Our allergy doctor Vienna VA inhabitants respect will also prescribe an epinephrine self-injectable device such as an EpiPen, Auvi-Q, or Adrenaclick for use by the patient or parent in case of inadvertent exposure resulting in a systemic reaction.

Insect venom allergies affect thousands of patients annually in the U.S. They can cause life-threatening allergic reactions after stings by honey bee, yellow jacket, yellow faced hornets, white faced hornets, wasps, and fire ants. Our Allergy doctor Vienna VA residents trust performs allergy skin tests in order to detect one’s sensitivity to insect venoms. Our allergist may offer desensitization injections (i.e., allergy shots) to individuals with positive skin tests along with a convincing history of a systemic reaction in order to reduce the risks of a life-threatening reaction after such a sting.

The board certified allergy doctors at Black & Kletz Allergy have been treating patients for allergies, asthma, and immunologic conditions for over many years and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have been serving the Washington, DC, Northern Virginia, and Maryland metropolitan area for over 5 decades and treat both adult and pediatric patients. All 3 offices at Black & Kletz Allergy offer on-site parking and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call one of our offices 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 compassionate setting.

Asthma is chronic inflammatory condition of the airways of the lungs.  Asthma can affect both allergic and non-allergic individuals.   There is an increased risk of developing asthma if there is a family history of asthma or allergies.  Most people that have asthma also have allergic rhinitis (hay fever).  On the other hand, about half of the individuals that have allergic rhinitis also have asthma.  About 8% of the U.S. population has asthma.  Asthma is the most common chronic condition in children.  Asthma prevalence has been increasing over the last few decades.  The average child with asthma misses between 4 to 5 days of school per year due to asthma.  The average adult with asthma misses about 5 days of work per year due to asthma.  The annual cost on the U.S. healthcare system just due to asthma is about $20 billion.  There is an additional $10 billion per year added to the healthcare system just due to allergies alone.  The statistics above are staggering and people with allergies and asthma need to realize how prevalent their diseases are and that allergists (who specialize in treating allergies and asthma) can help reduce their suffering and help reduce unnecessary emergency room visits and admissions to the hospital, which greatly increase the costs of these diseases.

As we are in the Spring season, many individuals with allergic asthma may begin to experience a worsening of their asthma.  The symptoms that one experiences typically can be any or all of the following:  wheezing, shortness of breath, chest tightness, and/or cough.

Asthma can be life-threatening and it is imperative that one is taught about the symptoms and what should be done depending on the severity of one’s symptoms.

It is important that the asthmatic individual understand their triggers and to try to avoid the offending trigger.  In the Spring, tree pollens, grass pollens, and molds are largely responsible for causing asthma exacerbations.  It is thus important for individuals with asthma to practice pollen avoidance measures which include the following recommendations:

The board certified allergists at Black & Kletz Allergy have the expertise in diagnosing and treating asthma in adults and children.  We have been treating the people of the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  It is important that the allergist take a thorough history and examination from the individual as not everyone that has “asthma symptoms” ends up having asthma.  There is an important saying in medicine which states that “All that wheezes is not asthma.”  This means that there are many other medical conditions that can present with wheezing that are not asthma.  Some of these medical conditions include heart disease, COPD (emphysema and/or chronic bronchitis), GERD (acid reflux), etc.  Once diagnosed, there are a multitude of treatment options to control one’s asthma.  The allergists and staff at Black & Kletz Allergy are diligent in educating the patient with asthma on what to look for and how to assess their severity of disease at any given time.  An asthma plan is discussed with individuals and inhaler technique is demonstrated to the patients.  Research shows that patients notoriously use their inhalers incorrectly unless they are shown the correct method.  Medications used to treat asthma can include several types and classes of lung inhalers, tablets, capsules, syrups, granules, and Xolair (omalizumab) injections in select patients.  Allergy shots (i.e., allergy immunotherapy, allergy injections) are a very effective way to treat asthma and have been used very successfully for more than 100 years.  The allergists at Black & Kletz Allergy also make themselves available 24 hours a day/ 7 days a week for any questions or concerns that you might have regarding your allergies and/or asthma.

If you would like a consultation for your asthma symptoms, please call us at Black & Kletz Allergy to make an appointment.  Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day.  We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA) and Manassas, VA.  There is parking at each location and the Washington, DC and McLean, VA locations are also accessible by using the Metro.  We would be happy to assist you in diagnosing your asthma symptoms and helping you manage your asthma so that you can participate in the things you enjoy without the constant fear of your asthma symptoms.

The vexing question about what to do about the alarming increase in peanut and other food allergies may have been finally answered.  The prevalence of peanut allergy tripled in the U.S. in the past decade while also rising in Africa and Asia.  It affects more than 1% of the U.S. population and is the leading cause of anaphylaxis and death from food allergy.  The American Academy of Pediatrics recommended in the year 2000, that parents refrain from feeding peanuts to children until 3 years of age hoping to reverse the trend.  However in 2008, after reviewing the published literature, the American Academy of Pediatrics retracted its recommendation, stating that there was insufficient evidence to call for early food avoidance.  Last month, (February of 2015), at the annual conference of the American Academy of Allergy, Asthma, and Immunology, the results of a landmark prospective, randomized controlled study addressing this issue were revealed and simultaneously published in the New England Journal of Medicine online.  The data strongly suggested that feeding peanut products regularly to infants with eczema, egg allergy, and a family history of food allergies from 6 months of age dramatically reduces the risk of peanut allergy, compared to children who avoided exposure to peanuts.  The differences in the two controlled groups were so stark that the guidelines are likely to be revised soon to promote early introduction of peanut products into the diets of at-risk children.

Prick skin testing with peanut extract and a blood test to measure antibodies to peanut protein are routinely employed in detecting allergic sensitivity to peanuts.  The recent availability of tests to measure antibodies to specific components of peanut proteins increased the predictability of adverse reactions on exposure to peanuts in sensitized children and adults.  These tests are also helping physicians to identify the appropriate patients and the clinical situations for in-office oral challenges with peanut products, which is the gold standard in the accurate diagnosis of peanut allergy.

In the past decade, a number of small, largely uncontrolled clinical trials have suggested that oral immunotherapy (giving children with peanut allergies increasing doses of peanut flour or peanut extract by mouth over time) can effectively desensitize many children with peanut allergy.  Although peanut oral immunotherapy shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice.  Until more data is available, strict peanut avoidance is the current standard of care.

The board certified allergists/immunologists at Black & Kletz Allergy are can answer your questions and address your concerns regarding peanut allergies or any other type of allergy.  We have been serving the Washington, DC, Northern Virginia, Maryland metropolitan area for over 50 years and offer 3 convenient locations with parking.  Our office locations are in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Our Washington, DC and McLean, VA are accessible by the Metro.  Please call us at one of our locations to schedule an appointment or you can Request an Appointment online on our website and we will respond within 24 hours by the next business day.

With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.

Some vaccines like the MMR (measles, mumps, and rubella), influenza, yellow fever, and certain rabies vaccines are grown in chicken embryo cultures and may contain small amounts of egg protein in them, raising concerns about potential adverse reactions in children and adults with egg allergies.

Other vaccines contain small amounts of gelatin which can cause adverse reactions in patients allergic to gelatin.  Some of these vaccines include MMR, influenza, varicella, DTaP (diphtheria, tetanus, and acellular pertussis), yellow fever, rabies, shingles (herpes zoster), and Japanese encephalitis.

Below are the most current recommendations as of February 2015:

The board certified allergists of Black & Kletz Allergy have over 50 years of experience in addressing the vaccination needs of people with food allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area based on the latest evidence-based clinical guidelines.  If you need to consult us on vaccinations, please make a appointment at one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA) or Manassas, VA.

Dr. Michael R. Kletz has done clinical research on the topic of the administration of egg-derived vaccines in patients with a history of egg sensitivity.  Please click his research article that was published in the Annals of Allergy in the following link: http://www.ncbi.nlm.nih.gov/pubmed/2346238

In the winter, everyone seems to either have had a “cold” or knows someone who has a “cold.”  When people refer to a “cold,” they are actually referring to some sort of respiratory tract infection.  To understand a respiratory tract infection, one must first know the parts of the body that make up the respiratory tract.  The respiratory tract can be broken down into two parts:  the upper respiratory tract and the lower respiratory tract.

The upper respiratory tract is located outside of the chest and is made up of the following:

The lower respiratory tract is located in the chest and is made up of the following:

Infections of each site above can occur and each has a corresponding name associated with the location.  Infections of such areas are usually named by putting the suffix “itis” (which means “inflammation of”) at the end of the anatomical location. The names of the infections of each location are listed below:

The cause of most respiratory tract infections is viruses.  There are over 200 known viruses that cause these infections.  In addition to viruses, a bacteria, fungus, or parasite can also be the cause of a respiratory tract infection. Most of the viruses that cause respiratory tract infections are the following:  rhinovirus, adenovirus, influenza virus (the “flu”), parainfluenza virus, enterovirus, coronavirus, and respiratory syncytial virus (RSV).

The symptoms of a respiratory infection range in type and severity depending upon the duration, and the virulence of the virus, bacteria, fungus, or parasite.  It also depends if the individual has any pre-existing risk factors or medical illnesses such as diabetes, immunodeficiency, elderly, underlying lung disease (asthma, COPD or chronic obstructive pulmonary disease, cystic fibrosis, etc.), smoking, allergies, congestive heart failure, crowded living conditions (i.e., dormitories, nursing homes, hospitals), exposure to others with a “cold” or flu, and/or lack of vaccination .  Common symptoms include:

The diagnosis involves taking a detailed history followed by a careful physical examination.  Laboratory studies may include blood work, throat culture, chest X-ray, and CT scan of the sinuses.

Prevention of respiratory tract infections can never be 100%, but there are some common sense things that should be done in order to minimize contracting and passing on the infection.  One should avoid contact with other sick individuals, wash one’s hands frequently, stay home from school and/or work if one develops symptoms, get vaccinations for influenza ( flu) annually, if appropriate for that individual, get the Pneumovax 23 and/or Prevnar 13 vaccination (pneumonia shots) if elderly or immunocompromised, consult your physician within 48 hours for known exposure to the flu so that an antiviral medication such as Tamiflu can be prescribed within 48 hours of the beginning of flu symptoms.  Note that there are rapid diagnostic tests which entail a quick painless nasal swab to diagnose the flu. The result of the test is back within 15 minutes. It can be done in order to determine if you have the flu.  Keep in mind that the tests are between 50-70% accurate, but can help the physician in the diagnosis.

Treatment may range anywhere from supportive care such as drinking plenty of fluids, rest, gargling with salt water, and over the counter medications, to treatment with antibiotics, antiviral medication, corticosteroids, bronchodilator medications, intravenous therapy, oxygen administration, and very rarely a surgical procedure may be necessary. The vast majority of upper respiratory infections will resolve on their own, since most of them are of viral origin.

The board certified allergists of Black & Kletz Allergy have been treating respiratory tract infections in the Washington, DC Northern Virginia, and Maryland metropolitan area for over 5 decades.  If you are experiencing any of the above symptoms, please contact us for an appointment at any one of our 3 convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), or Manassas, VA.  You can also click Request an Appointment and we will answer you within 24 hours of the next business day to schedule you an appointment. We strive to provide excellent care to our patients in a friendly, comfortable, and professional setting.