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Can Sleep Disorders be Due to Allergies?

A top allergist Arlington, VA trusts examines the correlation between allergies and sleep disorders
Sleep disorders affect about 30% of the population.  Several sleep disorders have been linked to allergies.  People who suffer from hay fever (allergic rhinitis) are more than twice as likely to have insomnia as those individuals who do not have hay fever.  They are also more than twice as likely to have problems falling asleep.  A little more than one-third of individuals with hay fever complain of insomnia.  Almost two-thirds of these same allergic people complain that they do not get enough sleep.  For comparison, only one-sixth of individuals without allergies say they have insomnia and one-quarter of individuals without allergies say that do not get enough sleep.  The severity of the sleep disorders also increased as the severity of the allergies increased, showing a direct proportional relationship.  Sleep disorders are linked to sleepiness during the day, fatigue, depression, decreased ability to learn, decreased memory, decreased productivity at school and/or work, and a decreased quality of life.  Interestingly, allergic rhinitis has been linked to many of the same symptoms.  The combination of allergic rhinitis and a sleep disorder can have deleterious effects on these individuals.

Obstructive sleep apnea is a sleep disorder that is caused by repeated interrupted breathing which does not allow an individual to get enough “deep” sleep that is required to rejuvenate the body.  As a result, excessive daytime sleepiness or falling asleep at inappropriate times is the hallmark of this condition.  It is often caused by one’s tongue sliding back in the throat, in combination with a relaxed airway which changes shape to a more oval (rather than round) shape which gives way to less “room” for air to be able to get to the lungs from the nose or mouth.  This combination of things often causes the individual to snore.  People with obstructive sleep apnea are unable to breathe in air due the blockage caused by a tongue that is blocking the airway on top of an already relaxed smaller diameter airway.  These individuals literally stop breathing for typically 20 to 60 seconds.  When this occurs, there is an “emergency” sensor called the carotid body near the carotid arteries in one’s neck, that detects the lowering of the oxygen and rise in carbon dioxide in the blood.  This triggers the awakening center in one’s brain and the individual awakens for a few seconds allowing them to unknowingly move their tongue and re-form their throat shape to the normal awakened state.  Breathing is then reestablished.  This cycle in people with obstructive sleep apnea occurs many times per hour.  It can occur greater than 50 times per hour, resulting in a lack of restful sleep.  Obstructive sleep apnea has been linked to allergic rhinitis.  People with allergic rhinitis often have nasal congestion which causes the upper airway to narrow.  Individuals with hay fever also are more prone to sinus infections.  Most people with sinus infections also have nasal congestion as part of their symptoms.  The upper airway narrowing that occurs due to nasal congestion increases the likelihood of snoring and obstructive sleep apnea.  Obstructive sleep apnea should not be taken lightly as some of the complications of obstructive sleep apnea include heart disease, stroke, increased risk for motor vehicle accidents, and sexual dysfunction.

If you snore, experience insomnia, have difficulty falling asleep, and/or have daytime sleepiness, the board certified allergists at Black & Kletz Allergy can order a sleep study as well as diagnose and treat you for allergic rhinitis, if applicable.  We treat both adults and children and have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  Black & Kletz Allergy has offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  All our offices have on-site parking and our offices in Washington, DC and McLean are Metro accessible.  We offer a free shuttle between our McLean office and the Spring Hill metro station.  If you have a sleep disorder and/or hay fever symptoms, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours by the next business day.  Black & Kletz Allergy strives to provide quality allergy, asthma, sinus disease, hives, and immunologic care to the Washington, DC metro area community in a caring and professional manner as we have done for more than 50 years.

7 Things You Can Do To Get Ready for the Tree Pollen in the Spring

Well it is the middle of March in Arlington, VA, Centreville, VA, and Vienna, VA as well as the rest of the Washington, DC, northern Virginia, and Maryland metropolitan area, and Spring is around the corner.  Pretty soon the cars will be covered in yellow pollen, the cherry trees will be in full blossom, and many allergy sufferers will be complaining of hay fever (i.e., allergic rhinitis) symptoms.  As the temperature climbs, the buds will appear on various trees in the Washington, DC area.  This coincides with the release of tree pollen from numerous trees in the area.  Some of the more prevalent trees to cause allergy symptoms in the Arlington, Centreville, and Vienna areas of northern Virginia include, but are not limited to, the following trees:  alder, ash, beech birch, box elder, cedar, cottonwood, elm, hazelnut, hickory, maple, mulberry, oak, pecan, pine, poplar, sycamore, walnut, and willow.  Currently, the tree pollen counts are elevated after a relatively recent mild winter this year.  The pollen counts tend to increase as the Spring progresses, usually peaking in late April – early May.  The tree pollen counts tend to peak at about 1,200 grains of tree pollen per cubic meter of air.  For reference, in the Washington, DC area, a tree pollen count of 80 or more is considered “high.”

As Vienna allergists, we see that the manifestations that allergy sufferers experience vary in both the type and severity of the symptoms.  Some of the classic symptoms of Spring hay fever may include sneezing, runny nose, itchy nose, nasal congestion, post-nasal drip, itchy roof of the mouth, itchy ears, itchy eyes, watery eyes, redness of the eyes, puffy eyes, dark circles under the eyes, sinus congestion, sinus headaches, sinus pain, fatigue, and, snoring.  If the allergies effect the lungs, they can cause or exacerbate asthma symptoms such as wheezing, shortness of breath, chest tightness, and/or coughing.

Given the above, there are 7 simple ways to get ready for the tree pollen in the Spring which are as follows:

1.)  Check the pollen count, so you know when the counts are high, so you can avoid being outdoors, if possible.  (You can check the pollen count by clicking Today’s Pollen Count or clicking it at the top right of our website daily.)

2.)  Try to minimize your exposure to the tree pollen by closing the windows in your home and car and turning on the air conditioner and setting it to “re-circulate” so it will not bring in outside air that is high in tree pollen.

3.)  Be proactive and begin using prescribed or over the counter nasal sprays a few days prior to when you normally begin to feel the symptoms of tree pollen allergies.

4.)  If you go outdoors or enjoy exercising outside, try to avoid exercise early in the morning as the pollen count tends to be highest at these times.

5.)  If outdoors for a prolonged period of time during the tree pollen season, shower and change your clothes as soon as you re-enter your home.

6.)  Minimize your contact with pets and individuals who have spent a lot of time outdoors as they will bring the pollen to you.

7.)  Wear sunglasses to prevent the tree pollen from directly entering your eyes.

In addition to the above 7 ways to help prevent the tree pollen from aggravating your allergies, there a multitude of medications that can be taken in order to help reduce allergy symptoms you can get from your Vienna allergist.  The medications come in the forms of tablets, capsules, powders, syrups, nasal sprays, and inhalers.  Allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are an extremely effective treatment for hay fever and asthma.  They are effective in 80-85% of patients that take allergy shots.  They take about 4-6 months to become effective and the average person is on allergy shots for 3-5 years.

The board certified allergists of Black & Kletz Allergy have been diagnosing and treating both adults and children in the Washington, DC, northern VA, and Maryland metropolitan area for over 50 years.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  There is on-site parking at all of the offices.  The Washington, DC and McLean, VA office locations 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.  The Vienna allergy doctors of Black & Kletz Allergy specialize in all types of allergic conditions including hay fever, asthma, sinus disease, hives, eczema, swelling problems, food and medication allergies, and immunological disorders.  If you would like to schedule an appointment, please call us or alternatively you can click Request an Appointment and we will respond back to you within 24 hours on the next business day.

New Tests for Food Allergies

It is estimated that about 3 million children and adolescents in the U.S. have food allergies. As an allergy doctor serving Mclean VA, I see many food allergy cases. For reasons that are not entirely clear, the incidence (newly reported and diagnosed cases) has been increasing steadily over the past several years.

Milk, wheat, egg, peanuts, tree nuts, and shellfish account for a vast majority of food allergies. Among these, peanuts and tree nuts (e.g., almonds, Brazil nuts, cashews, hazelnuts, pecans, walnuts) are more likely to cause serious life threatening allergic reactions.  They are also less likely to be “outgrown” than other food allergies.

The diagnosis of peanut and tree nut allergies from an allergy doctor in Mclean VA is based on a detailed history of the nature of reaction and the specific food trigger along with the results of prick skin tests and/or blood tests to estimate the level of an antibody called a specific IgE.  An elevated specific IgE level indicates a higher likelihood of a reaction upon exposure to the specific food.  Elimination of any exposure to the involved food and carrying a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q) are the only treatment options at this time.

Many children diagnosed with peanut and tree nut allergies and their parents experience considerable anxiety about accidental ingestion and the potential for a serious reaction.  A few newly available tests may ease their fears to some extent.

Both prick skin tests and blood tests, while extremely useful in detecting sensitivity, can also be falsely positive in a significant percentage of patients (especially in children with eczema) and can overestimate the risk of a reaction upon exposure.  Peanuts and tree nuts contain more than 10 types of proteins which trigger an allergic reaction, and some of them are more dangerous than others.

Until recently, the available tests for peanut allergy only measure the total quantities of all peanut specific antibodies.  A new “component” blood test can measure the levels of individual peanut protein antibodies, helping us better delineate the actual risk of a reaction.  The five major peanut proteins are as follows:  Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9.  An elevated Ara h 1, Ara h 2, or Ara h 3 level predicts a higher likelihood of a reaction than an elevated Ara h 8 or Ara h 9 protein level.

Children with elevated Ara h 2 levels should strictly avoid all exposure to all peanut products at all times.  Ara h 8 resembles the protein found in birch pollen, which is one of the tree pollens that is responsible for hay fever (i.e., allergic rhinitis) in the Spring in the Washington, DC metropolitan area.  Higher levels of Ara h 8 in the absence of Ara h 1, Ara h 2, and/or Ara h 3 can predict less severe reactions with symptoms limited to an itchy mouth, throat, and/or lips [i.e., Pollen-food syndrome (formally known as oral allergy syndrome)].  These children can undergo oral food challenges to peanuts under controlled conditions in the presence of a board certified allergist.

Oral food challenges to peanuts involve consumption of tiny quantities of peanut-containing foods while closely monitoring for adverse reactions.  Small incremental doses are given at regular intervals.  If the usual daily dose is tolerated, peanut can then be integrated in the regular diet of the patient.  It goes a long way in reassuring the family and alleviating the anxiety.  Similar tests are also available for certain tree nut specific component proteins.

The board certified allergists at Black & Kletz Allergy treats both adults and children and will gladly answer any questions you have concerning food component testing and related food allergy issues.  Black & Kletz Allergy has 3 offices in the Washington, DC, northern Virginia, and Maryland metropolitan area with 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 allergy doctor Mclean VA, 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, asthma, sinus, and immunological services to the DC metro area for more than 50 years.

New Treatments For Asthma

More than 22 million people in the U.S. suffer from asthma. As Centreville allergists, we know there are many options for treating your
allergies. Though several effective medications are available, many asthmatics frequently experience severe flare-ups of their asthma causing shortness of breath, wheezing, and/or cough.  About 400, 000 people end up getting hospitalized every year in the U.S. for management of their acute exacerbations.

As asthma is a chronic inflammatory condition involving the lungs, most currently available preventive maintenance medications are in the form of anti-inflammatory drugs inhaled directly into the lungs.  A few oral medications are also frequently employed, though they are usually less effective.

A third class of medications consists of injectable agents given every few weeks on a regular basis.  These are called monoclonal antibodies which target and reduce the numbers of certain specific mediators which contribute to the severity of asthma.

One of them, Xolair (omalizumab), has been available for the past several years.  It reduces the numbers of IgE antibodies which play a crucial role in causing exacerbations of asthma.  In selective patients who meet certain criteria, it has been found to be very useful in reducing the frequency of asthma symptoms and the need for emergency treatments.

A second drug in this class, called Nucala (mepolizumab), was recently approved by the FDA for the treatment of severe asthma.  It is a monoclonal antibody produced by recombinant DNA technology which targets and blocks a protein mediator called IL-5 (interleukin 5).  IL-5 causes an increase in the number of a particular type of white blood cell called an eosinophil which contributes to tissue damage in the lungs.  Since Nucala blocks the effect of IL-5, the resulting number of eosinophils decreases which reduces the tissue damage in the lungs of asthmatics.

In clinical trials, Nucala has shown to decrease the numbers of asthma exacerbations, emergency room visits and hospitalizations compared to a placebo.  It has been approved to treat severe and persistent asthma in adolescents above 12 years of age and adults who are still symptomatic despite the regular use of other controller medications.

While the dose and the frequency of administration of Xolair is determined by the weight of the patient and the serum IgE level, Nucala is given in a standard dose of 100 mg. every 4 weeks.  It can be injected under the skin in the arms, thighs, or abdomen.  The only criterion for the use of Nucala is a blood eosinophil count of more than 150 cells/mcL (which can be measured in a routine CBC) in patients with uncontrolled asthma.  The most common side effects of Nucala include headache, injection site reactions (pain, redness, swelling, itching, and/or a burning feeling at the injection site), back pain, and/or fatigue.

This new medication is a welcome addition to our armamentarium in our battle with uncontrolled asthma. It has the potential to greatly benefit certain selective patients whose asthma is predominantly mediated by harmful eosinophils. Being allergists in Centerville, we are happy to see additional alternative therapeutic options for the treatment of asthma.

In addition to the above treatment modalities for asthma, allergy shots (i.e., allergy injections, allergy immunotherapy, allergy desensitization) are a very effective in the treatment of asthma.  It should be noted that Xolair as well as Nucala can be given in combination with allergy shots.

The board certified allergists at Black and Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area will gladly answer any questions and concerns about this new treatment modality. Dr. Michael Kletz and Dr. Appaji Gondi, Centreville allergists at Black and Kletz Allergy, have been treating both adults and children with hay fever, with hay fever, asthma, sinus problems, insect sting allergies, eczema, hives, swelling episodes, food and medication allergies, and  immunological problems for more than 50 years.  We have an office in Washington, DC and 2 offices in Northern Virginia with locations in McLean, VA (Tysons Corner, VA) and Manassas, VA.  All 3 office locations offer on-site parking and the Washington, DC and McLean, VA locations 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.  For an immediate appointment, please call us or you may click Request an Appointment and we will respond within 24 hours by the next business day.

Allergies and Sinus Infections

People who have allergies are more prone to developing acute, chronic, and recurrent sinus infections (i.e., acute sinusitis, chronic sinusitis, recurrent sinusitis).  Allergic rhinitis (hay fever) is a condition in which allergens such as dust mites, molds, pollens, cats, dogs, and/or cockroaches will cause classic allergy symptoms in individuals that are sensitized to these allergens.  Some of the typical symptoms may include:  runny nose, nasal congestion, post-nasal drip, sneezing, itchy nose, itchy throat, snoring, sinus pressure, and/or sinus headaches.  The allergens cause inflammation and swelling in the nasal passages and sinus cavities.  These allergies can also lead to the development of nasal polys which further aggravate nasal congestion.  In the month of February, in the areas surrounding our Washington, DC, Manassas and McLean allergist offices, like Arlington, Centreville and Vienna, the allergens primarily responsible for causing allergic rhinitis symptoms include:  dust mites, molds, cats, dogs, cockroaches, and tree pollens.  The trees in the Washington, DC area usually begin to pollinate in mid to late February.  If the month is on the warmer side, the trees pollinate earlier.

When an allergic individual is exposed to an allergen to which they are sensitized, they exhibit the symptoms as mentioned above.  This predisposes the allergic person to develop sinus infections.  When someone develops nasal congestion or has nasal polyps due to allergies, the capability for the sinuses to drain properly diminishes.  As a result, the mucus becomes stagnant in the nasal passages and accumulates in the sinuses.  When the mucus “sits” in the sinuses, it is more likely to become infected with bacteria.  The dark, moist, stagnant environment in the sinuses is a perfect breeding ground for bacteria; much like a stagnant pond is much more likely to develop algae than a free flowing river.  Hence, if allergies are treated or prevented, then one is less likely to develop a sinus infection.

Allergic rhinitis can be treated with a multitude of medications which may include antihistamines, decongestants, expectorants, nasal sprays, saline irrigation of the nose, and/or leukotriene antagonists.  Allergic rhinitis symptoms can be prevented by avoiding the offending allergen, although this is difficult to accomplish in many cases.  Allergy shots (i.e., allergy immunotherapy, allergy desensitization, allergy injections) are another way to minimize or prevent allergic rhinitis symptoms from occurring.  They are 80 – 85% effective and have been used in the U.S. for over 100 years.  Patients on allergy shots often realize a decrease in both the number and the severity of sinus infections.

Note that in addition to allergies, February is a time of the year that has other nonallergic factors which increase the likelihood of developing sinus infections.  In the Winter, there tends to be more “colds,” (which are due to viruses), as well as other viruses in circulation that cause upper respiratory tract infections.  Notwithstanding, people tend to stay indoors more often during the Winter, resulting in individuals being in closer contact with each other than at other times of the year.  This further increases the chance of spreading these viral upper respiratory tract infections.  In addition, the flu season occurs during the Winter which affects the nose and sinuses in most individuals.  The flu, which is caused by the influenza virus, also predisposes individuals to sinus infections.

Sinus infections can also exacerbate both allergy-induced and nonallergy-induced asthma.  When an asthmatic develops an upper respiratory tract infection such as a sinus infection, it also commonly aggravates their asthma symptoms which generally include wheezing, shortness of breath, coughing, and/or chest tightness.  This can be very serious and the asthmatic should see their allergist so their sinus infection can be treated effectively and without delay.  In addition to the asthma symptoms, acute sinus infections typically present with sinus headaches, nasal congestion, post-nasal drip, purulent discolored nasal discharge, and possibly a low grade fever.  Recurrent sinus infections may indicate an additional immunological defect and an immune system evaluation should be performed by the allergist.  Chronic sinus infections usually indicate that antibiotic therapy needs to be given to the patient for a much longer course than the typical 10-14 days given with acute sinus infections.  Another interesting fact about chronic sinus infections is that they can cause exacerbations of someone’s asthma without any sinus-related symptoms present.  Patients with chronic sinusitis may not have any symptoms at all.

If you suffer from allergies and/or sinus infections, please call Black & Kletz Allergy to schedule an appointment with one of our board certified allergists.  We treat both adults and children, and have 3 offices in the Washington, DC, Northern VA, and Maryland metro area.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location and the Washington, DC and McLean, VA offices are Metro accessible, with a free shuttle between the McLean office and the Spring Hill metro station on the silver line.  Black & Kletz Allergy has been providing high quality allergy, asthma, and immunology care to the DC metro area for over 50 years.  Please call us for an appointment today or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day.

Allergies in a Warm Winter

Serving as Vienna, Centreville, and Arlington allergists, we have noticed that we are experiencing a relatively mild Winter so far.  Some reports indicate that this is the third balmiest winter in several decades.  The grass is still green in many of our yards and the air is warmer and moister than usual.

Every year, a hard freeze kills several types of weeds and keeps many molds in a dormant state for a few months. Higher than normal temperatures can not only prolong the pollen season, but it also can result in the proliferation of molds.

Molds are fungal organisms that release tiny spores into the atmosphere.  These microscopic spores are inhaled by us and can reach the deeper parts of our lungs.  In sensitive individuals, these can adversely affect the eyes, nose, sinuses, and lungs.  We are in fact noticing higher numbers of mold-related allergy sufferers this season than in the previous years.

Some typical symptoms seen in people with mold allergies may include sneezing, itchy eyes, redness of the eyes, watery eyes, nasal congestion, runny nose, post-nasal drip, itchy throat, sore throat, itchy ears, fatigue, sinus pressure and/or sinus headaches.  The congestion in the nose or sinuses can block the drainage pathways from the sinuses which can predispose one to sinus infections.  These sinus infections may cause facial pressure and/or pain, discolored secretions, and headaches.  In individuals with a history of asthma, an exacerbation can be triggered by the mold resulting in an increase in the frequency and severity of coughing, wheezing, and difficulty in breathing.

Exposure to outdoor molds can be reduced by avoiding raking wet leaves and damp mulch.  Molds need moisture to grow and indoor mold spores can be kept at low levels by closing the windows and keeping the humidity below 55%.  High efficiency particulate air filters (i.e., HEPA filters) are helpful in trapping the dust mites and mold spores and recirculating fresher air.  It is also interesting to note that dust mites flourish when the humidity is high.  Dust mites (the main culprits of “dust” allergies) also are more prevalent during the Winter when people use their heat in their homes.  Many “dust allergic” individuals also suffer from mold allergies as well, so this unseasonably warm Winter is causing even more havoc to these people.

Several over the counter and prescription medications like non-sedating antihistamines, topical ocular preparations, and intranasal sprays can effectively mitigate the symptoms when preventive measures are less than adequate.  It is especially important for asthmatic individuals to take their controller medications on a daily basis to protect their lungs from allergic inflammation and thus prevent a flare-up of breathing difficulties.

The board certified allergists at Black & Kletz Allergy are always ready to answer your questions and address your concerns.  Black & Kletz Allergy has 3 office 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 with on-site parking at each location.  The Washington, DC and McLean offices are Metro accessible and there is a free shuttle between the McLean office and the Spring Hill metro station on the silver line.  The allergy specialists of Black & Kletz Allergy treat both children and adults and have been serving the greater Washington, DC area for over 50 years.  If you or someone you know suffers from allergies or asthma, please call us for an appointment.  Alternatively, you can click Request an Appointment and we will respond within 24 hours of the next business day.

Cold-Induced Allergic and Immunologic Conditions to Consider for the Winter

As Winter begins and the temperatures plummet, the cold air can cause havoc on individuals with certain allergic and immunologic conditions that are caused or made worse with cold weather.  Some of the allergic and immunologic conditions that are exacerbated by cold weather include cold-induced pruritus (itching), cold-induced urticaria (hives), cold-induced angioedema, (swelling), cold-induced anaphylaxis, Raynaud’s disease, Raynaud’s phenomenon, cryoglobulinemia, cold agglutinin disease, and cold-induced asthma.

Cold-induced Pruritus, Urticaria, Angioedema, and Anaphylaxis

Cold-induced pruritus, cold-induced urticaria, cold-induced angioedema, and cold-induced anaphylaxis are all very similar conditions.  The major difference between them is the severity of the reaction to the cold.  Exposure to cold temperatures can result in itching, hives, swelling, and/or anaphylaxis to the cold-exposed part of the body.  Cold-induced pruritus, cold-induced urticaria, and cold-induced angioedema are conditions with increasing severity respectively.  Cold-induced urticaria can usually be diagnosed by an allergist in the 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.  Cold-induced angioedema can be very serious if swelling develops in the tongue and/or throat which can potentially block the flow of air into the lungs.  In such circumstances, these patients should be taught how to use a self-injectable epinephrine devices (i.e., EpiPen, Auvi-Q) and they should carry them at all times.  If used, they should go to the nearest emergency room, even after using the epinephrine.  Cold-induced anaphylaxis is a life-threatening condition where the cold causes a systemic reaction which involves several body systems such as the skin, respiratory, and circulatory systems.  Again, these individuals should be taught how to use a self-injectable epinephrine devices and they should carry them at all times.  If used, they should go to the nearest emergency room, even after using the epinephrine.  Individuals that have severe reactions to the cold need to be educated on how to help prevent these reactions as well as how to treat them.  Treatment begins with avoiding the cold whenever possible.  In addition, various medications can be used to help prevent the itching, hives, swelling and/or anaphylaxis that may occur in people with these conditions.

Rarely, the above conditions can be associated with some systemic diseases and blood tests for cryoglobulins and cold agglutinins may be appropriate.  A brief summary of these 2 rarer diseases are discussed below.

Cryoglobulinemia

Cryoglobulinemia is a disease in which patients have high levels of immunoglobulins (antibodies) that bind together and “clump up” to form a “precipitate” in the bloodstream when the body’s temperature drops below the normal 98.6°F.  The majority of the immunoglobulins are Immunoglobulin M (IgM), but Immunoglobulin G (IgG), and Immunoglobulin A (IgA) also cause this disease.  These antibodies are thus called cryoglobulins since the prefix “cryo” means “cold” in Greek.  When these cryoglobulins form a precipitate, it causes an obstruction in the blood vessels and blocks the flow of blood to the periphery.  As a result, it may cause gangrene in the fingers and toes since less or no blood reaches these areas.  Damage can also occur in the skin, joints, nerves, muscles, kidney, and liver.  Interestingly, when the body temperature reaches 98.6°F again, usually by warming methods used in therapy, the cryoglobulins go back into solution causing the precipitate to “dissolve” and the flow of blood is re-instated through the blood vessels again.  The disease is most common in individuals 50 years of age and above and there are 3 types of cryoglobulinemia.  The causes of cryoglobulinemia may include several underlying diseases or conditions.  Some of the more common underlying disorders include multiple myeloma, Waldenström’s macroglobulinemia, autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus (lupus), certain leukemias, and infections such as Mycoplasma pneumonia, hepatitis C, hepatitis B, post-streptococcal glomerulonephritis, and HIV.  The treatment of cryoglobulinemia begins with treating the underlying disorder.  Keeping the individual warm with protective clothing, avoiding cold liquids, and avoiding exercise in the cold, can all help prevent the body temperature from getting too low.

Cold Agglutinin Disease

In cold agglutinin disease, patients have high levels of Immunoglobulin M (IgM) antibodies in their bloodstream which attack their own red blood cells when their body temperature is below 88°F.  Occasionally, the antibody Immunoglobulin G (IgG) or even rarer, the antibody IgA (IgA) can cause this disorder.  When the red blood cells are attacked, they are destroyed, leading to a type of anemia (low red blood cell count).  As with cryoglobulinemia, there may be an underlying illness or condition causing cold agglutinin disease.  Some of these underlying causes may be due to chronic lymphocytic leukemia, lymphoma, Waldenström’s macroglobulinemia, and infections such as mononucleosis, HIV, and Mycoplasma pneumonia.  Treating the underlying disorder, as well as keeping the patient warm by using protective clothing, avoidance of drinking cold liquids, eating good sources of folic acid in fruits and vegetables, and avoidance of strenuous exercise, particularly in the cold air all are effective in the management of this disease.

Raynaud’s Disease and Raynaud’s Phenomenon

Raynaud’s disease and/or Raynaud’s phenomenon occurs when there is decreased blood flow to the fingers, toes, nose, and/or earlobes when someone is exposed to the cold.  It is thought to occur as a result of vasospasm (spasm of the blood vessel) causing the decrease in blood flow.  These vasospastic events are generally episodic in nature.  Initially the skin of these regions turns a whitish-pale color.  At this point, the skin feels cold and can feel numb.  The oxygen supply is thus reduced causing a bluish tint to the skin.  When the episode is finished and/or the body part gets re-warmed, blood flow to the skin areas is resumed and the skin turns reddish in color and then finally the color becomes normal.  This phase is generally accompanied by local swelling with an associated tingling pin and needle sensation like when someone’s fingers or toes “fall asleep.”  It is often referred to the disease that is red, white, and blue.  Raynaud’s disease and Raynaud’s phenomenon are more common in females.  The term Raynaud’s Disease is used when there is no reason identified as an underlying reason for the vasospasm.  On the other hand, Raynaud’s phenomenon is used to describe the same situation only when there is an identifiable underlying condition that is believed to cause the decreased blood flow.  Some of the underlying secondary diseases may include autoimmune or connective tissue disorders such as systemic lupus erythematosus (lupus), systemic sclerosis (scleroderma), polymyositis, dermatomyositis, Sjögren’s syndrome, mixed connective tissue disease, rheumatoid arthritis, and Takayasu’s arteritis.  Other underlying conditions known to cause Raynaud’s phenomenon include atherosclerosis, malignancy, hypothyroidism, multiple sclerosis, Lyme disease, carpal tunnel syndrome, and certain medications (e.g., beta blockers, sulfasalazine, ergotamine, bromocriptine, bleomycin, pseudoephedrine, methylphenidate, dexmethylphenidate).  The treatment of Raynaud’s phenomenon is primarily to treat the underlying condition.  In addition, with both Raynaud’s disease and Raynaud’s phenomenon, it is important to keep warm by wearing gloves, mittens, socks, scarves, ear muffs, and hats.  There are several medications that can also be given such as alpha blockers, calcium channel blockers, and vasodilators.

Cold-induced Asthma

Cold dry air is a known irritant to the respiratory passages and can trigger an increase in the frequency and severity of asthma.  The symptoms that asthmatics experience may include wheezing, chest tightness, coughing, and/or shortness of breath.  Exercising in the cold is even worse in many patients with asthma.  It is important for individuals with asthma to understand their triggers and to pre-medicate, with some of their asthma medications, before venturing out into the cold.  The patient should also understand when to call their allergist, before their asthma symptoms get out of control.

The board certified allergists at Black & Kletz Allergy have been treating cold-induced allergic and immunologic conditions in adults and children.  We have been providing quality allergy care to those located in the Washington, DC, Northern Virginia, and Maryland metropolitan area for more than 50 years.  Black & Kletz Allergy provides on-site parking at all of their convenient locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA locations are Metro accessible and there is a complementary shuttle that runs between our McLean office and the Spring Hill metro station on the silver line.  Please call any one of our offices for a consultation for your allergy, asthma, or sinus needs or alternatively, please click Request an Appointment and we will respond within 24 hours on the next business day.

Winter Allergies

As we approach the Winter season, many allergy sufferers in the Washington, DC metropolitan area either notice allergy symptoms or still continue to have symptoms that they have had throughout the year. Manassas and Centreville allergists, see these individuals with hay fever (allergic rhinitis) and/or asthma symptoms. In the Winter, allergies are typically caused by dust mites, molds, pet dander, cockroaches, and/or rodents. The dust mites, molds, and pets, however, are the most common allergens that cause the allergy suffering during the winter.

The most common symptoms that allergic individuals experience during the winter include: sneezing, runny nose, nasal congestion, post-nasal drip, decreased sense of taste and/or smell, itchy eyes, watery eyes, redness of the eyes, clogged ears, sinus pressure and/or headaches, chest congestion, wheezing, shortness of breath, coughing, chest tightness, and fatigue. If allergies are untreated, they may cause individuals to develop sinus infections. In addition to allergies during the Winter, many upper respiratory viruses including influenza (i.e., flu) can mimic the symptoms of allergies. These viruses also infect many people who already have winter allergies, which causes the person to have even more “allergy symptoms,” although some of the manifestations are actually due to the viral infection rather than the allergen. In the end, from the patient’s perspective, they just feel awful. Board certified Centreville allergists and Manassas allergists are trained to recognize the difference between viral and allergic conditions. The board certified allergists at Black & Kletz Allergy diagnose and treat both adults and children with allergies and asthma.

Asthma in the Centreville and Manassas area is similar to that of asthma in the greater Washington, DC area. During the late Fall and Winter months when the temperature becomes colder, many asthmatics have an increase in their asthma symptoms. These symptoms usually include wheezing, chest tightness, shortness of breath, and/or coughing. Each individual asthmatic patient may have different triggers when it comes to aggravating their asthma symptoms. The cold air, the change in temperature, molds, and dust seem to be the most common factors that cause exacerbations of asthma during the Winter months. It is therefore important for patients to understand their triggers and to use medications and/or allergy shots (i.e., allergy immunotherapy) to help prevent asthma exacerbations. The allergy doctors of Black & Kletz Allergy have had over 50 years of experience in the Centreville, VA and Manassas, VA area in the diagnosis and management of asthma. Since asthma can be a very serious disease, individuals with the symptoms of asthma should seek the advice of a board certified allergist.

In addition to allergic rhinitis, asthma, and upper respiratory tract infections, the Winter’s cold temperatures in the Centreville and Manassas area can cause hives (urticaria), generalized itching (pruritus), and/or swelling episodes (angioedema) in a select group of people. The conditions are called cold-induced urticarial, cold-induced pruritus, and cold-induced angioedema respectively. In fact, a small percentage of individuals can even develop life-threatening anaphylaxis when exposed to the cold. This condition is called cold-induced anaphylaxis. Such individuals should carry a self-injectable epinephrine device (e.g., EpiPen, Auvi-Q) to be used if anaphylactic symptoms occur. They should also always go to the nearest emergency room after using a self-injectable epinephrine device as the device may only works for about 15-20 minutes.

If you suffer from any of the symptoms listed above, please feel free to call Black & Kletz Allergy of the Centreville and Manassas area or alternatively, you can click Request an Appointment and we will respond within 24 hours on the next business day. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. All of our 3 office locations have on-site parking and the Washington, DC and McLean offices are Metro accessible. There is a free shuttle that brings patients back and forth between our McLean office and the Spring Hill metro station on the silver line. Black & Kletz Allergy takes pride in providing high quality health care to the Washington, DC, Northern Virginia, and Maryland metropolitan area.