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Climate Change and Allergic Disease | Allergist Tysons Corner VA

The Allergists Tysons Corner VA Trust Explain the Effects of Climate Change on Your Allergies
The climate in places like Tysons Corner, VA, Falls Church, VA, and Gainesville, VA, as well as the rest of the Washington, DC metropolitan area, plays a significant role in producing allergens that annoy sensitized individuals.  The DC metro area was built on a swamp and there tends to be high counts of mold spores throughout the year, particularly from the Spring through the Fall.  Our humid Summers also account for excessive mold growth.  Pollen production is also a major problem in the Washington, DC metro area, mostly in the Spring and Fall.

Though there are still some unresolved controversies, the preponderance of evidence indicates that our climate has steadily changed over the past several decades and it is likely to continue to change in the near future.  This climate change has the potential to alter the incidence and severity of allergic and respiratory diseases in humans in the following ways:

  1. Climate warming and higher carbon dioxide levels will lead to longer pollen seasons.
  2. More hot summer days will generate ozone which triggers more flare-ups of breathing difficulties for people with chronic respiratory conditions like asthma.
  3. With rising sea levels and changes in rainfall patterns, mold allergies are likely to increase.
  4. Warming conditions may lead to the increased prevalence of biting and stinging insects, as well as the potential for more infectious tropical diseases that are transmitted by mosquitoes (e.g., Zika virus, chikungunya, dengue fever, encephalitis, malaria).
  5. The effect of fewer cold winter days on respiratory infections from viruses and bacteria is unpredictable.

More energy efficient and tighter homes will lead to an increase in indoor air pollution.  Accumulation of volatile organic compounds, radon gas, smoke, particulates, and protein allergens will increase the risk of respiratory illnesses.  In addition, higher water vapor and moisture levels will increase dust mite populations and cause an escalation of mold growth.

“Green practices” like composting facilities may cause increased respiratory diseases through the increased fungal burden that they put into the air.  Burning wood produces harmful chemicals including carbon dioxide, carbon monoxide, unburned hydrocarbons, and formaldehyde.  Inhaling particles coated with these chemicals contribute to asthma and chronic obstructive pulmonary disease (i.e., bronchitis, emphysema).

Ragweed flowers earlier and produces more pollen in urban locations where carbon dioxide concentrations and temperatures are higher.  The same effect can be seen with other allergenic species including poison ivy.

Whatever the coming changes may bring, a few proven environmental control measures such as keeping the indoor humidity lower to limit dust mite and mold growth, as well as decreasing outdoor activities on high pollen days, can help minimize allergic symptoms and reduce the need for medications.
Contact a Top Allergist Tysons Corner VA Relies On
The board certified allergists Tysons Corner VA trusts at Black & Kletz Allergy see patients from Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as many other cities and towns in the Washington, DC, Northern Virginia, and Maryland metropolitan area. They are ready to work with you in teaching you how to improve your environment which subsequently will help relieve your allergic and asthmatic symptoms.  The allergy doctors at Black & Kletz Allergy treat both adults and children.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices offer on-site parking and the Washington, DC and McLean, VA locations are Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Springhill metro station on the silver line.  Please call one of our convenient offices to make an appointment or if you prefer, you can click Request an Appointment and we will respond within 24 hours.  Black & Kletz Allergy has been providing excellent allergy and asthma care to the general population of the greater DC area for more than 50 years in a caring and professional setting.

Rashes from Plants

The Allergists McLean VA Trust for Plant Rash Treatment
With the advent of summer, many people in Gainesville, VA, Falls Church, VA, Tysons Corner, VA, as well as the rest of the Washington, DC metropolitan area, are experiencing various types of rashes after outdoor activities.

“Irritant contact dermatitis” develops in individuals with very sensitive skin when they handle plants with prickles or barbs.  Some other type of plants cause skin reactions only in people who are previously sensitized to them.  This is called “allergic contact dermatitis.”  Physical contact of the skin with oil from these plants, called urushiol, is usually the culprit in these instances.

Poison ivy, poison oak, and poison sumac are the common plants that produce urushiol and trigger inflammation of the skin.  They grow as shrubs in open fields, wooded areas, on the roadside, as well as in backyards and parks throughout Falls Church, VA, Gainesville, VA, and Tysons Corner, VA.

The offending oils can be found on the leaves, stems, flowers, and roots of these plants. Exposure to even a small amount of urushiol can result in a severe rash in susceptible people. Touching the plants directly or indirect contact through pets, tools, and/or clothing can lead to the rash.  Airborne exposure can also occur especially when the plants are burned.

The symptoms can start anywhere from a few hours to a few days after the contact and usually presents itself as redness, swelling, itching, and/or burning of the exposed areas of the skin.  The rash may get more severe over the next few days and form blisters of various sizes.  They are usually distributed in a linear or streaky pattern depending on the type of contact.  The fluid that oozes from the blisters does not contain urushiol and therefore is not contagious.

The diagnosis is established after a detailed history and physical examination.  No blood tests or X-rays are needed.  The characteristic appearance of the lesions and their distribution pattern provide useful clues.

Thoroughly rinsing the exposed area with large amounts of warm water as soon as possible after known contact with plants may help remove the offending oily resins to some extent. After the rash appears, some helpful treatments consist of the following:

  1. Cool compresses to the affected skin.
  2. Local application of soothing agents such as calamine lotion and/or oatmeal baths.
  3. Antihistamines like Benadryl (i.e., diphenhydramine) by mouth to help relieve itching.
  4. If the affected area is limited and the rash and itching are intense, a topical medium to high potency steroid cream may be prescribed by an allergist in McLean, VA or the DC area.
  5. In more severe cases, an oral corticosteroid course may be needed to reduce the inflammation and prevent progression.
  6. In case of secondary bacterial infection, antibiotics are sometimes required.

One to three weeks is the usual duration of the condition.  Future episodes can be prevented by the following:

  1. Familiarizing with the appearance of the plants in order to recognize and avoid exposure.
  2. Wearing protective clothing including long sleeves, pants, boots, and gloves before outdoor activities.
  3. Applying commercially available OTC barrier creams to the skin in order to reduce or prevent contact with the toxic oils.
  4. Thoroughly washing clothes and bathing pets with protective gloves after coming into contact with the plants.

The board certified allergists at Black & Kletz Allergy in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA have had many years of experience in treating poison ivy, poison oak, and poison sumac and will readily answer your questions and address your concerns at any time.  In addition to treating poison ivy, poison oak, and poison sumac, we also diagnose and treat both adults and children with hay fever (i.e., allergic rhinitis), asthma, food allergies, medication allergies, sinus disease, immune disorders,  eczema (i.e., atopic dermatitis), hives (i.e., urticaria), swelling episodes (i.e., angioedema), and other types of skin rashes.  The 3 offices of Black & Kletz all 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 suffer from allergies, please call our office to make an appointment or alternatively, you can click Request an Appointment and we will respond to you within 24 hours by the next business day.  The allergist McLean VA patients trust at Black & Kletz Allergy have been serving the allergy and asthma needs of the Washington, DC metro area for more than 50 years and we take pride in providing quality care in a friendly and professional environment.

It is the Summer – What You Should Know About Insect Sting Allergies

From Allergy Doctors Vienna VA Patients Trust
Now that the weather in Tysons Corner, VA, Gainesville, VA, and Falls Church, VA and the rest of the Washington, DC metropolitan area has warmed up, as it is now Summer, the risk of an insect sting has increased.  The most common stinging insects in the Washington, DC metro area are honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  They all introduce their venom into their subjects when they sting their prey.  In some cases, people have toxic (i.e., non-allergic) reactions to the insect stings, particularly if stung by several insects at the same time.  The body, in this case, generally reacts to the venom as if it was a poison.  This can occur because the victim is exposed to an over-abundance of venom at one time.  A toxic reaction can cause symptoms similar to those of an allergic reaction, but also may include symptoms such as nausea, fever, and seizures.  This can be life-threatening and depends on the amount of venom injected into the individual.  On the other hand, about 3% of individuals experience true allergic reactions, which is usually not dependent on the amount of venom, but to the allergic response to the venom by the individual.  These allergic reactions can also be life-threatening.

When stung, most individuals have no reaction or a small local reaction.  People with this type of response are at no increased risk for a systemic (anaphylactic) reaction than that of the general population.  Other people will develop a large local reaction, where the area that was stung gets red and very swollen.  This large local reaction can reach the size of a baseball in some cases.  Still, however, there is no increased risk in these individuals of a systemic or anaphylactic reaction from the insect sting.  On the other hand, a small percentage of individuals will develop a systemic reaction to an insect sting which may include some or all of the following:  generalized itching (i.e., pruritus), hives (i.e., urticaria), swelling (i.e., angioedema) of another area of the body where the sting did not take place, abdominal cramping and pain, wheezing, shortness of breath, chest tightness, coughing, feeling faint, and drop in blood pressure.

If a person has had a large local reaction or a systemic reaction to an insect sting, they should definitely seek a consultation with a board certified allergist like the allergy specialists of Black & Kletz Allergy.  The allergists that Tysons Corner, VA, Falls Church, VA, Gainesville, VA, and Washington, DC residents have trusted for years have had over 50 years’ experience diagnosing and treating insect sting allergies.  A comprehensive history and physical examination is taken and then a decision is made whether to test that individual for allergies to honey bees, yellow jackets, white-faced hornets, yellow-faced hornets, and wasps.  Allergy testing can be done via blood or by skin tests.  The allergist will then decide the preferred method of testing for each specific individual, depending on the history of the reaction that is ascertained at the visit.

Measures in order to help prevent insect stings are discussed with patients, as well as what things should be done, if a future sting occurs.  For example, if stung by a honey bee, a stinger is left in the skin of the victim.  One should never pull out the stinger, as this actually increases the amount of venom that is introduced into the individual by causing contractions of the venom sac which is hidden under the skin of the person.  Instead, one should scrape off the stinger with a finger nail, credit card, etc. in order to prevent the introduction of more venom into the body of the individual.

If a patient has a positive allergy test to any of the stinging insect venoms, it is imperative that he/she go on a course of venom allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization) as it is extremely successful in preventing further anaphylactic reactions from insect stings.  The procedure entails giving progressively larger doses and volumes of insect venom to the individual weekly over a period of 10 weeks, then every 2 weeks for 1 dose, then every 3 weeks for 1 dose, then a maintenance dose every 4 weeks for 1 year, and then the maintenance dose can be decreased to every 6 weeks for several years.  The maintenance dose is roughly equivalent to the amount of venom in an actual sting.  Therefore, if someone gets stung while they are on a maintenance dose of venom immunotherapy, they are essentially getting the same dose of venom as they normally get every 6 weeks.  For this reason, they usually do not have a systemic reaction to the stinging insect, because they are protected due to the allergy shots.

All patients with allergic reactions to stinging insects are prescribed a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q, Adrenaclick).  At Black & Kletz Allergy, individuals are taught the correct method on how to use, when to use, and what to do, after using these devices.  We have training devices that we use to show patients the proper way to use them.  As a general rule, if someone is stung by a stinging insect and experiences any systemic sign or symptom, they should use the self-injectable epinephrine device and go immediately to the closest emergency room.

Reach Out To The Allergy Doctors Vienna VA Patients Call For Relief
Insect sting allergies in cities such as Tysons Corner, VA, Falls Church, VA, and Gainesville, VA as well as others in the Washington, DC, Northern Virginia, and Maryland metropolitan area are not uncommon.  During the Summer and early Fall, there are more insect stings taking place and it is very important to take precautions to reduce the likelihood of getting stung.  The allergy doctors of Black & Kletz Allergy see both adults and children with insect sting allergies, in addition to other allergic disorders such as allergic rhinitis (i.e., hay fever), asthma, hives, swelling episodes, eczema, sinus disease, food allergies, medication allergies, and immune disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA, all of which offer on-site parking.  The Washington, DC and McLean offices are Metro accessible and the McLean office offers a free shuttle that runs between the office and the Spring Hill metro station on the silver line.  Please call one of our offices to make an appointment or you can click Request an Appointment and we will respond to you within 24 hours by the next business day. Black & Kletz Allergy takes pride in providing excellent quality allergy, asthma, and immunology care to the Washington, DC metro area community in a friendly, convenient, and professional setting.

“Microbiome” and Allergies

Explained By Allergists McLean VA Patients Trust
There has been an increase in the incidence of allergic diseases over the past 20-30 years and this phenomenon is more pronounced in industrialized countries compared to developing countries.  Many researchers believe that environmental and dietary changes play major roles in the development of allergies.  This is true in areas such as Falls Church, VA, Gainesville, VA, and Tysons Corner, VA as well as the rest of the Washington, DC metro area.

The primary role of our immune system is to defend and protect us from infections caused by germs like viruses, bacteria, and parasites.  Exposure of the immune system to infections with germs in early life stimulates the maturation of the immune system in a normal balanced way.  The absence of this stimulation can trigger the immune system to mistake innocuous substances such as dust mites, molds, pollens, and certain foods as potentially harmful and mount a defensive attack on them causing allergic disease.  This “hygiene hypothesis” aims to explain why more people suffer from allergic disorders in the developed, overly hygienic Western world.  An alternative interpretation of the evidence supporting the hygiene hypothesis forms the basis for the “microflora hypothesis,” which says that rather than specifically limiting infection, even the decreased exposure to microbes changes the colonization of bacteria of the infant gut, which has a negative effect in the development of the normal immune system which ultimately leads to allergic disease.

An adult human harbors about 100 billion bacteria in the intestines alone.  These gut bacteria account for 90% of the cells in the human body!  Human cells contain about 21,000 different genes, but the microbes living in the human comprise about 3 million genes.  The composition and function of the bacteria in the gut varies from person to person (i.e., biodiversity) and evolve during the first years of life and stabilize within the first 3 years of life.

The development of the gut microbiome (i.e., all the microorganisms that live in the gut) is influenced by interactions between diet, environment, and host-associated factors.  There is increasing evidence that these bacteria play many helpful roles in the modulation of our immune responses, especially in maintaining a balance between 2 different types of white blood cells called Th1 lymphocytes and Th2 lymphocytes.  The Th1 lymphocytes help protect us from infections, whereas the Th2 lymphocytes help mediate allergic disease.

The emerging hypothesis infers that environment or lifestyle-driven aberrancies in the early-life gut microbial composition and function represent a key mediator of childhood allergies and asthma.  Significant perturbations in the gut bacterial composition, especially reduced diversity, in the Western societies due to frequent antibiotic usage, environmental and lifestyle changes, etc. have disrupted the mechanisms of mucosal tolerance leading to more allergic disease.

Epidemiologic and clinical data supporting this interpretation include:

  1. A positive correlation between increasing risk for asthma and allergies and increasing use of antibiotics in industrialized countries.
  2. Correlations between altered fecal microbial flora and atopic disease
  3. Successful prevention and/or reduction of allergies in some individuals by the use of oral probiotics (live commensal bacteria) and dietary changes.

A recent meta-analysis of 25 studies revealed that the administration of probiotics reduces allergy-causing IgE antibody levels and the risk of atopic sensitization.  An example of dietary factors influencing allergies is the landmark LEAP study which demonstrated that early introduction of peanut products to high risk infants significantly decreased the subsequent development of peanut allergy.

There are a number of ongoing studies which will improve our understanding of the mechanisms underlying allergic disorders and hopefully offer new and exciting options in the management of these conditions in near future.

The board certified allergists of Black & Kletz Allergy always strive to keep abreast of new developments in the field of Allergy, Asthma, and Immunology in order to offer new and emerging diagnostic and therapeutic modalities, as soon as they are available.  Black & Kletz Allergy has 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and offer on-site parking at each location.  In addition, the Washington, DC and McLean 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.  The allergy specialists of Black & Kletz Allergy see both adults and children in the Tysons Corner, VA, Falls Church, VA, and Gainesville, VA areas and we have been serving the greater Washington metro area for over 50 years.  Please call one of our convenient offices to make an appointment or alternatively, you can click Request an Appointment and we will reply within 24 hours by the next business day.

Air Quality and Its Effects on Allergic Individuals

The Washington, DC, Northern, Virginia, and Maryland metropolitan area has its share of pollutants in its air as well as the many allergens that are known to be prevalent. The allergens that are common in the DC metro area include tree and grass pollens in the Spring, ragweed pollen in the Fall, and mold spores which are perennial in nature. The molds are year-round due to the history of Washington, DC being a swamp many years ago. The humidity also tends to be high in the area, which favors the growth of molds. Regarding pollutants, there are many different types of pollutants in the Washington, DC metropolitan area including such cities as Gainesville, VA, Falls Church, VA, and Tysons Corner, VA.. Some of these pollutants include carbon monoxide, ozone, organic dusts and other fine particulate matter, nitrogen dioxide, sulfur dioxide, and lead emissions.

It is not news to anyone that the traffic in the Washington, DC metro area is sometimes horrific. Not only does it play havoc with people’s temperament, but so many motor vehicles produce emissions which contribute greatly to the air pollution and thus the air quality of the area. In the summers, this pollution tends to be worse. The sunny days will produce increased levels of ozone which has been determined to be hazardous to one’s health, particularly people with lung disease such as people with asthma and chronic obstructive pulmonary disease (COPD). Chronic bronchitis and emphysema are the two most common conditions that contribute to COPD.

Almost all patients with allergic rhinitis (i.e., hay fever) and/or asthma know a lot about the pollen count and what it means. The pollen count is the number of pollen grains in one cubic meter of air. For example, if the pollen count for tree pollen is 250, it means that there are 250 grains of tree pollen in a sample of air that is 1 meter X 1 meter X 1 meter. Keep in mind that 1 meter is 39.37 inches. Different locations throughout the U.S. have different guidelines depending on the types of pollens they have and the quantity of the pollen released into the air. As a general rule, the pollen count levels can be interpreted by the following values: Trees – 1-14 is Low; 15-89 is Moderate; 90-1,499 is High; 1,500 and above is Very High. Grasses – 1-4 is Low; 5-19 is Moderate; 20-199 is High; 200 and above is Very High. Weeds – 1-9 is Low; 10-49 is Moderate; 50-499 is High; 500 and above is Very High. Molds – 1-6,499 is Low; 6,500-12,999 is Moderate; 13,000-49,999 is High; 50,000 and above is Very High. In fact, you can always click Today’s Pollen Count at the top of our website to see the latest pollen count for the Washington, DC, Northern Virginia, and Maryland metropolitan area. Many individuals use this knowledge to help them guide when they should avoid certain outdoor activities. Generally, the pollen counts are the highest in the mornings through midday. Planning to do outdoor activities, such as exercising or doing yard work, in the evening is usually recommended to minimize pollen exposure.

In addition to being aware of the pollen count, it is also important to be aware of the Air Quality Index (AQI). The AQI indicates how polluted the air is in your area. The AQI is calculated based on 5 major pollutants which include carbon monoxide, nitrogen dioxide, sulfur dioxide, fine particulate matter, and ground-level ozone. The last two pollutants (fine particulate matter and ground-level ozone) pose the greatest threat to an individual’s health. The AQI is divided into 6 different zones of increasing amounts of pollution and thus health risk. The zones are color-coded and in order from less pollution to more pollution are as follows: Green, Yellow, Orange, Red, Purple, and Maroon. In the Washington, DC area, it is not uncommon to have a few “Code Red” days during the summer, particularly when it is hot, humid, and sunny. “Code Green” is the best air quality and poses little or no risk of any health concern. “Code Yellow” signifies acceptable air quality and may pose a moderate health concern for a very small number of people who are very sensitive to air pollution. “Code Orange” indicates an unhealthy quality of air for some sensitive groups of people. “Code Red” means that the air quality is generally unhealthy for the general public, although usually only sensitive groups will experience more serious health effects. “Code Purple” notifies the general public that the air is very unhealthy and tends to occur in emergency conditions, such as when there is a chemical spill. “Code Maroon” indicates hazardous conditions where everyone will most likely experience untoward health issues. Generally, it is recommended to stay indoors when the level is “Code Red” and above.

The board certified allergists of Black & Kletz Allergy treat patients of all ages including children and the elderly in the Falls Church, VA, Tysons Corner, VA, and Gainesville, VA areas. Children and elderly persons tend to be more sensitive to poor air quality, as well as individuals with lung conditions such as asthma and COPD. Black & Kletz Allergy has 3 office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area with offices 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 office and the Spring Hill metro station on the silver line. If you would like to make an appointment, please call us or you can click Request an Appointment and we will respond within 24 hours by the next business day. The allergy doctors of Black & Kletz Allergy have been serving the greater Washington, DC metro area for more than 50 years and we pride ourselves in excellent quality allergy, asthma, and immunology care in a friendly, caring, and professional environment.

Asthma and Aspirin

Providers of Asthma Treatment Gainesville VA Patients Trust: Dr. Kletz & Dr. Gondi
Any provider of asthma treatment in Gainesville can tell you that about 10% of all adults with asthma may have a condition called Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad, or Aspirin-Sensitive Asthma.

The 3 components of the disease are:

  1. Persistent asthma
  2. Chronic inflammation in the nose and sinuses with polyp formation
  3. Allergic sensitivity to aspirin and other non-steroidal anti-inflammatory drugs NSAID’s

The asthma associated with AERD tends to be more severe and poorly responsive to the usual treatments.  When providing the treatment for allergies and asthma Gainesville VA residents need, we see that most patients also suffer from recurrent sinus infections and often experience a reduced sense of smell and/or taste.

The adverse reactions on exposure to aspirin and/or NSAID’s can include:

  1. Flushing, rash, and/or itching
  2. Increased nasal congestion
  3. Facial pain and headache over the forehead region
  4. Coughing, wheezing, and/or heaviness in the chest
  5. Abdominal cramps and/or nausea
  6. Dizziness

What causes it?

AERD is not a genetic or inherited condition.  The exact cause of the disorder is not known at this time, although a lot of research is being done in order to try to find a cause.  The patients have higher than normal levels of eosinophils (i.e., a type of white blood cell that tends to be high in allergic individuals) in their blood and in the sinuses, and these cells usually play a role in causing chronic allergic inflammation.  They also have high levels of substances called leukotrienes which also cause inflammation.  Ingestion of aspirin and/or NSAID’s leads to a further increase in these leukotrienes resulting in a flare-up of asthma symptoms.

How is it treated?

  1. Patients who are diagnosed with AERD and who have not been desensitized to aspirin should always avoid taking aspirin and other NSAID’s like ibuprofen (e.g., Motrin, Advil) naproxen (e.g., Naprosyn, Aleve), diclofenac (e.g., Voltaren, Arthrotec), indomethacin (e.g., Indocin), meloxicam (e.g., Mobic), piroxicam (e.g., Feldene), nabumatone (e.g., Relafen), sulindac (e.g., Clinoril), ketorolac (e.g., Toradol), oxaprozin (e.g., Daypro), etc.  Acetaminophen (e.g., Tylenol) is a suitable alternative medication for relief of pain. Certain related non-steroidal anti-inflammatory drugs called COX-2 inhibitors like celecoxib (Celebrex) may be safer alternatives to aspirin in some individuals.
  2. In spite of avoiding these drugs, many patients will continue to experience frequent asthma symptoms, repeated sinus problems, and growth of nasal polyps.  They may need daily inhaled corticosteroid medications into their lungs to control asthma and daily corticosteroid nasal sprays and saline irrigations into their nostrils to control nasal congestion and polyps.
  3. Medications that inhibit leukotrienes like zileuton (Zyflo), which reduce the production of leukotrienes, or montelukast (Singulair) and zafirlukast (Accolate), which block the effects of leukotrienes on tissues can be helpful in certain patients to reduce the exacerbation of symptoms.
  4. Many patients also need sinus surgery and removal of nasal polyps, often more than once, as polyps tend to regrow after the surgery.  Regular use of intranasal corticosteroids and oral leukotriene modifiers after the surgery can help some patients in slowing the progression of their disease.
  5. Aspirin desensitization (i.e., the administration of gradually increasing doses of aspirin under close monitoring in a hospital or clinic, followed by daily intake of a standard maintenance dose of aspirin by mouth) has been shown to reduce the need for medications and the number of surgeries in some patients with AERD who were unresponsive to other standard treatments.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both adults andchildren with asthma, AERD, sinus disease, nasal polyps, other allergic and immunologic disorders.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible.  There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line.  To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day.  Black & Kletz Allergy has been serving the asthma and allergy needs of the DC metro area community for more than 50 years and we strive to administer high quality allergy and asthma care in a caring professional environment.

Allergist Gainesville VA: Can Allergies Cause Dental Problems?

Dr. Kletz & Dr. Gondi, Trusted Gainesville Allergists, Discuss Dental Problems and Allergies
As allergists that Gainesville, VA calls upon, we know that when one thinks about allergies and allergy symptoms, dental problems usually do not come to mind.  In fact, most people tend to separate dental and medical problems into two distinct categories.  Medical diseases can and do influence your dental health.  Most people know that certain heart defects and murmurs may require premedication with antibiotics in order to prevent subacute bacterial endocarditis.  Patients with GERD (gastroesophageal reflux disease), Sjögren’s syndrome, anorexia, and bulimia are more prone to cavities of the teeth.  There are many more medical conditions which can have profound implications on the health of one’s teeth which will not be discussed.

What about allergies?  Can they cause dental problems?  The simple answer to this question is:  Yes

Many children with hay fever (allergic rhinitis) have nasal congestion as a major feature of their disease.  The nasal congestion frequently causes these children to become “mouth breathers,” since they are unable to breathe through their noses.  As the children grow, they develop a narrow high upper arched palate in their mouths which results in malocclusion (i.e., poor bite) of their teeth.  The teeth grow in crooked usually resulting in the need for costly braces by an Orthodontist.  Seeing a board certified allergist like the ones at Black & Kletz Allergy in the Gainesville, VA, Falls Church, VA , and Tysons Corner, VA areas can prevent this type of dental problem in children if addressed early on.  The allergists at Black & Kletz Allergy would perform a comprehensive history and physical examination and likely do allergy testing to find out if and what the child is allergic to in the environment.  Allergies to dust mites, molds, pollens (e.g., trees, grasses, weeds), pets, and cockroaches are very common allergens that can cause chronic nasal congestion.  There are other nasal conditions, such as nasal polyps, which are usually due to an underlying allergy that can also cause chronic nasal congestion.  After fully evaluating the child, a treatment plan would be discussed with the parent(s) which may include measures to avoid the offending allergen, use medications in the forms of syrups, powders, tablets, capsules, nasal sprays, eye drops, and/or begin a course of allergy immunotherapy (i.e., allergy shots, allergy injections, allergy desensitization).  Allergy immunotherapy or allergy shots are very effective as they work in 80-85% of the individuals taking them.  They are given to people ranging in age from young children through the elderly.  They have been given in the U.S. for over 100 years.  Treating the hay fever early in its course is very effective in preventing the dental malocclusion that occurs too often in untreated individuals with this condition.

Another problem that people face when it comes to allergies and dentistry is the common “I am allergic to Novocain” response that dentists hear over and over again from patients.  We, as allergists near Gainesville, VA, also hear this common complaint.  Dentists frequently have to use a “numbing medicine” before they can do certain dental procedures such as root canals, pulling teeth, dental implants, putting in crowns, etc. in order to prevent pain from occurring in their patients.  Many times the “allergy” symptoms described are really a side effect of the Epinephrine (adrenaline) that is frequently mixed in with the “numbing medicine” rather than a true allergy to the “numbing medicine” itself.  Epinephrine is usually mixed in with the “numbing medicine” as a way to constrict the small blood vessels in the mouth which helps prevent excessive bleeding.  The most common “numbing medicines” or local anesthetics used are categorized as “Caine drugs.”  (See “Medication Allergies”).  Some examples of “Caine drugs” include Novacain (procaine), Xylocaine (lidocaine), Carbocaine (mepivacaine), Marcaine (bupivacaine), and Pontocaine (tetracaine).  Some individuals are truly allergic to the local anesthetic and some are even allergic to the preservatives found in the local anesthetic.  It turns out, however, that most individuals who think they are allergic to a “Caine drug” usually are not when skin tested by an allergist.  It is important, however, to see a board certified allergist and have skin testing performed to rule out a “Caine drug” allergy, as such an allergy can be very serious and potentially life-threatening.  The allergy doctors in the Gainesville, VA, Falls Church, VA, and Tysons Corner, VA areas at Black & Kletz Allergy routinely see patients with this potential allergy and skin test them to a specific local anesthetic in the “Caine drug” class at one of our 3 office locations in theWashington, DC, Northern Virginia, and Maryland metropolitan area.  If the skin testing to a specific “Caine drug” is negative, then the allergist will let your dentist know that is fine to use that particular medication.  Note that it is possible to be allergic to one specific “Caine drug” but not another specific “Caine drug.” (Example: One can be allergic to Novacain but not Xylocaine).

The board certified allergists at Black & Kletz Allergy treat both adults and children and will answer any questions you have concerning local anesthetic allergy testing as well as other medication allergy testing such as penicillin testing.  Black & Kletz Allergy has locations 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 offices are also Metro accessible.  There is a free shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  If you would like to make an appointment with an allergist, 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 has been providing quality allergy care to the DC metro area for more than a half century.

Epinephrine Auto-Injectors

The Allergy Doctor Centreville, VA Relies On Explains Epinephrine Auto-Injectors
Severe sensitivity to certain foods, insect venoms, and certain medications can lead to a life- threatening reaction called anaphylaxis.  The symptoms usually begin within a few minutes after exposure and can progress very rapidly.  Anxiety is often the initial symptom and the other usual manifestations include generalized itching, redness, hives, swelling of the eyelids, lips, tongue, and/or throat (i.e., angioedema) leading to difficulty in swallowing and breathing. Other signs can include excessive sweating, rapid pulse, and a sudden drop in blood pressure.

Epinephrine (adrenaline) is a self-injectable medication and is the first line treatment option for anaphylaxis.  It can stall the progress of the reaction and can be life-saving by reversing the deleterious effects of anaphylaxis.  To be maximally effective, epinephrine needs to be administered as soon as possible after the onset of the first symptom.  In fact, delayed use of epinephrine is the leading cause of mortality in anaphylaxis.  It is therefore imperative for all people susceptible to severe allergic reactions to have a self-injectable epinephrine immediately available at all times.

The foods most likely to cause anaphylaxis include peanuts, tree nuts, fish, and shellfish.  In children and adults who are severely sensitized, other foods like milk and eggs can also cause severe adverse reactions.  The insect stings that are known to cause anaphylaxis belong to the Hymenoptera family and include honeybees, yellow jackets, hornets, wasps, and fire ants.  Penicillin and related antibiotics are the most common drugs that are associated with a tendency to cause life-threatening reactions.

Epinephrine auto-injectors are available by prescription only and are covered by most insurances.  One of the products marketed under the trade name Auvi-Q was voluntarily recalled by the manufacturer in October 2015 and two other products Epipen and Adrenaclick are currently available.  A generic version of an epinephrine auto-injector is also offered by certain pharmacies. Note that there are generally 2 doses (0.15 cc. and 0.3 cc.) of each epinephrine auto-injector.  The dose depends on the weight of the individual, such that the 0.3 cc. dose is the dose usually given individuals weighing greater than or equal to 66 lbs.  The 0.15 cc. dose (e.g., EpiPen Jr.) is generally given to children weighing 33-66 lbs.

Although the medication is identical, different brands have different administration methods and it is crucial that the patient receive adequate training and practice with a training device to get familiarized with the specific technique. The medicine is usually injected intramuscularly (IM) into the outer part of the thigh, even through clothing, and the device is kept in place for about 10 seconds.  It is recommended that two doses be carried at all times, as the second dose may be needed if the symptoms persist about 10-15 minutes after the first dose.

The most common side effects of epinephrine include palpitations, tremors, and restlessness. However the benefits of epinephrine almost always outweigh the risks.  After using the epinephrine, it is important to go to the nearest emergency department to be monitored.  In some individuals with anaphylaxis, a late phase reaction can occur anywhere from 4 to 72 hours (4-8 hours is more typical) after the initial anaphylactic reaction.  Patients and/or parents should also contact the allergist for reevaluation and for replenishment of epinephrine auto-injectors.  The devices should be stored at room temperature and should never be frozen or exposed to high temperatures or direct sunlight.

The board certified allergists and the staff at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area are trained and experienced in evaluating the need for, prescribing, and teaching the technique for epinephrine auto-injectors.  We have 3 offices in the DC metro area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All of our offices have on-site parking and the Washington, DC and McLean offices are Metro accessible.  We offer free shuttle service between our McLean office and the Spring Hill metro station on the silver line.  To make 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 has been providing quality care allergy, asthma, and immunology services to the Washington, DC , Northern Virginia, and Maryland metro area community  for more than a half century.