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New Guidelines for the Prevention of Peanut Allergy

More and more children and adults are being diagnosed with peanut allergy in the U.S. in the past few decades.  Peanut allergy was estimated to affect about 0.4% of children and 0.7% of adults in 1999.  By 2010, the prevalence increased to about 2% of all children.  Peanut allergy is the leading cause of death related to food allergies in U.S.

Until a few years ago, it was thought that delaying the introduction of allergenic foods to at-risk children reduced the likelihood of the development of food allergies.  However, a recent landmark study published in 2015 called LEAP (Learning Early About Peanut Allergy) provided evidence to the contrary. Based on the new findings, the National Institute of Allergy and Infectious Diseases amended the previous recommendations and issued new guidelines favoring early introduction of peanut products in children at risk for the development of peanut allergy.

It is known that infants diagnosed with eczema and/or allergies to eggs are at higher risk of developing peanut allergies.  These children were the focus of the new guidelines.  Though it is possible that other groups of children with a family history of food allergies and/or history of allergic reactions to other foods such as milk, soy, wheat, etc. also are more likely to develop peanut allergy, these children were not included in the current recommendations due to lack of enough evidence at this time.

Guideline 1:

In infants with no eczema or any food allergy, peanut products should be introduced in their diet in accordance with family preferences.

Guideline 2:

In infants with mild to moderate eczema with no other food allergy, peanut-containing foods should be introduced at about 6 months of age.  Other solid foods should be introduced before peanut-containing foods to ensure that the infant is developmentally ready.  These infants may have dietary peanut introduced at home, though some caregivers and healthcare providers may desire an in-office supervised feeding, evaluation, or both.

Guideline 3:

Infants with:

1. Severe eczema (defined as those with persistent and recurrent flare-ups of eczema needing prescription-strength medications)

2. Egg allergy (defined as those with a history of a reaction to egg and a positive skin prick test or a positive oral egg food challenge)

3. Both 1 and 2 above need to be tested for possible peanut allergy as follows:

1. If the blood test shows no peanut specific IgE antibody, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.

2. If the blood test shows elevated peanut IgE antibody, the children need prick skin testing with peanut antigen by an allergist.

A. If the skin test shows a wheal of 0 to 2 mm. in diameter, peanut-containing foods should be introduced either at home or in a supervised setting in the doctor’s office at 4 to 6 months of age.

B. If the skin test reveals a wheal of 3 to 7 mm. in diameter, a supervised in-office feeding or a graded oral food challenge with peanut should be undertaken. In the case of no adverse reaction, peanut-containing foods should be introduced in their diet.  In the case of an adverse reaction, peanut products should be strictly avoided.

C. If the skin test’s wheal diameter is 8 mm. or larger, these infants should avoid peanut products and should continue to be evaluated and managed by an allergist.

Infants, who are candidates for the introduction of peanut-containing foods at 4 to 6 months of age, should receive about 2 grams of peanut protein in the first feeding.  Subsequently, they should also be regularly fed about 6 grams of peanut protein per week, divided in 3 or more feedings.

It is hoped that this strategy will help in development of tolerance to peanut products and will substantially reduce the likelihood of the development of peanut allergy which can be very serious and even fatal.

Black & Kletz Allergy has board certified allergists in 3 convenient locations in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area.  The allergists are trained and very familiar performing prick skin testing as well as oral food challenges in the appropriate individuals.  Black & Kletz Allergy diagnoses and treats both adults and children.  We offer on-site parking in our Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA locations.  The Washington, DC and McLean, VA offices are Metro accessible and the McLean office has a free shuttle that runs between the McLean office and the Spring Hill metro station on the silver line.  If you are concerned that you or your child has a peanut allergy or any other type of food allergy, please call us to schedule 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 needs of allergy and asthma sufferers in the Washington, DC metro area for more than 50 years.

Dust Mite Allergy

What are dust mites ?
Dust mites are microscopic bugs that are about 0.25 mm. in length. They are arachnids like spiders and scorpions and like the former, generally have 8 legs. They tend to live in pillows, mattresses, bedding, carpeting, plush toys, upholstered furniture, etc. and are responsible for allergy and asthmasymptoms in many individuals. When someone speaks of a dust allergy, they are in fact referring to dust mite allergy. Dust mites can survive in a broad range of environmental conditions but prefer warmer temperatures and places with higher humidity. They tend not to like high altitudes, but still can survive at relatively high elevations. Dust mites survive by eating organic matter such as your flaky dead skin that sloughs off of you each night while you are asleep. They also eat your hair, fingernails, fungi, bacteria, and can eat animal fur. For these reasons, dust mites tend to be most problematic in one’s bedroom. In addition, people tend to spend a lot of time in their bedrooms. A disgusting fact is that there are millions of these tiny bugs living on the average mattress.

Why are people allergic to them and what are the symptoms of dust mite allergy?
People are actually allergic to the allergens in the dust mite’s fecal material. The two most common species of dust mites found in the United States are Dermatophagoides farinae and Dermatophagoides pteronyssinus. There are many dust mite allergens which are divided into groups. The allergens in Group 1 and Group 2 are generally the most bothersome to individuals. The allergens “Der f 1” and “Der p 1” are the most allergenic proteins that are produced by these two mites. When a sensitized individual inhales these proteins, as well as other dust mite proteins, allergic symptoms may occur which can cause all or some of the following symptoms: itchy eyes, watery eyes, red eyes, runny nose, nasal congestion, post-nasal drip, sneezing, sinus headaches, wheezing, cough, shortness of breath, and/or chest tightness. These symptoms can be the same symptoms as some people experience with pollen, mold, and/or pet allergies. In addition, dust mites may cause exacerbation of one’s eczema (atopic dermatitis).

What can be done to minimize one’s exposure to dust mites?
It is advantageous to cover one’s pillows, mattress, and box spring with allergy-proof encasings that zipper up over the pillows, mattress, and box spring. This allows one to have a “protective” barrier in place between the dust mites and the individual’s nose which is responsible for inhaling the highly allergenic proteins of the dust mites. It is also beneficial to avoid wall-to-wall carpeting, especially in the bedroom and to get rid of plush stuffed animals in children’s bedrooms. Anything that tends to gather dust such as curtains also should be avoided. In addition, it is also beneficial to wash bedding in water that is equal to or greater than 130°F. The hot water will kill the dust mites, although dust mites will continue to reproduce and always will be present. Using a HEPA air filter is another important tool to reduce allergen exposure. Make sure to keep the humidity in the house below 50% as it has already been mentioned above that dust mites thrive in high humidity, particularly over 70% humidity. It is preferable to avoid sleeping in basements, as they tend to be damper and concrete floors also should be avoided, since they tend to increase moisture.

How is dust mite allergy diagnosed and treated?
When an individual sees a board certified allergist, it is important for the allergist to take a detailed history from the patient so as to ascertain if his/her symptoms could possibly be due to dust mites. One common feature amongst people with dust mite allergies is that their symptoms can and usually are perennial in nature and not just seasonal as found often in patients with pollen allergies. It is also very common for patients with dust mite allergy to have a worsening of their symptoms in the Fall and Winter, which is usually the time that the heat gets turned on in most homes and businesses, particularly in the Washington DC, Northern Virginia, and Maryland metropolitan area. The next step in diagnosing dust mite allergy is a thorough physical examination to look for visual clues of hay fever (allergic rhinitis) and/or asthma. Allergy skin testing or allergy blood testing can be performed in order to confirm the diagnosis. Once a dust mite allergy is diagnosed, there are a few options for treatment which involve a combination of reducing one’s exposure to dust mites as mentioned in the previous paragraph, and medical treatment. Treatment can be given to patients by either using medications and/or receiving allergy immunotherapy (i.e., allergy shots, allergy desensitization). Allergy medications may include antihistamines, decongestants, nasal sprays, and/or eye drops, etc. Allergy desensitization has been around for over a century and has been proven to be very effective to treat dust mite allergies, as well as pollen, mold, pet, insect sting hypersensitivity, etc.

What should you do next?
The allergists at Black & Kletz Allergy are board certified in both adult and pediatric allergy, asthma, and immunology. We are proud to have served the Washington DC metropolitan area community for many decades and if you or someone you know appears to be suffering from “dust” allergies or allergies due to an “unknown” cause, please give us a call at one of our 3 convenient office locations in the area or click Request an Appointmentand we will contact you within 24 hours on the next business day after your request, so that we can schedule an appointment for you.

It’s an Early Spring – What Can You Do Now?

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:

  1. If doing yardwork or exercising outdoors, wash and change your clothes and take a shower after come inside.
  2. If you must do yardwork, wear a mask, preferably a respirator mask with a HEPA filter.
  3. Keep the windows and/or sunroof closed in your cars.
  4. Wash your pet if he/she has been outdoors for a prolonged period of time as the fur/hair collects pollen.
  5. 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.
  6. Watch the pollen count. You can check it daily on our website.  Click Today’s Pollen Count.
  7. 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.
  8. Make sure you clean and/or change your filters in both your home and car.
  9. 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.
  10. 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.
  11. 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.

Allergies to Vaccines

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.

5 Unusual Allergies that are Not Uncommon

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.

Allergy to Latex

What is it?

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.
  • Rubber industry workers

What are the symptoms?

  • Itching (i.e., pruritus), rash, and/or hives (i.e., urticaria)
  • Nasal congestion, runny nose, and/or itchy nose
  • Wheezing, shortness of breath, chest tightness, and/or coughing
  • Swelling (i.e., angioedema) of parts of the body such as the throat, lips, eyes, and tongue.
  • Nausea and/or dizziness
  • 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.

How the Cold Weather Affects Allergic Individuals and Asthmatics

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.

Respiratory Infections

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:

  1. Severe, such as fever of more than 102°F and discolored nasal secretions or facial pain lasting for more than 3 to 4 days.
  2. Persistent nasal discharge or daytime cough lasting longer than 10 days.
  3. Worsening fever, cough, or nasal discharge after initial improvement of a viral upper respiratory infection lasting for 5 to 6 days.
  4. Sinus X-rays and CT scans are not routinely recommended.

Management:

  1. Watchful waiting is appropriate for uncomplicated cases.
  2. Amoxicillin or Augmentin is the preferred first-line antibiotic choice.
  3. 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.
  4. 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.

  1. Fever of more than 102°F, rapid heart-beat, rapid breathing, and abnormal lung examination findings may suggest pneumonia.
  2. Discolored sputum does not always indicate bacterial infection.
  3. Chest X-rays are not needed in most instances.

Medications for relief of symptoms may include:

  1. Cough suppressants (e.g., codeine, dextromethorphan)
  2. First generation antihistamines (e.g., diphenhydramine)
  3. Decongestants (e.g., pseudoephedrine, phenylephrine)
  4. Bronchodilators (e.g., albuterol)

Non-specific upper respiratory tract infections (URI’s):

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.