The vexing question about what to do about the alarming increase in peanut and other food allergies may have been finally answered. The prevalence of peanut allergy tripled in the U.S. in the past decade while also rising in Africa and Asia. It affects more than 1% of the U.S. population and is the leading cause of anaphylaxis and death from food allergy. The American Academy of Pediatrics recommended in the year 2000, that parents refrain from feeding peanuts to children until 3 years of age hoping to reverse the trend. However in 2008, after reviewing the published literature, the American Academy of Pediatrics retracted its recommendation, stating that there was insufficient evidence to call for early food avoidance. Last month, (February of 2015), at the annual conference of the American Academy of Allergy, Asthma, and Immunology, the results of a landmark prospective, randomized controlled study addressing this issue were revealed and simultaneously published in the New England Journal of Medicine online. The data strongly suggested that feeding peanut products regularly to infants with eczema, egg allergy, and a family history of food allergies from 6 months of age dramatically reduces the risk of peanut allergy, compared to children who avoided exposure to peanuts. The differences in the two controlled groups were so stark that the guidelines are likely to be revised soon to promote early introduction of peanut products into the diets of at-risk children.
Prick skin testing with peanut extract and a blood test to measure antibodies to peanut protein are routinely employed in detecting allergic sensitivity to peanuts. The recent availability of tests to measure antibodies to specific components of peanut proteins increased the predictability of adverse reactions on exposure to peanuts in sensitized children and adults. These tests are also helping physicians to identify the appropriate patients and the clinical situations for in-office oral challenges with peanut products, which is the gold standard in the accurate diagnosis of peanut allergy.
In the past decade, a number of small, largely uncontrolled clinical trials have suggested that oral immunotherapy (giving children with peanut allergies increasing doses of peanut flour or peanut extract by mouth over time) can effectively desensitize many children with peanut allergy. Although peanut oral immunotherapy shows promise, the evidence currently available on its effectiveness, risk benefit, and potential long-term consequences is insufficient to support its use in clinical practice. Until more data is available, strict peanut avoidance is the current standard of care.
Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from hay fever (allergic rhinitis). In the early Spring, tree pollen is mainly responsible for the symptoms that cause hay fever.
There are of course molds in the air simultaneously, but they are always present in Washington. In the DC area, trees usually begin to pollinate at the end of February, peak in mid- to late-April and continue to pollinate through late May and occasionally through early June. Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar. Later in the season, the predominant tree that causes problems for individuals with tree pollen allergies is the oak tree. Other tress that pollinate in this later time frame include hickory, walnut, and pine.
It is interesting to note that, in general, people are not allergic to flowering trees (i.e., cherry tree, dogwood tree). Many people think they are allergic to flowering trees because they develop allergy symptoms when these trees are in bloom, however, it is usually not due to these trees, but due to other non-flowering trees that happen to pollinate at the same time. Nature is behind this sleight of hand trickery. Flowering trees have pollen that is fairly heavy in weight. Since the pollen is heavy, it is not easily wind-disbursed and as a result, individuals do not breathe in the pollen and thus do not become sensitized to these pollens. The flowers are present in order to attract insects such as bees. When the bee lands on the flower, the pollen sticks to the abdomen of the bee. The bee will then fly to another flower of another tree and the pollen will intermingle with that flower. It is by this method that cross-pollination is achieved, made possible by the aid of the bees. Non-flowering trees such as cedar, maple, elm, alder, birch, poplar, oak, hickory, walnut, etc. have very light weight pollen. These pollens are easily wind-disbursed. It is these wind-disbursed tree pollens that individuals breathe in and become sensitized to, that are the cause of hay fever symptoms in sensitized people. It just so happens that people develop their hay fever symptoms at the same time when the flowering trees bloom. People then associate these flowering trees with their symptoms and blame their symptoms on the wrong trees.
The symptoms of tree pollen allergies are the classic symptoms of hay fever. They can include any or all of the following: runny nose, stuffy nose, post-nasal drip (which can lead to a sore throat, hoarseness, and/or cough), sneezing, itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, itchy throat, sinus pressure and/or pain, wheezing, chest tightness, cough, and/or shortness of breath.
The following are some measures that can be taken to reduce one’s exposure to the tree pollen in the Spring besides living in a “plastic bubble:” It is advisable to keep one’s windows and sunroof closed. It is advisable to turn on the air conditioner and change air filters regularly (about once a month). Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside. Choose an automobile that has a filter in its air conditioning unit, if possible. Avoid yard work and mowing lawns. If a person needs to do yard work, wear a filtration face mask in order to diminish exposure to the pollen. If one goes outdoors, shower, wash one’s hair, and change one’s clothing upon returning home to decrease pollen exposure. Wash your pets regularly and avoid close contact with a pet that goes outdoors during the pollen season since they carry tree pollen on their coats. Monitor pollen counts daily. Click Today’s Pollen Count to view the daily pollen count. Stay indoors wherever possible when the pollen count is high (generally on dry warmer days). Note that rain washes pollen from the air causing pollen counts to be lower on wet cooler days. Avoid drying clothes outdoors when the pollen count is elevated. Avoid contact lenses which may trap pollen in one’s eyes. Since pollen is released in the early mornings, try to avoid exercising during this time.
The diagnosis and treatment of tree pollen allergies begins with a thorough history and physical examination by a board certified allergist. Our board certified allergists in both adult and pediatric allergy at Black & Kletz Allergy have had more than 50 years of experience diagnosing and treating tree pollen allergies in the Washington, DC, Northern Virginia, and Maryland metropolitan area. After the history and physical examination, allergy testing is usually done by skin testing, or in some cases, by blood tests to confirm if the patient is in fact allergic to trees. Once confirmed, there are a multitude of treatment options to alleviate the annoying symptoms of tree pollen allergies. In addition to pollen avoidance measures in the above paragraph, the treatment of tree pollen allergies includes medications which can include oral medications (tablets, capsules, syrups, granules, etc.), nasal sprays, eye drops, and/or lung inhalers. If there are additional environmental allergens that are found in a particular person which correlate with his/her symptoms during a different time of the year (Fall, Winter, etc.), then allergy shots (also referred to as “allergy immunotherapy” or “allergy desensitization”) may be a great way to treat the pollen allergy. They are extremely effective and have been available for over 100 years.
If you would like a consultation for your hay fever symptoms, please do not hesitate to call Black & Kletz Allergy to make an appointment. Alternatively, you can click Request an Appointment and we will get back in touch with you within 24 hours of the next business day. We have 3 convenient locations in the Washington, DC metropolitan area with office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. There is parking at each location and the Washington, DC and McLean, VA locations are accessible by using the Metro. Whether your hay fever symptoms are seasonal or perennial, we would be happy to help you.
With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.
Some vaccines like the MMR (measles, mumps, and rubella), influenza, yellow fever, and certain rabies vaccines are grown in chicken embryo cultures and may contain small amounts of egg protein in them, raising concerns about potential adverse reactions in children and adults with egg allergies.
Other vaccines contain small amounts of gelatin which can cause adverse reactions in patients allergic to gelatin. Some of these vaccines include MMR, influenza, varicella, DTaP (diphtheria, tetanus, and acellular pertussis), yellow fever, rabies, shingles (herpes zoster), and Japanese encephalitis.
Below are the most current recommendations as of February 2015:
MMR vaccine:
Can be safely given in a single dose without prior testing in all children and adults with a history of egg allergy.
Influenza vaccine:
People with a history of egg allergy who have experienced hives (urticaria) after exposure to should not receive the live influenza vaccine (FluMist). They can, however, receive a recombinant (egg-free) influenza vaccine (Flublok) if they are 18 years of age or older, or they can receive an inactivated vaccine. Either the recombinant or the inactivated influenza vaccine must be administered by a health care provider familiar with the potential manifestations of egg allergy. The patient must also be observed by the provider for at least 30 minutes for signs of a reaction after administration of each vaccine dose. Note that neither the recombinant (Flublok) nor the inactivated influenza vaccines contain any live influenza virus, unlike the live attenuated (weakened) influenza vaccine (FluMist) which does contain live influenza virus. FluMist is given intranasally (in the nose) rather than the inactivated influenza vaccine which can be given either as an intramuscular or an intradermal injection. The recombinant influenza vaccine is given as an intramuscular injection. Also note that FluMist is only given to individuals from ages 2 through 49. FluMist should not be given to pregnant women or in patients with an immunodeficiency (weakened immune system) without consulting their physician. FluMist should not be given to children and adolescents through age 17 years of age who are receiving aspirin therapy or aspirin-containing therapy because of the association of Reye’s Syndrome with aspirin and wild-type influenza infection.
People who have had more severe reactions to egg such as dizziness and/or lightheadedness, angioedema (swelling), vomiting, breathing difficulties (i.e., wheezing, shortness of breath), and/or who have been treated with epinephrine in the past for an egg allergy can also receive the recombinant influenza vaccine (egg-free) if they are 18 years of age or older or an inactivated influenza vaccine. This must only be given by a physician, such as an allergist, with experience in the recognition and management of severe allergic conditions like anaphylaxis. These individuals must also be observed for at least 30 minutes after vaccination.
People who have had anaphylactic reactions to the previous doses of any vaccine due to sensitivity to any of its components (i.e., gelatin, thimerosal, antibiotics) of the vaccine, should not receive any further doses of that particular vaccine. Note that thimerosal-free influenza vaccines can be obtained for those who are either allergic to thimerosal or do not want thimerosal.
Individuals who have had Guillan-Barré Syndrome (a severe paralyzing illness) should not get any vaccine without consulting their physician.
People with egg allergies should also not get the vaccinations for yellow fever and certain rabies vaccines since they also may contain small amounts of egg protein. The rabies vaccine Imovax can however be given to people with egg allergies, as Imovax is not cultured in chicken embryos and therefore does not contain egg proteins. Desensitization to the yellow fever vaccine can be performed by an allergist in a medical setting. If either the yellow fever or rabies vaccine is necessary, please consult with your physician.
Dr. Michael R. Kletz has done clinical research on the topic of the administration of egg-derived vaccines in patients with a history of egg sensitivity. Please click his research article that was published in the Annals of Allergy in the following link: http://www.ncbi.nlm.nih.gov/pubmed/2346238
In the winter, everyone seems to either have had a “cold” or knows someone who has a “cold.” When people refer to a “cold,” they are actually referring to some sort of respiratory tract infection. To understand a respiratory tract infection, one must first know the parts of the body that make up the respiratory tract. The respiratory tract can be broken down into two parts: the upper respiratory tract and the lower respiratory tract.
The upper respiratory tract is located outside of the chest and is made up of the following:
Pharynx – The space inside the mouth where the passages of the nose connect to the mouth and throat
Epiglottis – The flap that covers the trachea (windpipe) during swallowing, so that food does not enter the trachea and thus the lungs. It is on top of the larynx (voice box)
Larynx – The voice box (part of the throat that contains the vocal cords which is just above the trachea or windpipe)
The lower respiratory tract is located in the chest and is made up of the following:
Trachea – The windpipe or breathing tube
Bronchi – The trachea splits into 2 different smaller tubes. One tube goes into the right lung and the other goes into the left lung.
Lungs – Consists of bronchioles (very small divisions of the bronchi within the lungs) and alveoli (very small air sacs within the lungs where air exchange of oxygen and carbon dioxide occurs)
Infections of each site above can occur and each has a corresponding name associated with the location. Infections of such areas are usually named by putting the suffix “itis” (which means “inflammation of”) at the end of the anatomical location. The names of the infections of each location are listed below:
Lungs – Pneumonia (Note that one can also have bronchiolitis and/or alveolitis)
The cause of most respiratory tract infections is viruses. There are over 200 known viruses that cause these infections. In addition to viruses, a bacteria, fungus, or parasite can also be the cause of a respiratory tract infection. Most of the viruses that cause respiratory tract infections are the following: rhinovirus, adenovirus, influenza virus (the “flu”), parainfluenza virus, enterovirus, coronavirus, and respiratory syncytial virus (RSV).
The symptoms of a respiratory infection range in type and severity depending upon the duration, and the virulence of the virus, bacteria, fungus, or parasite. It also depends if the individual has any pre-existing risk factors or medical illnesses such as diabetes, immunodeficiency, elderly, underlying lung disease (asthma, COPD or chronic obstructive pulmonary disease, cystic fibrosis, etc.), smoking, allergies, congestive heart failure, crowded living conditions (i.e., dormitories, nursing homes, hospitals), exposure to others with a “cold” or flu, and/or lack of vaccination [i.e., influenza (flu), Pneumovax 23 and/or Prevnar 13 (pneumonia shots)]. Common symptoms include:
Malaise
Runny nose
Stuffy nose
Sore throat
Headache
Post-nasal drip
Cough (with or without sputum)
Fever and/or chills
Body aches
Wheezing
Shortness of breath
Chest pain
The diagnosis involves taking a detailed history followed by a careful physical examination. Laboratory studies may include blood work, throat culture, chest X-ray, and CT scan of the sinuses.
Prevention of respiratory tract infections can never be 100%, but there are some common sense things that should be done in order to minimize contracting and passing on the infection. One should avoid contact with other sick individuals, wash one’s hands frequently, stay home from school and/or work if one develops symptoms, get vaccinations for influenza ( flu) annually, if appropriate for that individual, get the Pneumovax 23 and/or Prevnar 13 vaccination (pneumonia shots) if elderly or immunocompromised, consult your physician within 48 hours for known exposure to the flu so that an antiviral medication such as Tamiflu can be prescribed within 48 hours of the beginning of flu symptoms. Note that there are rapid diagnostic tests which entail a quick painless nasal swab to diagnose the flu. The result of the test is back within 15 minutes. It can be done in order to determine if you have the flu. Keep in mind that the tests are between 50-70% accurate, but can help the physician in the diagnosis.
Treatment may range anywhere from supportive care such as drinking plenty of fluids, rest, gargling with salt water, and over the counter medications, to treatment with antibiotics, antiviral medication, corticosteroids, bronchodilator medications, intravenous therapy, oxygen administration, and very rarely a surgical procedure may be necessary. The vast majority of upper respiratory infections will resolve on their own, since most of them are of viral origin.
Black & Kletz Allergy offers the services of a full time immunologist Chantilly, VA residents respect, who serves the population in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area. Our allergy and immunology practice has the following 3 office locations: Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.
Our immunologist Chantilly, VA inhabitants trust, is a specialist physician trained and experienced in diagnosing and treating the disorders of the immune system. Our immune system exists to protect us from infections and cancers. It defends us against infections from various germs (e.g., viruses, bacteria, fungi, parasites). Our immunologist Chantilly, VA residents admire, can accurately diagnose various disorders of the immune system and offer effective treatments in order to improve the quality of life of individuals with these immune disorders.
The immune system can be defective either from birth (i.e., primary immune deficiency conditions) or the immune function can deteriorate later in life due to various organic diseases (i.e., secondary immune deficiency disorders). Our immunologist Chantilly, VA inhabitants have confidence in, may perform various tests to differentiate these conditions from one another so that appropriate treatments can be offered.
Primary immune deficiency disorders may lead to an increase in the frequency and severity of infections. This tendency can begin either in infancy or later in life depending on the specific type of disorder and its severity. These infections can take the form of frequent respiratory (i.e., ears, nose, throat, sinuses, lungs), gastrointestinal, skin and soft tissue, and/or urinary tract infections. Infections such as otitis media (i.e., middle ear infection, recurrent strep infections of the throat, sinusitis, bronchitis, pneumonia, skin boils, and recurrent urinary tract infections are just some of the infections that are prevalent in individuals with an immunodeficiency. It is important to note that some of the immune disorders may also present with skin disorders such as eczematous rashes.
The evaluation for these conditions by our immunologist Chantilly, VA residents respect begins with a comprehensive history taken by our immunologist. Our immunologist will delve into the nature, frequency, and severity of such infections. After a thorough history is taken, it is followed by a detailed physical examination. The diagnosis will be confirmed by the immunologist Chantilly, VA inhabitants trust after performing specific laboratory tests. These tests may involve the determination of the numbers and functions of certain types of white blood cells known as lymphocytes.
Some types of lymphocytes (i.e., B lymphocytes or B cells) are responsible for producing antibodies (i.e., immune globulins) as an immune defense and other types of lymphocytes (i.e., T lymphocytes or T cells) are instrumental in the type of defense known as cell-mediated immunity. It is possible that either or both types of immune defenses can be defective. Our immunologist Chantilly, VA residents respect will evaluate for many different types of disorders before finally establishing the diagnosis. Our immunologist Chantilly, VA residents admire will also test for the responses to immunizations that the patients received during their childhood. Individuals with immune deficiencies will not be able to mount adequate responses to vaccinations.
One example of an immunodeficiency is the condition known as common variable immunodeficiency. Common variable immunodeficiency is one of the most common primary immune deficiencies, even though the prevalence is about 1 in every 50,000 individuals. In this condition, either the number or the function of the lymphocytes is defective. As a result, protective antibodies are not manufactured in sufficient numbers, which predisposes the patient to more frequent and severe infections.
Individuals with immune deficiencies are usually treated by our immunologist Chantilly, VA inhabitants trust with regular antibody replacements. The process of antibody replacement involves infusions of commercially available pooled antibodies every 1 to 4 weeks. These immunodeficiencies usually need long-term continuous treatments in order to prevent recurrent infections.
Another way that the immune system can malfunction is by turning against its own organs or tissues. This phenomenon is called autoimmunity. Essentially, one’s immune system sees its own body as “foreign” and as result, attacks its own organs and/or body tissues. Clinical manifestations vary widely depending on the organs involved. These autoimmune disorders are also evaluated and co-managed by our immunologist Chantilly, VA residents respect, typically along with a Rheumatologist.
The allergists at Black & Kletz Allergy treat both pediatric and adult patients. We have 3 offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our office locations have on-site parking. The Washington, DC and McLean, VA offices are Metro accessible and the McLean, VA office has a free shuttle that runs between our office and the Spring Hill metro station on the silver line. You may also click Request an Appointment and we will respond within 24 hours by the next business day. Black & Kletz Allergy has been a fixture in the greater Washington, DC, Northern Virginia, and Maryland metropolitan area for over 50 years for our exceptional services for the diagnosis and treatment of allergies, asthma, and immunological disorders.
Black & Kletz Allergy practice offers the services of a full time pediatric allergist Ashburn, VA inhabitants respect. Our pediatric allergists underwent several years of specialized training in the diagnosis and treatment of all types of allergic and immunological disorders affecting children, as well as adults. They also have decades of experience in managing these disorders as they have treated thousands of children and young adults.
Our pediatric allergist Ashburn, VA residents trust evaluates and treats, among other things, environmental, food, insect sting, and medication allergies. Inhalant allergens or aeroallergens typically affect the upper and lower respiratory tract and eyes. Food allergens can affect the gastrointestinal tract, skin (i.e., eczema, hives), and rarely multiple systems in a condition known as anaphylaxis (i.e., acute severe life-threatening reaction). Anaphylaxis as well as skin symptoms can also be caused by medication allergies such as penicillin, sulfa, aspirin, ibuprofen, etc.
When aeroallergens [i.e., dust mites, mold spores, pollens (trees, grasses, weeds), animals (cat, dog, cockroach)] affect the eyes, the condition is called allergic conjunctivitis. The conjunctivae are the thin transparent membranes that covers the front side of the eyeballs. When the conjunctivae are exposed to the aeroallergens that the child has previously been sensitized to, these membranes become inflamed. Due to increased blood flow, the eyes turn red and excessive tears are produced. The eyes also itch, sometimes uncontrollably. Our pediatric allergist Ashburn, VA residents admire begins his evaluation by obtaining a comprehensive history of the frequency and severity of the specific symptoms, with special attention to their seasonal variation, if any. The next step would be prick skin testing or a blood testing in order to identify the specific allergen triggers. After the diagnosis is established, our pediatric allergist Ashburn, VA inhabitants trust provides detailed information about the various ways of avoiding exposure to the offending allergens. When avoidance is not practical or feasible, our board certified allergist will usually prescribe medications in order to alleviate the bothersome symptoms that arise from allergies. These medications may include oral medications, nasal sprays, eye drops, and/or topical skin medications.
When inhalant allergens affect the upper respiratory tract, the condition is termed allergic rhinitis, which indicates inflammation of the mucus membrane lining of the inside of the nose and throat. After performing a comprehensive history, our pediatric allergist Ashburn, VA residents respect will usually perform diagnostic skin and/or blood tests, as appropriate. The symptoms of allergic rhinitis (i.e., hay fever) may include nasal congestion (i.e., due to inflammatory swelling of the tissues called turbinates which are located inside the nostrils), runny nose (i.e., due to excessive secretion of mucus), post-nasal drip (i.e., due to excessive drainage of mucus down the back of the throat), and itching of the nose and/or throat. In addition to information about environmental control, the pediatric allergist Ashburn, VA inhabitants admire will prescribe medications I order to provide relief from the annoying symptoms of allergies. These again may include include oral medications, nasal sprays, eye drops, and/or topical skin medications.
When the environmental controls and medications do not adequately control the symptoms, the pediatric allergist Ashburn, VA residents trust can offer a long term treatment option called allergen immunotherapy. This modality entails exposing the immune system to gradually increasing doses of allergen extracts in small increments at regular intervals in a standardized protocol. This process is very effective in building tolerance to the allergens that the child is sensitized to. This process helps in preventing the symptoms and reducing the need for medications in the long term.
When the inhalant allergens affect the lower respiratory tract, inflammation of the tissues inside the lungs may result in the symptoms of asthma. These can consist of coughing, chest tightness, wheezing, and difficulty in breathing. The pediatric allergist Ashburn, VA residents admire at Black & Kletz Allergy has over 30 years of experience in treating children with asthma. Our allergist will identify the relevant allergens by allergy testing and will provide detailed information to children and their parents as to how to avoid exposure to them. Many children with asthma need inhaled medications in order to adequately control their asthma. There are daily maintenance medications to control the inflammation, prevent the symptoms, reduce exacerbations, and preserve the lung function. The pediatric allergist Ashburn, VA residents trust will give detailed information to the patients and their families regarding various medication options including the benefits and risks with each as well as help choose the most appropriate medication in a shared decision making process. In addition to providing prescriptions, the pediatric allergist Ashburn, VA inhabitants respect will explain and demonstrate the proper technique of using the various inhaler devices, which could consist of metered dose aerosols and dry powder inhalers. The pediatric allergist Ashburn, VA residents trust will also coach the parents to properly monitor their child’s symptoms and lung function parameters.
The other conditions treated by pediatric allergist Ashburn, VA residents admire include hives or urticarial (i.e., itchy red blotches and welts of various sizes and shapes on the skin) and eczema or atopic dermatitis (i.e., dry, flaky, itchy and sometimes excoriated skin patches over face, trunk and extremities). Allergic sensitivity to certain foods can play a role in these disorders. The pediatric allergist Ashburn, VA residents trust offers testing to detect the offending foods and teaches children and their parents about ways of avoiding exposure to them. Unfortunately, desensitization options are not available for most foods (except peanuts) and avoidance of exposure is the only option in its management. Epinephrine auto-injectors are prescribed by the pediatric allergist Ashburn, VA residents admire for children at risk for anaphylaxis and our allergist will demonstrate the proper technique of using these devices. Note that if an epinephrine auto-injector is ever used, it is very important to then go immediately to the closest emergency room.
The board certified pediatric allergists at Black & Kletz Allergy have been diagnosing and treating children and adults in the Washington, DC metropolitan area for more than 50 years. We have 3 convenient locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA which all offer on-site parking. The Washington, DC and McLean, VA locations are Metro accessible and there is a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. Please call us to make an appointment or you can click Request an Appointment and we will reply within 24 hours by the next business day. The pediatric allergy specialists of Black & Kletz Allergy are eager to help you with your allergy, asthma, sinus, and immunology needs. We are dedicated to providing excellent care and service to you and your family.
Black & Kletz Allergy has an allergist northern VA resident’s trust on its staff for more than 30 years. The allergist northern VA of Black & Kletz Allergy has on its staff is board certified in allergy and clinical immunology with decades of experience in treating both allergic and immunological disorders. Some of the conditions treated and managed by the allergist northern VA inhabitants believe in are seasonal and year-round respiratory allergies caused by environmental and aeroallergens, food allergies, medication allergies, skin allergies, insect venom allergies, chemical sensitivities, asthma, eczema, and immunodeficiencies.
Aeroallergen or environmental allergen sensitivity leads to a condition commonly known as hay fever, which is technically called allergic rhinitis which can be seasonal or perennial in nature. Our allergist northern VA residents admire will identify the specific allergens that each patient is sensitized to by performing relevant allergy tests. The results will enable our allergist to recommend relevant environmental control measures which would minimize one’s exposure to the triggering agents and thus lessen the suffering of the affected individuals. Some of the mostly indoor allergens playing a role in causing hay fever symptoms may include dust mites, mold spores, animal dander, and cockroaches. Outdoor allergens may include pollens from trees, grasses, and weeds. Note that molds are both indoor and outdoor allergens.
Black & Kletz Allergy’s allergist northern VA resident’s trust is trained in performing and interpreting allergy skin and blood tests to accurately identify the triggers in an individual patient and diagnose the conditions based on a comprehensive history and physical examination complemented by allergy test results. Our allergist northern VA inhabitant’s respect is also experienced in providing the necessary education to patients and the most appropriate ways of managing their condition. The management options considered and offered to the patient by our allergist northern VA appreciate may include various medications as well as allergy desensitization. Medications may help to relieve allergy symptoms and make the patient more comfortable. Two examples of medications used in the treatment of allergies include antihistamines in order to help relieve itching, sneezing, runny nose, and watery eyes, as well as nasal sprays which are used to help control nasal congestion, runny nose, and post nasal drip.
It should be noted that in general, medications only mask the symptoms of allergies and do not treat the underlying cause of allergic disorder. Our allergist northern VA inhabitant’s trust has special expertise in treatment modalities called immune therapies (i.e., immunotherapy) which alter the underlying mechanism of allergy and build up tolerance to the allergens, so that symptoms can be prevented instead of being masked. These desensitization therapies have been in use for more than 100 years. During the process of desensitization, the allergist northern VA residents admire identifies the relevant specific allergic antigens for an individual and makes a serum of these antigens which will be administered by injections under the skin at regular intervals with gradually increasing concentrations and volumes. This systematic exposure to the allergens helps the immune system develop tolerance to these allergens. This process is akin to vaccinations against infectious agents such as viruses and bacteria which effectively prevents serious diseases subsequently when natural exposure to these microbes occurs.
The process of desensitization can have 2 main side effects. The allergist northern VA resident’s respect is trained and experienced in detecting these adverse reactions very early and to treat them expeditiously. The more common side effects are local reactions at the site of injections in the form of local itching, redness, and/or a small to moderate sized local swelling. These reactions can begin after a few hours and can last a few days. They can be managed with the local application of ice, using an over-the-counter corticosteroid cream, and/or taking an anti-inflammatory medication such as ibuprofen to help relieve any discomfort.
Very rarely, there can be a generalized or systemic reaction after an allergy injection which could be more dangerous. The allergist northern VA resident’s praise monitors patients after the injections very closely in order to detect it early. Black & Kletz Allergy’s allergist northern VA inhabitant’s respect has the special training and expertise needed to treat these adverse reactions and to arrest their progress, if they should happen to occur.
The board certified allergy specialists at Black & Kletz Allergy have 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. The allergy doctors at Black & Kletz Allergy are extremely knowledgeable regarding allergies and other related conditions such as asthma, eczema, sinus problems, hives, swelling episodes, generalized itching, eosinophilic esophagitis, and immune disorders. We diagnose and treat both adult and pediatric patients. To schedule an appointment, please call any of our offices or you may alternatively click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years and we look forward to providing you with comprehensive allergy care in a professional and cordial environment.
It is an awful thought, but many people are allergic to cockroaches. No one likes to think that they are within miles of a cockroach, however, cockroach allergy is one of the most common indoor pests. They can cause many problems for those allergic to them including allergic rhinitis symptoms (sneezing, runny nose, nasal congestion, etc.), asthma symptoms (wheezing, shortness of breath, chest tightness, and/or cough), and skin symptoms (itching and/or rash). There is a very strong correlation between chronic asthma and cockroach allergy. Since cockroaches live in homes and businesses throughout the year, patients suffering from cockroach allergy have year-round symptoms. Other allergens such as dust mites, mold, and pets can also cause perennial symptoms and must also be assessed when diagnosing an allergy or asthma patient for year-round symptoms. In addition to causing allergies and asthma, cockroaches can also carry and transmit various diseases.
Cockroaches live just about everywhere and have adapted to living in all types of climates. There are over 3,500 species and they have been around for more than 300 million years. In general, cockroaches are nocturnal and are usually not seen during the daylight hours. Since cockroaches prefer moist and warmer environments, they tend to gather more in kitchens, bathrooms, basements, cracks in the walls, and closets. In the U.S., the two most common species are the German (Blattella germanica) and American (Periplaneta Americana) cockroaches. They tend to be much more common in the inner cities. Thus, cockroach allergies are fairly prevalent in people living in inner cities. Anywhere between 30 – 60% of asthmatics living in an urban area are said to be allergic to cockroaches. Overall, about 33% of the U.S. population are sensitive to cockroaches, if they are allergic to at least one other allergen such as dust mite, mold, pollen, pets, etc.
In inner-city children with asthma, the percentage of cockroach sensitivity increases to between 55 – 80%. Most urban locations, including Washington, DC, have their fair share of cockroaches living amongst us. It is estimated that over 75% of urban homes and/or apartments have cockroaches present. Even more shocking is that the number of cockroaches living in each home or apartment ranges from about 1,000 to over 300,000 insects. For every cockroach you see, there are approximately 800 present that you don’t see.
The cause of cockroach allergy Is due cockroach allergens. These allergens are found in the saliva, feces, and exoskeleton of the insect. The most common cockroach allergens are Bla g 1, Bla g 2, and Per a 1. Other cockroach allergens include Bla g 4, Bla g 5, Bla g 6, Bla g 7, Bla g 8, Bla g 9, Per a 2, Per a 3, Per a 4, Per a 5, Per a 6, Per a 7, Per a 8, Per a 9, and Per a 10.
One can be diagnosed with cockroach allergy by seeing an allergist who would then take a careful history from the patient. After an examination, the allergist would test the patient for cockroach allergy by either skin or blood testing.
The treatment of cockroach allergy first involves prevention of further contact with cockroaches. This is easier said than done. It is very difficult to get rid of every cockroach in a home, but there are some things that should be tried which include: keep garbage and food in closed containers; make sure that there are no leaky pipes or faucets; do not leave dirty dishes in the sink or on kitchen countertops; do not bring food into the bedrooms; make sure to close up any holes in the walls or baseboards to decrease entry and exit paths for cockroaches; contact an exterminator for help with cockroach infestation. In addition to prevention, there are a multitude of medications that can be used to help relieve the allergy, asthma, and/or skin symptoms that one can experience from their cockroach sensitivity. They come in various formulations including pills, syrups, nasal sprays, inhalers, and creams. Allergy shots (allergy immunotherapy) are a very effective means to treat cockroach allergy and are used in both children and adults.
Mammalian Meat Allergy is a delayed allergic reaction triggered by eating the meat of some mammals. The condition was discovered by researchers at the University of Virginia only a few years ago. Their findings of this new allergy were published in 2009. The allergy initially was confined to the southeastern part of the U.S. with a majority of the cases in Virginia. Subsequently, the condition has become more widespread.
Mammalian Meat Allergy is initiated by a bite from a Lone Star Tick (Amblyomma americanum), named because of its distinctive small white mark on its back. Many people deny a tick bite and instead say there were bitten by chiggers (a type of mite), even though chiggers do not cause the allergy. For this reason, it is prudent that an allergist ask the patient if they have ever been bitten by a tick or a chigger. In susceptible individuals, the bite sets off a chain reaction which results in the formation of an IgE antibody (the “allergy” antibody) that attaches to a carbohydrate (sugar) present in the meat of only mammals called galactose-alpha-1,3-galactose (also known as “alpha-gal”). This is present in mammalian meat such as beef (cow), pork (pig), lamb (sheep), venison (deer), rabbit, goat, bison, whale, etc. It is also important to point out that for people who travel to exotic locations, one must be aware that there are other mammals that are eaten which contain alpha-gal. Some of these mammals include horse, dog, cat, squirrel, guinea pig, kangaroo, and whale, to name a few. Since fish, shellfish, and poultry (i.e., chicken, turkey, duck, quail) are not mammals; they do not have alpha-gal.
In this condition, unlike a typical food allergy, the symptoms usually do not start for several hours (typically 3-6 hours) after the consumption of the offending meat from a mammal. In more common food allergies like peanut, tree nut, fish, and shellfish allergies, symptoms usually begin in less than one hour after exposure to the food. When a person who harbors this antibody eats the meat from mammals, it causes release of histamine and other chemicals which are responsible for allergic reactions. The symptoms can include itching, rashes, hives, swellings of lips, tongue and other soft tissues, abdominal pain, nausea, vomiting, and diarrhea. In severe instances, it can also lead to life threatening anaphylactic reactions resulting in difficulty in breathing, drop in blood pressure, dizziness, and loss of consciousness. In summary, the person will develop delayed anaphylaxis, angioedema (swelling), and/or urticaria (hives).
If you have experienced any of the above symptoms, please call Black & Kletz Allergy and request to see one of our board certified allergists at any one of our 3 locations in Northern Virginia and Washington, DC. We can confirm or rule out the condition by taking a complete history, performing an examination, and obtaining a blood sample. Avoiding meat from mammals and in severe cases limiting the intake of dairy products can prevent serious and dangerous adverse reactions.
The onset of winter in the Washington DC metro area has brought two cold-related health problems to the forefront.
The first one concerns many people with respiratory disorders like asthma and COPD (Chronic Obstructive Pulmonary Disease). Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of respiratory symptoms like coughing, wheezing, and shortness of breath. In addition, respiratory infections, especially caused by viruses, are more prevalent during the winter months. Influenza (the “flu”) is just one of the many viral infections which are notorious in aggravating asthma and pulmonary-related conditions.
Avoiding exposure to the cold air, in addition to minimizing the chance of developing a viral upper respiratory tract infection by frequent hand washing and covering one’s sneezes and coughs, can help prevent flare-ups in people with breathing difficulties such as asthma and COPD. People with persistent asthma (defined by any asthma symptom which occurs more often than twice a week during the daytime and/or more often than twice a month during the nighttime) need to use their controller medications on a daily basis as prescribed, in order to reduce the chances of exacerbating their asthma. Controller medications may include inhaled corticosteroids, long-acting beta agonists, leukotriene antagonists, and/or theophylline. In more severe asthmatics that meet certain criteria, a humanized antibody called Xolair (omalizumab), may also be prescribed in order to help prevent asthma exacerbations.
The second issue concerns people with a history of a specific type of “hives” called “cold-induced urticaria.” Though there are usually multiple triggers for hives (urticaria), exposure to colder temperatures can result in giant hives over exposed skin in susceptible individuals. The condition can be very serious in selected patients and is usually diagnosed in our office by an “ice cube test,” where an ice cube is placed on the forearm of the patient for 10 to 15 minutes and then removed. When the skin re-warms in a few minutes, an elevated red wheal or hive in the shape of the ice cube confirms this disorder. In rare instances, this condition is also associated with some systemic diseases and blood tests for cold agglutinins and cryoglobulins may be appropriate. Treatment begins with avoiding the cold when possible. In addition, various medications can be used to help prevent the hives and/or anaphylaxis that can occur in people with this condition.
The vexing question about what to do about the alarming increase in peanut and other food allergies may have been finally answered. The prevalence of peanut allergy tripled in the U.S. in the past decade while also rising in Africa and Asia. It affects more than 1% of the U.S. population and is the leading cause of anaphylaxis and death from food allergy. The American Academy of Pediatrics recommended in the year 2000, that parents refrain from feeding peanuts to children until 3 years of age hoping to reverse the trend. However in 2008, after reviewing the published literature, the American Academy of Pediatrics retracted its recommendation, stating that there was insufficient evidence to call for early food avoidance. Last month, (February of 2015), at the annual conference of the American Academy of Allergy, Asthma, and Immunology, the results of a landmark prospective, randomized controlled study addressing this issue were revealed and simultaneously published in the New England Journal of Medicine online. The data strongly suggested that feeding peanut products regularly to infants with eczema, egg allergy, and a family history of food allergies from 6 months of age dramatically reduces the risk of peanut allergy, compared to children who avoided exposure to peanuts. The differences in the two controlled groups were so stark that the guidelines are likely to be revised soon to promote early introduction of peanut products into the diets of at-risk children.
Spring is rapidly approaching in the Washington, DC metropolitan area and that means many people will be suffering from 
With the recent resurgence of vaccine-preventable diseases like measles in the United States, in addition to the ongoing active influenza (flu) season, the issue of food allergies and vaccinations has become a hot topic.
In the winter, everyone seems to either have had a “
It is an awful thought, but many people are allergic to cockroaches. No one likes to think that they are within miles of a cockroach, however, cockroach allergy is one of the most common indoor pests. They can cause many problems for those allergic to them including 
Mammalian Meat Allergy is a delayed allergic reaction triggered by eating the meat of some mammals. The condition was discovered by researchers at the University of Virginia only a few years ago. Their findings of this new allergy were published in 2009. The allergy initially was confined to the southeastern part of the U.S. with a majority of the cases in Virginia. Subsequently, the condition has become more widespread.
The onset of 
