People in the Washington, DC, Northern Virginia, and Maryland metropolitan area as well as in the Northeast are experiencing record warm temperatures this Winter. This warm weather seems to have confused the trees into releasing their pollen much earlier this year than in previous normal years. In February of this year, tree pollen counts hit “high” levels a few times, when normally they are at the most a “low” level by the end of February. In addition to Washington, DC, the tree pollen counts has been much higher than normal this February in the following Northern Virginia cities: Tysons Corner, VA, Vienna, VA, McLean, VA, Great Falls, VA, Arlington, VA, Fairfax, VA, Falls Church, VA, Alexandria, VA, Annandale, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Bristow, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Haymarket, VA, Gainesville, VA, Warrenton, VA, Springfield, VA, Ashburn, VA, Dumfries, VA, Culpeper, VA, Leesburg, VA, and Purcellville, VA. In Maryland, the tree pollen counts have also been “high” this February in the following cities: Potomac, MD, North Potomac, MD, Rockville, MD, Gaithersburg, MD, Germantown, MD, Olney, MD, Darnestown, MD, Bethesda, MD, North Bethesda, MD, Chevy Chase, MD, Great Falls, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Temple Hills, MD, Columbia, MD, Annapolis, MD, and Baltimore, MD.
Tree pollen usually begins to pollinate in late February and generally stops pollinating in May, however this year, tree pollen was seen in January. Along with tree pollen comes misery for millions of allergic individuals who are sensitive to tree pollen. The symptoms that allergic individuals typically experience may include sneezing, runny nose, nasal congestion, itchy nose, post-nasal drip, itchy throat, sinus congestion, sinus headaches, itchy eyes, puffy eyes, watery eyes, fatigue, snoring, and/or asthma (e.g., wheezing, shortness of breath, chest tightness, coughing). Many people with hay fever (i.e., allergic rhinitis) are more prone to developing sinus infections (i.e., sinusitis) as well.
In order to try to ward off allergy and asthma symptoms at the beginning of the season, several things can be done by the allergy sufferer before the symptoms begin or certainly before the symptoms get bad. Some of these things that can be done in order to help prevent allergy symptoms include:
If doing yardwork or exercising outdoors, wash and change your clothes and take a shower after come inside.
If you must do yardwork, wear a mask, preferably a respirator mask with a HEPA filter.
Keep the windows and/or sunroof closed in your cars.
Wash your pet if he/she has been outdoors for a prolonged period of time as the fur/hair collects pollen.
If you need to do outdoor activities, try to do them in the late afternoon or after it rains, when the pollen levels are lower. Pollen counts are higher in the mornings.
Watch the pollen count. You can check it daily on our website. Click Today’s Pollen Count.
If you need to go outdoors, try to avoid going out in hot, windy, dry days as the pollen counts tend to be higher on these days.
Make sure you clean and/or change your filters in both your home and car.
Make sure the setting on your car’s air conditioning system is set on recycle in order to avoid fresh air from the outside from entering your vehicle.
Begin your allergy medications at the beginning of the season or even a few days before the season begins, only if suggested by your allergist.
If you are on allergy shots (I.e., allergy immunotherapy, allergy injections, allergy desensitization), increase the frequency of the injections at the start of the season and continue that increased frequency throughout the season.
The board certified allergists at Black & Kletz Allergy have been diagnosing and treating allergic rhinitis and asthma in both adults and children for more than 50 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 doctors at Black & Kletz Allergy have the expertise in order to take outstanding care of your allergy, asthma, sinus, skin-related disorders, and immunological needs. Our goal is to serve the greater Washington, DC metro community with first-rate allergy care with boundless dedication and great pride as we have done for many years.
About 220 million doses of vaccines are distributed in the United States each year. Mild swelling and redness at the site of the injections and fever lasting for 1 to 2 days are very common reactions after vaccinations. These adverse reactions do not preclude receiving future doses of the vaccines. Rarely, however, sensitivity to a vaccine constituent may cause a lump at the injection site several hours after its administration, and this is also not a contraindication to subsequent vaccination. In cases of severe adverse reactions, on the other hand, it is prudent to avoid further vaccination with that particular vaccine. In these cases, a board certified allergist may measure the levels of IgG antibodies to the immunizing agent(s) to detect whether the individual has the sufficient amount of protective antibody levels. Depending on the levels, the allergist can help determine whether further doses are needed. If needed, the allergy doctor will discuss the risks of re-vaccination and may desensitize the individual to a particular vaccine, if the ability exists for that immunizing agent.
In cases of an anaphylactic reaction (a severe life-threating reaction involving multiple organ systems) to a vaccine, further evaluation should be undertaken by an allergist in an attempt to identify the culprit allergen. These types of reactions are more often caused by additives (e.g., preservatives) or residual vaccine components, such as gelatin, rather than the microbial immunizing agent itself.
Patients who experience an apparent anaphylactic reaction should undergo immediate-type allergy skin testing to confirm that the reactions were mediated by an IgE antibody and to determine the responsible component of the vaccine. If the skin tests are negative, the chance that the patient has IgE antibodies to any vaccine component are negligible, and the vaccine can usually be administered under physician supervision with epinephrine and other medications readily available. If the skin tests are positive and suggestive of an IgE-mediated reaction, consideration may be given to administer all future doses in a graded fashion under close physician monitoring.
Pregnant women should not receive live vaccines. They can however be given inactivated influenza (i.e., “the flu”), tetanus, and hepatitis B vaccines, if approved by their Obstetrician. Live vaccines should also not be given to persons with immune system defects and/or function because of a risk of it resulting in a generalized infection with that immunizing agent or vaccine.
Certain vaccinations (e.g., MMR) and/or the preservatives used in some vaccines (e.g., thimerosal) have been purported to have long-term consequences such as autism. Other vaccines (e.g., hepatitis B, influenza, tetanus) have been alleged to cause or aggravate multiple sclerosis. Epidemiological studies have not supported such associations at this time, so it is probably safe to say that it is very unlikely that the MMR vaccine or thimerosal causes autism. Likewise it is also fair to say that at this time in is very unlikely that the hepatitis B vaccine causes multiple sclerosis or that the hepatitis B, influenza, and/or tetanus vaccines worsen a patient’s multiple sclerosis. It is however very important to discuss such apprehensions with your physician before receiving a vaccination, as you are your best advocate.
Individuals with a history of a suspected egg allergy should be evaluated by an allergist to determine the status of their egg allergy. Most people, even with confirmed egg allergy, should receive influenza vaccinations because the risks of vaccinating are generally outweighed by the risks of not vaccinating. Skin testing with the influenza vaccine is no longer recommended in people with a history of an allergic reaction to eggs.
Patients with egg allergy with a history of only hives after egg ingestion can receive the influenza vaccine in a primary care provider’s office provided the appropriate personnel and equipment are available, whereas those with a history of more severe reactions to egg ingestion should receive their vaccine in an allergist’s office.
In patients with a history of an allergic reaction to the influenza vaccine itself, additional evaluation is appropriate including skin testing with the vaccine and vaccine ingredients. For patients with positive skin test results, the vaccine can either be administered in multiple divided doses (i.e., desensitization) or it can be withheld.
The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area. We welcome any and all questions regarding vaccines including their possible benefits and the potential untoward reactions. Black & Kletz Allergy diagnose and treat both adults and children and have had more than 50 years of experience dealing with the subject of vaccinations. We test, administer, and desensitize patients to many kinds of vaccinations depending upon the type of vaccination and their need to receive the inoculation. Black & Kletz Allergy has 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 and we offer a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line. Please call us to make an appointment for any of your allergy, asthma, and immunology needs or alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day. The allergy doctors at Black & Kletz Allergy are happy to assist you by providing high quality allergy care in a professional and friendly environment.
Most people are aware of many of the typical allergies that a lot of individuals suffer from, but did you know that there are many unusual allergies that are kind of common? Some of the classic allergies or allergic conditions that most people have heard about include hay fever (i.e., allergic rhinitis), food allergies, medication allergies, insect sting allergies, asthma, hives (i.e., urticaria), and eczema. There are however some unfamiliar allergies that exist that one may want to be aware of, as they are not uncommon.
Allergy to Vibration
The medical term for this allergy is vibratory urticaria. Individuals with this condition develop hives on the skin where they have been exposed to vibration or repetitive stimulation. Individuals who work with jackhammers may develop hives on their hands. People who mow the lawn may get hives on their hands or if they use a riding lawn mower, they may also develop hives on any part of their body that vibrates. Hand clapping and drying oneself with a towel are also common causes. The hives may be accompanied by itching, swelling, and/or local redness. They generally occur within 10 minutes after stimulation of the skin and typically last less than 2 hours, although more severe reactions are known to occur. Treatment is based on prevention, antihistamines, and other medications.
Allergy to Kissing
This actually is usually due to the person being allergic to a medication, cosmetic, and/or specific food such as peanuts, tree nuts, fish, and shellfish, although any food can cause this condition. There are reported cases of allergic individuals that have kissed another person who had recently eaten a food that the allergic individual was allergic to resulting in an allergic reaction in the allergic individual. The allergic reaction can be mild (e.g., itchy lips, itchy mouth, rash on lips, rash in mouth), moderate, or severe (e.g., hives, wheezing, shortness of breath, throat swelling, anaphylaxis), which can be life-threatening. In fact, there have been fatalities documented. Understanding what allergies you have is the first step to preventing this type of unwanted allergic reaction.
Allergy to the Sun
Often referred to as solar urticaria, this condition and is characterized by itching, burning, and hives in sun-exposed areas of the body. In some individuals, they can occur on parts of the body that are covered by thin light clothing. The symptoms usually occur within a half-hour of sun exposure and usually lasts for a few hours after there is no more sun exposure. The disorder can occur from natural sunlight or artificial lighting. Treatment generally involves avoiding sunlight, antihistamines, Xolair (i.e., omalizumab) injections, and/or UV light treatments.
Allergy to Money
This may sound made up, but it is not uncommon for some individuals to develop rashes on their hands which usually begins about 24-48 hours after handling coins. The rashes can consist of blisters, redness, and/or dry skin and be accompanied by itching. The nickel in the coins is usually the culprit and nickel allergy is a fairly common cause of this contact dermatitis. People who handle money often such as cashiers and bank tellers, as well as jewelers (i.e., jewelry often contains traces of nickel) are more prone to this condition. People with this condition may also be bothered when they eat foods that are high in nickel (i.e., cocoa, soybeans, kidney beans, cashews, spinach). In addition to avoiding nickel, the treatment may include antihistamines, moisturizing creams, corticosteroid creams, and oral corticosteroids.
Allergy to Exercise
If you don’t feel like exercising, you may have a legitimate reason why. Exercise may cause many symptoms that are found in other allergic conditions. Exercise in some individuals may be a trigger and cause that individual to wheeze, become short of breath, develop chest tightness, and/or cough. This is often referred to exercise-induced asthma. In others, exercise may trigger generalized itching (i.e., pruritus), hives, swelling (i.e., angioedema), and/or anaphylaxis. These symptoms generally occur within minutes of completion of an exercise routine, but can occur during exercise itself. The symptoms generally subside within 3 hours. In a more unusual and rare condition, there is a condition where an individual will develop any of the above symptoms if they eat a certain food within 2 hours of exercising. These individuals can exercise without problems and they can eat that certain food without problems, but if they consume that food and exercise within 2 hours, the allergy or asthma symptoms occur. The foods most commonly associated with this condition include celery, shellfish, wheat, nuts, legumes, and seeds, although any food can trigger this condition referred to as “food-dependent exercise-induced” asthma, pruritus, urticarial, angioedema, and/or anaphylaxis.
The board certified allergists at Black & Kletz Allergy have treated numerous patients with all of the above conditions in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years. We treat both adults and children and we have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All 3 offices of Black & Kletz Allergy have 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 would like to be seen for hay fever, asthma, hives, swelling episodes, generalized itching, eczema, insect sting allergies, food allergies, medication allergies, or any other allergy or immunologic condition, please call us to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours of the next business day. Black & Kletz Allergy is proud to continue to provide high quality allergy and asthma care to the Washington, DC metropolitan area.
Latex is a milky sap produced by the rubber trees. It is combined with several chemicals in the manufacturing process to give latex its elastic characteristic.
Where is it found?
Natural rubber latex is used to make many common consumer products including balloons, toys, tires, elastic clothing waistbands, erasers, rubber bands, baby bottles, nipples used on baby bottles, pacifiers, athletic shoes, soles of shoes, condoms, etc. It is also utilized in the manufacturing of many medical and dental devices such as gloves, dental dams, airway and IV tubing, stethoscopes, and catheters. Synthetic rubber products (e.g., house paint) are not made with natural latex.
What causes allergies?
The immune system sees the protein in latex as a foreign invader. To help protect us from foreign aggressors, the immune system mounts a defensive attack against the allergenic proteins found in natural rubber latex by making antibodies (i.e., immunoglobulins) to fight it. When we are exposed to latex products, these antibodies attack the proteins in the latex, releasing chemical mediators into the bloodstream (e.g., histamine, leukotrienes) which are responsible for the symptoms during allergic reactions.
Who is at risk?
Health care workers and others who wear latex gloves. Natural rubber proteins can attach to the cornstarch powder used in latex gloves and can become airborne and cause reactions through inhalation.
People who have had multiple surgeries, such as children with spinal defects.
Anaphylaxis, a severe life-threatening reaction manifested by a multiple organ system allergic reaction which may include a drop in blood pressure, breathing difficulty, generalized itching, hives, swelling, and/or abdominal cramping, as well as other symptoms.
The above symptoms usually begin within a few minutes after latex exposure and are categorized as an immediate hypersensitivity reaction. The reactions usually occur only after a number of exposures, but the severity of reactions can worsen with repeated exposures.
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 called allergic contact dermatitis. It is similar to the reaction that is caused by poison ivy, poison oak, and poison sumac, which is referred to as a delayed-type hypersensitivity reaction.
Are foods a problem?
People who are sensitive to latex can also adversely react to certain fruits and vegetables such as apples, avocados, bananas, chestnuts, carrots, celery, kiwi, melons, papayas, potatoes, and tomatoes due to the sharing of similar proteins (i.e., cross-reactivity).
How is the condition diagnosed?
When the history is suggestive of a latex allergy, a blood test can be done to confirm the diagnosis. Furthermore, allergy skin testing can also be done in individuals who have a negative blood test but the index of suspicion for a latex allergy is high.
What treatments are available?
As one cannot be desensitized to latex, avoidance of latex exposure (both contact and inhalation) is the only way to protect individuals from untoward reactions.
Health care workers should wear synthetic and non-powdered gloves which do not contain natural rubber products.
Patients with a history of previous reactions should be exposed only to non-latex medical products and devices and operated upon only in non-latex environments.
The latex-allergic individual should wear a medical alert bracelet, so that people are aware of their allergy.
The latex-allergic person should always carry an EpiPen, Auvi-Q, and/or Adrenaclick self-injectable device for emergency treatment and know to then go immediately to the closest emergency room.
The board certified allergy specialists at Black & Kletz Allergy have 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area and are very experienced in the diagnosis and treatment of latex allergies. Black & Kletz Allergy treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to make an appointment or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, metropolitan area for more than 50 years and we pride ourselves in providing excellent allergy and asthma care in a professional and pleasant setting.
Now that it is Winter and the temperatures are cold, one may think that they do not have anything to worry about when it comes to allergies and asthma in the Washington, DC metropolitan area like in the cities of McLean, VA (Tysons Corner, VA), and Manassas, VA. Unfortunately, this is not true, as the cold weather can mimic allergies in many individuals and produce the same symptoms that occur in allergic people. In addition, during the Winter, there are many allergens that still exist (i.e., dust mites, molds, pet dander and saliva, cockroaches, rodents) which cause allergic and asthmatic symptoms in susceptible individuals. Furthermore, there are a lot of viruses that are prevalent in the Winter that can also cause symptoms that can be confused with allergies. These viruses are also responsible for upper respiratory tract infections (URI’s) that are known to exacerbate asthma in many asthmatics.
It is well known that cold air can cause a runny nose and watery eyes. The runny nose is a result of the vascular constriction caused by the cold air. Non-allergic individuals that have these symptoms may think they have allergies. Allergic individuals that have these symptoms may truly be having these symptoms because of the vascular constriction or because they are at increased exposure to allergens found during the Winters such as dust mites, molds, pet dander and saliva, cockroaches, and rodents. Cold air is also a very well know trigger in many asthmatics and in these patients can cause wheezing, shortness of breath, chest tightness, and/or coughing. Exercising in the cold air is another important trigger for many asthmatics.
During the Winters in the Washington, DC, Northern Virginia, and Maryland metropolitan area, it is common for people to contract a multitude of viruses that cause upper respiratory tract infections. The most common viruses that are responsible for URI’s include the rhinovirus, influenza virus (i.e., flu), parainfluenza virus, coronavirus, respiratory syncytial virus (i.e., RSV), picornavirus, adenovirus, coxsackievirus, and echovirus. URI’s cause many symptoms that are the same as allergic rhinitis symptoms such as nasal congestion, runny nose, sneezing, sinus headaches, clogged ears, cough, and fatigue. In addition, URI’s are known to exacerbate asthma in many asthmatics.
Three other conditions that the cold can cause that can be misconstrued as an allergy include hives (i.e., urticaria), swelling episodes (i.e., angioedema), and generalized itching (i.e., pruritus). These skin conditions can be caused by exposure to cold air or cold water. There a many factors that can cause hives, swelling episodes, and/or itching; some of which include medication allergies, food allergies, certain infectious diseases, autoimmune disorders, and thyroid abnormalities. In the Winter in the Washington, DC metro area, one must also think of the cold weather as a cause of these skin conditions.
The board certified allergists at Black & Kletz Allergy have more than 50 years of experience in diagnosing and treating allergies, asthma, hives, swelling episodes, generalized itching, URI’s (including sinus infections and bronchitis) in both adults and children. Whether they are caused by the cold or caused by other factors, Black & Kletz Allergy has the experience and expertise in treating these conditions. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at all locations. The Washington, DC and McLean, VA offices are Metro accessible and we provide a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy is proud to provide high quality allergy care to the Washington, DC, Northern Virginia, and Maryland metropolitan area residents in a friendly and professional setting.
The onset of winter in the Washington, DC, Northern Virginia, and Maryland metropolitan area brings with it an increase in the frequency of respiratory infections. In comparison to individuals without an underlying long-term health condition, people with a history of allergies, asthma, diabetes, as well as individuals with suppressed immune systems are more susceptible to respiratory tract infections.
Some common respiratory infections during the Winter include:
Sinus infections (acute rhinosinusitis):
According to Centers for Disease Control and Prevention, about 1 in 8 adults are diagnosed with sinus infections yearly, resulting in more than 30 million diagnoses in the U.S. More than 90% of these cases are viral. Antibiotics are not guaranteed to be of any benefit, even when they are caused by bacteria.
Bacterial cause is more likely when the symptoms are:
Severe, such as fever of more than 102°F and discolored nasal secretions or facial pain lasting for more than 3 to 4 days.
Persistent nasal discharge or daytime cough lasting longer than 10 days.
Worsening fever, cough, or nasal discharge after initial improvement of a viral upper respiratory infection lasting for 5 to 6 days.
Sinus X-rays and CT scans are not routinely recommended.
Management:
Watchful waiting is appropriate for uncomplicated cases.
Amoxicillin or Augmentin is the preferred first-line antibiotic choice.
The macrolide class of antibiotics [(e.g., azithromycin (Z-Pak)] is not recommended as up to 40% of the bacteria causing sinus infections are not sensitive to them.
For patients are who are allergic to penicillin, doxycycline or the quinolone class of antibiotics are suitable alternatives.
Bronchitis:
Inflammation of the lining of the bronchial tubes that carry air in and out of the lungs causes a cough lasting several days or weeks.
Fever of more than 102°F, rapid heart-beat, rapid breathing, and abnormal lung examination findings may suggest pneumonia.
Discolored sputum does not always indicate bacterial infection.
Most adults experience two to four URI’s (e.g., “colds”) each year. More than 200 different types of viruses are known to cause the common cold.
Prominent “cold” symptoms consist of nasal congestion, clear runny nose, post-nasal drip, sore throat, cough, fever, headache, and/or body aches.
Treatment is mostly geared towards relieving symptoms, as the condition usually resolves spontaneously after a few days to one week and antibiotics are not needed.
Decongestants combined with first-generation antihistamines may provide short-term relief of nasal symptoms and cough. Anti-inflammatory medications (e.g., ibuprofen, naproxen) can relieve fever and aches. Nasal saline irrigation can sometimes be helpful.
Pharyngitis (throat inflammation):
About 90% of throat infections are caused by viruses. Only about 5 to 10% of cases are due to bacteria which are commonly referred to as “Strep throat.”
Rapid Antigen Detection Test (RADT), also known as a “strep-test” may be necessary to distinguish between viral and bacterial pharyngitis, as the clinical features are similar in both conditions.
Antibiotics are not recommended for patients with a negative RADT result. For those with a positive RADT result, amoxicillin or penicillin VK are the drugs of choice as they are very effective against streptococcal bacteria. For penicillin-allergic patients, antibiotics in the macrolide class, as well as clindamycin, may be utilized. The duration of treatment for bacterial pharyngitis is typically 10 days.
The board certified allergists at Black & Kletz Allergy have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metro area and are very experienced in managing various respiratory infections. They are experts in checking the immune systems in individuals that develop frequent and/or unusual infections, since they are also immunologists. Black & Kletz treat both adults and children and have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to make an appointment. Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been serving the Washington, DC, Northern Virginia, and Maryland metro area for more than a half a century and pride ourselves in providing excellent quality allergy, immunology, and asthma care in a professional and friendly setting.
As we enter the Winter season, while many people see an improvement in their allergy symptoms because of the lack of pollen in the air, many other individuals experience a worsening of their allergy symptoms due to the increase in the amount of perennial allergens that are present during this time of the year. Specifically, people with sensitivities to dust mites, molds, pets, and cockroaches tend to do worse in the Fall and Winter months. Despite the fact that all of these allergens are omnipresent in the Washington, DC, Northern Virginia, and Maryland metropolitan area, and are present year-long, during the colder months, individuals tend to “close up” their homes and workplaces more than in the Spring and Summer months. During the Fall and Winter, people generally keep the windows shut, turn on the heat, and go outdoors less often. These factors all play a role in increasing the exposure to more quantities of dust mite, mold, pet dander, and cockroach allergens. Hence, individuals may be bothered more in the Fall and Winter.
It is noteworthy to mention that all of the above allergens are found only indoors, except molds and occasionally pets. When the leaves fall from the trees in the Fall and get wet, molds will grow on the decaying leaves. In the Washington, DC metro area, the leaf mold is a major allergen that causes a great deal of suffering for many allergy patients. When the leaves are disturbed by either raking them, rainfall, or via the wind, the mold spores are more likely to become airborne, thus increasing the likelihood of them causing allergy symptoms in individuals with mold sensitivities. It is therefore recommended that a person with mold allergies should avoid exposure to leaves, particularly if they are or have been wet. They should also keep the humidity of their homes below 35%, if possible as there is direct correlation with increased humidity and the amount of mold growth. In the home, mold growth tends to be more abundant in basements, bathrooms, and kitchens due to the increased moisture found in these places.
The main culprits of dust allergy are the dust mites prevalent in the Washington, DC metropolitan area. There are 2 very common species of dust mites in the Washington, DC, Northern Virgina, and Maryland metro area. They are known as Dermatophagoides fariniae (i.e., American dust mite) and Dermatophagoides pteronyssinus (i.e., European dust mite). Both species are highly allergenic and tend to live indoors in places like carpeting, upholstered furniture, pillows, mattresses, box springs, and bedding. It is technically the fecal particles and exoskeleton that are the allergenic components of the dust mites. The dust mites are microscopic and look similar to a cockroach, however, they cannot be seen with the naked eye. They are about 0.25 mm. in length. They survive by eating dead skin that regularly sloughs off of humans each night. The dust mites thrive in warm moist climates and when the humidity is high. They do not survive if the temperature is over 130° F or when the altitude is greater than 1 mile (5,280 feet). Dust mites are known to be a cause of allergic rhinitis and asthma in many individuals. There are products that can be put on carpeting that act to kill dust mites, but these products have been shown not to very effective. Encasing one’s pillows, mattresses, and box springs in allergy-proof encasings are a fairly effective way to minimize exposure to dust mites.
When the home is “closed up,” pet allergens from the dander and saliva tend to be worse. Usually, however, pet allergy tends to be very similar for most individuals despite the time off the year. Likewise cockroach allergy is common particularly in major cities such as Washington, DC. Many homes, apartments, condos, restaurants, and public buildings in urban settings are infested with cockroaches, even though they may not be visible during the day to most people. It is important to make sure that traces of food are not left on counters, floors, etc., as this attracts cockroaches. There is a common strong association between cockroach allergy and childhood asthma in inner city populations. Cockroaches are potent allergens allergy sufferers of all ages and cause both allergic rhinitis and asthma symptoms.
Other than avoidance, which is always preferable, there are numerous medications that can be used by allergists to treat dust mite, mold, pet, and cockroach allergies. Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective tool that board certified allergists use to treat individuals with these allergies, as well as pollen allergies. They work in 80-85% of people and allergy injections have been used in the U.S. for over 100 years. The average length of treatment is 3-5 years.
The board certified allergists at Black & Kletz Allergy have been diagnosing and treating allergies and asthma for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Each office has on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and there is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. Please call for an appointment if you would like a consultation with one of our allergists, or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides itself in providing quality allergy and asthma care to the Washington, DC, Northern Virginia, and Maryland metropolitan area community.
Aspirin-Exacerbated Respiratory Disease (AERD) is an acquired condition in which the sensitivity to aspirin and/or related drugs (e.g., nonsteroidal anti-inflammatory drugs or NSAID’s) is associated with long term inflammation of the upper and lower airways.
How common is AERD?
Approximately 8% of the adults in the U.S. are asthmatics and 9% of those individuals have AERD. About 13% of U.S. adults have chronic nasal and/or sinus disease and 15% of those have AERD.
AERD is a clinical syndrome consisting of:
1. Growth of polyps inside the nose
2. Chronic sinus inflammation and/or recurrent sinus infections
3. Persistent asthma, which is often difficult to control
4. Allergic sensitization to aspirin and/or other nonsteroidal anti-inflammatory drugs (NSAID’s)
What causes AERD?
Although the exact cause remains unknown, a disorder in the metabolism or breakdown of a chemical called arachidonic acid is at the root of the condition. Aspirin is not the cause of the disorder, but in sensitive individuals, ingestion of aspirin will aggravate the underlying respiratory symptoms, probably by increasing the levels of inflammatory chemical mediators called leukotrienes. This process also leads to the accumulation of excessive numbers of eosinophils (i.e., “the allergy white blood cell”) in the respiratory tract.
Clinical Features:
1. Severe nasal congestion
2. Overgrowth of polyps in the nose, which typically recur after surgical removal
3. Decreased sense of taste and/or smell
4. Facial pressure and pain
5. Frequent headaches
6. Moderate to severe asthma causing wheezing, coughing, chest tightness and/or shortness of breath
7. Fatigue caused by sleep deprivation
8. Significant opacification of the sinuses seen in X-rays and CT scans of the sinuses
Diagnosis:
The diagnosis is suspected when there is a history of an exacerbation of one’s asthma following ingestion of aspirin and/or NSAID’s. The diagnosis is confirmed if the symptoms are induced or aggravated during an oral aspirin challenge, where incremental doses of aspirin are administered by mouth under the close monitoring by a board certified allergist.
Treatment Options:
Complete avoidance of aspirin and other salicylates (e.g.,diflunisal (Dolobid); salsalate (Disalcid), as well as other related NSAID medications called COX-1 inhibitors (e.g., all NSAID’s except celecoxib) will help some patients attain better control of their symptoms. For some individuals, however, these medications can be substituted for other similar NSAID pain relievers called COX-2 inhibitors [e.g., celecoxib (Celebrex)] without adverse effects. Note that Celebrex (celecoxib) is currently the only approved COX-2 inhibitor NSAID in the U.S. Some, but not all, of the common available NSAID’s which are COX-1 inhibitors include [e.g., ibuprofen (Motrin, Advil); naproxen (Aleve, Anaprox); fenoprofen (Nalfon); flurbiprofen (Ansaid); ketorolac (Toradol); diclofenac (Voltaren, Arthrotec); etodolac (Lodine); sulindac (Clinoril); oxaprozin (Daypro); indomethacin (Indocin); tolmetin (Tolectin); nabumetone (Relafen); piroxicam (Feldene); meloxicam (Mobic)]. Avoidance of aspirin is not always possible due to the need for aspirin in the management of heart, blood vessel, and joint diseases. In addition, even with the avoidance of aspirin and NSAID’s, AERD patients usually experience progressive airways disease, despite aggressive surgical intervention and/or topical or systemic anti-inflammatory treatment with corticosteroids and leukotriene antagonists like montelukast (Singulair), zafirlukast (Accolate), and zileutin (Zyflo).
For these individuals that need to be treated with aspirin, aspirin desensitization followed by regular long term intake of aspirin is an alternative option. Multiple studies have shown that desensitization and daily treatment with aspirin can significantly improve overall symptoms and quality of life, decrease formation of nasal polyps and sinus infections, reduce the need for oral corticosteroids and sinus surgery, and improve nasal and asthma scores in patient with AERD. Significant clinical improvement is seen in as little as 4 weeks after treatment.
The procedure for aspirin desensitization involves administering aspirin by mouth in gradually increasing doses at regular intervals, while closely monitoring for adverse effects in a controlled setting such as an allergy office. The process can take 1 to 2 days.
There is a potential for adverse reactions during the procedure like nasal congestion, generalized itching (pruritus), hives (urticaria), swelling of the soft tissues (angioedema), wheezing, breathing difficulty, drop of blood pressure, and/or anaphylaxis. In case of a minor adverse reaction, they may be treated with medications. After observation for about 3 hours, the last dose can be repeated. Many individuals will be able to successfully finish the procedure in spite of some untoward reactions. Pre-treatment with leukotriene antagonists (e.g., montelukast) play a role in minimizing the risk of reactions during the desensitization procedure.
Aspirin desensitization reduces nasal congestion and nasal polyp formation, improves respiratory symptoms, reduces the need for surgery, and decreases the need for ongoing medications. The board certified allergists at Black & Kletz Allergy have had over 50 years of experience with patients who have aspirin sensitivity. Desensitization in patients who are sensitive to aspirin can be done in any of our 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We offer on-site parking at all of our offices and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that transports patients between our McLean, VA office and the Spring Hill metro station on the silver line. For an appointment, please call us or alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy treats both adults and children suffering from all types of allergies (i.e., hay fever, food, medication, insect stings), asthma, sinus problems, hives, swelling episodes, eczema, and immunologic disorders. We strive to provide exceptional quality allergy and asthma care to the Washington, DC metro community in a friendly and professional setting.
Allergy shots are synonymous with other terms such as allergy immunotherapy, allergy injections, allergy desensitization, and allergy hyposensitization. The allergy shots Gainesville, VA residents rely upon are the same allergy shots that have been given in the U.S. for over 100 years. They have been an important method of preventing and/or diminishing allergy symptoms in tens of millions of individuals over the last century.
Allergy shots can be given to almost any person and are given to any individual over the age of 2. Usually, however, most children do not begin allergy injections earlier than 4 years of age. They can be given to children, teenagers, adults, and the elderly. They can be continued in a pregnant individual as well as in a person who is nursing, as long as it is confirmed by the patient’s obstetrician and/or pediatrician of the nursing baby.
Allergy injections are given to patients with allergic rhinitis (i.e., hay fever), allergic conjunctivitis, asthma, and venom hypersensitivity (i.e., allergy to stings of bees, wasps, hornets, yellow jackets, and/or bites from fire ants). The idea behind them is to get to the root of the problem, as opposed to treating the symptoms of allergic rhinitis, allergic conjunctivitis, and asthma. By receiving allergy injections, one’s body develops antibodies that help prevent the allergen (e.g., dust mites, molds, pollens, pets, cockroaches, venom) from causing the unwanted allergy and/or asthma symptoms.
Allergy immunotherapy is useful and may be considered when one is allergic to substances that cannot be avoided. They are also used in individuals that have failed over the counter therapy and/or prescription medications. There are other individuals that do not want to take medications on a daily basis. Others have very severe symptoms and develop secondary problems (e.g., sinus infections, ear infections, bronchitis, asthma) from untreated or sub-par treatment from medications. Many people cannot deal with the side effects of many of the allergy medications. Still others would like to treat the cause of the allergy rather than just treat the symptoms of allergy and/or asthma.
During allergy immunotherapy, very small doses of the allergens that the individual is allergic to are administered subcutaneously (i.e., just under the skin into the fat) of the arm(s) either once a week or twice a week, depending on the patient’s choice. Obviously, if the individual receives the injections more frequently (i.e., twice a week vs. once a week), he or she will get through the build-up process twice as fast. Each dose is increased in strength over the build-up period which at Black & Kletz Allergy is usually 18 doses. Therefore, the maintenance dose (i.e., top dose) is reached in 9 or 18 weeks depending if the individual gets his or her build-up shots twice a week or once a week respectively. Once the maintenance dose is reached, the individual can spread out the frequency of the injections to up to every 4 weeks. Note that many people get their shots more frequently throughout the year depending on their “bad” seasons, such as Spring and Fall which in the Washington, DC, Northern Virginia, and Maryland metropolitan area is very common. Others need their injections more frequently throughout the year since they have perennial symptoms which may require them to get the injections more frequently, depending on their severity of allergy and/or asthma symptoms. The average length of time someone is on the allergy shots Gainesville, VA residents receive from Black & Kletz Allergy ranges between 3-5 years. It is important to note that allergy shots to venoms have a different build-up and maintenance schedule.
The effectiveness of allergy injections is excellent. They have been shown work in 80-85% of individuals taking them. Venom immunotherapy is effective in over 90% of patients receiving them. Allergy injections may also prevent the development of asthma in children with allergic rhinitis. They help to prevent the inflammation that occurs in a typical allergic encounter. Normally when an individual is exposed to a known allergen, many chemicals such as histamine and leukotrienes are released into the bloodstream of the patient. These chemicals are responsible for producing the miserable symptoms of allergies, and in addition, cause inflammation to occur. The allergy shots Gainesville, VA patients receive help the body naturally produce antibodies that will help prevent this process from occurring and thus the individual suffers much less or not at all and has much less or no development of allergic inflammation.
There are essentially no side effects of allergy shots, however there are two risks. The first being the chance of having a local reaction at the site of the injection which may include localized itchiness, redness and/or swelling. The second risk is that of a systemic reaction such as developing generalized itching, hives, swelling, wheezing, abdominal cramps, drop in blood pressure, which potentially can be serious. For that reason, although very rare to occur, it is important to wait 30 minutes in our office after an allergy injection, so that we could treat you with epinephrine and/or Benadryl if necessary. Despite the rarity of a systemic reaction, it can occur and it is necessary to wait the 30 minutes after an injection. A longer wait time is needed for individuals receiving venom immunotherapy.
In summary, allergy shots are a very effective treatment modality for individuals with allergic rhinitis, allergic conjunctivitis, asthma, and/or venom hypersensitivity. As mentioned above, they have been given in the U.S. for over a century and can be given to all ages from young children to the elderly. The board certified allergists at Black & Kletz Allergy have been administering allergy shots for over 50 years. We have one office location in Washington, DC and 2 offices in Northern Virginia with one office in McLean, VA (Tysons Corner, VA) and another in Manassas, VA. We have on-site parking at all 3 office locations and the Washington, DC and McLean, VA offices are Metro accessible. There is a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line. If you suffer from allergies, asthma, sinus problems, hives, swelling episodes, and/or immunological conditions, please call our office to schedule an appointment or you can click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy prides ourselves in providing high quality allergy and asthma care in a professional, inviting, and friendly environment.
As we enter into the leaf-falling season, according to allergy specialists Gainesville, VA residents trust, some of us may experience a flare-up of mold-related health issues. Molds are tiny fungi and grow well in damp environments. Wet leaves form a substrate on which various types of molds can flourish. The microscopic spores released from growing molds float in the air and we breathe in these mold spores.
Exposure to certain molds can cause adverse human health effects through three specific mechanisms:
Generation of a harmful immune response (e.g., allergic or hypersensitivity pneumonitis)
Direct infection by the organism
Toxic/irritant effects from mold byproducts
ALLERGY:
It is estimated that approximately 10% of the population have IgE antibodies to common inhalant molds. About half of these individuals (5% of the population) are predicted to have, at some time, allergic symptoms as a consequence of exposure to fungal allergens. The best allergy specialists Gainesville, VA residents rely on, have stated that sensitization to molds, particularly Alternariaalternata, has been linked to the presence, persistence, and severity of asthma. Alternariaalternata is also referred to as “leaf fungi.”
Allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal sinusitis are two conditions which result from the hypersensitivity to certain molds in the Aspergillus family which causes excessive tissue inflammation in the lungs and sinuses respectively. Hypersensitivity pneumonitis is an uncommon but important disease that can occur as a result of mold exposure, particularly in occupational settings with high levels of exposure.
INFECTION:
Common superficial fungal infections like thrush, jock itch (i.e., tinea cruris), and toenail fungus are determined by local changes in the skin barrier and can occur in healthy individuals.
Host features (such as a compromised immune system) rather than environmental exposure, are the major determining factors of more severe opportunistic fungal infections.
TOXICITY:
The occurrence of mold-related toxicity from exposure to inhaled mycotoxins (i.e., toxins produced from molds) in non-occupational settings is not supported by the current data and its occurrence is improbable, according to allergy specialists in Gainesville, VA.
IRRITATION:
An irritant is a material causing ‘‘a reversible inflammatory effect on living tissue by a chemical action at the site of contact.’’ The eyes and the upper and lower respiratory tracts are usually affected by exposure to molds. Irritant effects are dose related and their effects are transient, disappearing when the exposure has diminished or ended.
ASSESSMENT:
In individuals with chronic inflammatory conditions affecting the respiratory tract, (e.g., allergic rhinitis, allergic conjunctivitis, asthma), the measurement of IgE antibodies to mold proteins by skin testing and/or blood testing is very helpful in the identification of the specific agents that trigger and aggravate allergic symptoms.
Allergy specialists Gainesville, VA residents trust, state that the measurement of specific IgE and IgG antibodies to certain mold proteins via blood testing can aid in the diagnosis of ABPA and/or hypersensitivity pneumonitis in people presenting with clinical manifestations suggestive of these conditions.
The board certified allergists at Black & Kletz Allergy have had many years of experience in diagnosing and treating mold-related health issues and offer services through our 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We diagnose and treat both adults and children who suffer from allergies, asthma, sinus problems, eczema, food allergies, insect sting allergies, medication allergies, hives, swelling episodes, generalized itching, and immunological conditions. Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. We have on-site parking at each office and the Washington, DC and McLean, VA offices are Metro accessible. The McLean, VA office offers a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call our office to schedule an appointment, if you suffer from mold allergies or any other type of allergy, sinus condition, or asthma. You can also click Request an Appointment and we will respond within 24 hours by the next business day. The best allergy specialists Gainesville, VA has to offer have been committed to providing high quality allergy care to the greater Washington, DC community for more than 50 years.
People in the Washington, DC, Northern Virginia, and Maryland metropolitan area as well as in the Northeast are experiencing record warm temperatures this Winter. This warm weather seems to have confused the trees into releasing their pollen much earlier this year than in previous normal years. In February of this year, tree pollen counts hit “high” levels a few times, when normally they are at the most a “low” level by the end of February. In addition to Washington, DC, the tree pollen counts has been much higher than normal this February in the following Northern Virginia cities: Tysons Corner, VA, Vienna, VA, McLean, VA, Great Falls, VA, Arlington, VA, Fairfax, VA, Falls Church, VA, Alexandria, VA, Annandale, VA, Reston, VA, Herndon, VA, Sterling, VA, Oakton, VA, Burke, VA, Bristow, VA, Manassas, VA, Centreville, VA, Chantilly, VA, Haymarket, VA, Gainesville, VA, Warrenton, VA, Springfield, VA, Ashburn, VA, Dumfries, VA, Culpeper, VA, Leesburg, VA, and Purcellville, VA. In Maryland, the tree pollen counts have also been “high” this February in the following cities: Potomac, MD, North Potomac, MD, Rockville, MD, Gaithersburg, MD, Germantown, MD, Olney, MD, Darnestown, MD, Bethesda, MD, North Bethesda, MD, Chevy Chase, MD, Great Falls, MD, Silver Spring, MD, Wheaton, MD, College Park, MD, Hyattsville, MD, Beltsville, MD, Bowie, MD, Clinton, MD, Temple Hills, MD, Columbia, MD, Annapolis, MD, and Baltimore, MD.
About 220 million doses of vaccines are distributed in the United States each year. Mild swelling and redness at the site of the injections and fever lasting for 1 to 2 days are very common reactions after vaccinations. These adverse reactions do not preclude receiving future doses of the vaccines. Rarely, however, sensitivity to a vaccine constituent may cause a lump at the injection site several hours after its administration, and this is also not a contraindication to subsequent vaccination. In cases of severe adverse reactions, on the other hand, it is prudent to avoid further vaccination with that particular vaccine. In these cases, a board certified allergist may measure the levels of IgG antibodies to the immunizing agent(s) to detect whether the individual has the sufficient amount of protective antibody levels. Depending on the levels, the allergist can help determine whether further doses are needed. If needed, the allergy doctor will discuss the risks of re-vaccination and may desensitize the individual to a particular vaccine, if the ability exists for that immunizing agent.
Most people are aware of many of the typical allergies that a lot of individuals suffer from, but did you know that there are many unusual allergies that are kind of common? Some of the classic allergies or allergic conditions that most people have heard about include 
What is it?
Now that it is Winter and the temperatures are cold, one may think that they do not have anything to worry about when it comes to allergies and 
The onset of winter in the Washington, DC, Northern Virginia, and Maryland metropolitan area brings with it an increase in the frequency of respiratory infections. In comparison to individuals without an underlying long-term health condition, people with a history of allergies, asthma, diabetes, as well as individuals with suppressed immune systems are more susceptible to respiratory tract infections.
As we enter the Winter season, while many people see an improvement in their allergy symptoms because of the lack of pollen in the air, many other individuals experience a worsening of their allergy symptoms due to the increase in the amount of perennial allergens that are present during this time of the year. Specifically, people with sensitivities to dust mites, molds, pets, and cockroaches tend to do worse in the Fall and Winter months. Despite the fact that all of these allergens are omnipresent in the 
Aspirin-Exacerbated Respiratory Disease (AERD) is an acquired condition in which the sensitivity to aspirin and/or related drugs (e.g., nonsteroidal anti-inflammatory drugs or NSAID’s) is associated with long term inflammation of the upper and lower airways.
Allergy shots are synonymous with other terms such as allergy immunotherapy, allergy injections, allergy desensitization, and allergy hyposensitization. The allergy shots Gainesville, VA residents rely upon are the same allergy shots that have been given in the U.S. for over 100 years. They have been an important method of preventing and/or diminishing allergy symptoms in tens of millions of individuals over the last century.
