Blog

A Spike in Allergy Symptoms in the Autumn?

• August 18, 2015
• BY BLACK & KLETZ ALLERGY

As we enter into the ragweed season, some of us with seasonal allergies may experience a flare-up of symptoms.

Ragweed is one of the several weeds that pollinate in late Summer and the early Fall.  Seventeen different species of ragweed grow in the United States.  Common ragweed grows up to five feet tall.  It has hairy stems and light green leaves, up to four inches long.  Ragweed grows in fields, gardens, and along roadsides.  It is an annual plant, which means it only lives for one season.

Ragweed flowers are yellowish-green in color and small in size.  They grow in clusters of up to six inches long near the top of the plant.  Ragweed flowers produce large amounts of pollen. The pollen is transferred from one plant to another by the wind as well as insects.

Ragweed allergy occurs when an individual’s immune system produces a forceful response to a foreign substance (i.e., ragweed pollen) that is actually harmless in most circumstances.  As a result, the individual experiences hay fever (allergic rhinitis), allergic conjunctivitis, and/or asthmasymptoms (see below).

Certain cells of the body begin releasing antibodies to proteins in the ragweed pollen.  This results in the production of several chemicals (e.g., histamine) that cause these allergy symptoms.  Some individuals with ragweed allergy may also get local itching of the mouth and throat areas when they eat fresh melons, bananas, kiwi, cucumbers, zucchini, and/or avocados.  This condition is called oral allergy syndrome, which is also known as pollen-food allergy syndrome.

Each ragweed plant can release approximately one billion grains of ragweed pollen in one ragweed season.  The grains are so light that the wind easily carries them into the air where individuals inhale the grains.  The result is that these individuals may become sensitized and allergic to the ragweed pollen.  The pollen travels very far by the wind and pollen has been detected hundreds of miles away.  Some studies suggest that rising temperatures and carbon dioxide (CO2) levels are extending the ragweed season.  In Northern Virginia and Washington, DC, ragweed begins to pollinate in mid-August, peaks after the Labor Day weekend in September, and lasts until the end of October when the first frost ultimately kills the plant.

What are the Symptoms?

The allergic reaction to all plants that produce pollen is commonly known as hay fever (allergic rhinitis).  Symptoms can include itchy eyes, watery eyes, red eyes, puffy eyes, itchy nose, runny nose, stuffy nose, post-nasal drip, itchy throat, and sneezing.  In those with severe allergies, asthma symptoms (i.e., wheezing, shortness of breath, cough, chest tightness), sinusitis, headaches, fatigue, and impaired sleep may also occur.

What Methods of Prevention are Recommended?

A few simple suggestions can dramatically diminish one’s exposure to pollen:

• It is preferable to stay inside when the pollen counts are at their highest.  In the Washington, DC area, this is in the mid-morning and the mid-afternoon.  One can track the pollen count in our area by clicking Today’s Pollen Count at the top of our website.
• After being outdoors, change your clothes after returning indoors and take a shower to remove the pollen.  Do not hang clothes outdoors to dry, as the pollen will collect on them.  Use a clothes dryer instead.
• Keep the windows closed in your car and home.   Turn on the air conditioner.  Make sure to change the air filters every 1-2 months.
• Shower before bed to remove pollen, especially from your face and hair.
• Use HEPA air filters in your home.

Diagnosing and Treating Ragweed Allergies:
When avoidance and prevention do not work, try over-the-counter medications.  If symptoms continue, or complications arise, it may be time to seek the advice of a physician.  The board certified allergists at Black & Kletz Allergy treat both adults and children with ragweed allergies and have done so for more than fifty years.  A thorough history and physical examination will be performed and allergy skin testing and/or allergy blood testing can be done in order to diagnose your condition.  Once a diagnosis of ragweed allergy is established, there are a multitude of medications available by prescription that can be tried in order to help alleviate your symptoms.  These medications come in the form of pills, capsules, syrups, powders, nasal sprays, eye drops, and inhalers.  Allergy shots (allergy immunotherapy, allergy injections) are an extremely effective means to treat not only ragweed allergy, but allergies (i.e., allergic rhinitis, allergic conjunctivitis, allergic asthma) in general.  They work in approximately 80-85% of individuals, but take about 4-6 months before they are effective for most individuals.  They have been around for over 100 years and can be given in children, adults, pregnant women, and the elderly with great success.

Black and Kletz Allergy has 3 convenient office locations in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We have offices in Washington, DC, McLean, Virginia (Tysons Corner, Virginia), and Manassas, Virginia.  The Washington, DC and McLean, VA offices are Metro accessible and all 3 locations offer on-site parking.  The allergists and staff at Black and Kletz Allergy will gladly answer any of your questions or concerns. We strive to offer individualized treatment plans in order to alleviate your unwanted allergy symptoms in a caring and professional setting.

Summer Itch or Rash?

• July 27, 2015
• BY BLACK & KLETZ ALLERGY

Outdoor activities in the summer can result in skin irritation and itching due to a variety of causes.

1. PAPULAR URTICARIA:  It is an excessive skin reaction to insect bites.  Crops of itchy, red bumps usually less than a half-inch in diameter appear over the exposed areas of the body.  They sometimes progress into fluid filled blisters grouped together.  Scratching them may lead to crusting and/or infected pustules.  The lesions usually last for days to weeks.  Despite the name urticaria, they are not hives, which are raised wheals usually resolving in hours.  The most common insects causing these reactions are mosquitoes, gnats, fleas, etc.  Treatments like topical corticosteroids to lessen the inflammation and oral antihistamines to relieve the itching can be helpful. Application of insect repellants to exposed areas before outdoor activities may help prevent the problem.
2. CONTACT DERMATITIS:  Skin exposure to the urushiol oil from the leaves of plants like poison ivy, poison oak, and poison sumac can cause severe redness, blistering, and burning sensation in sensitized individuals.  About 60-80% of individuals exposed to the urushiol oil become sensitized to it.  The condition usually begins 24-36 hours after exposure and can last a few weeks.  The lesions cannot be spread to other areas of the body through scratching or oozing of the blister fluid.  Because it can be a severe reaction, many patients will need corticosteroids by mouth for about a week to 10 days to control the condition.  Wearing long sleeves and pants, in addition to application of barrier creams before outdoor activities can be helpful in warding off the reaction in susceptible people.
3. MILIARIA:  Prickly heat manifests as tiny red or pink spots over the face, neck, upper back, chest, etc.  This condition is caused by clogged up sweat pores which results in retention of excessive sweat which then leads to irritation and itching.  Friction caused by clothing can aggravate the problem.  This condition can be alleviated by using prickly heat powders, calamine lotion, staying in a cool environment, keeping the affected area clean and dry, and taking frequent cool and light baths or showers.  Occasionally, topical corticosteroids are necessary to provide relief.
4. SUNBURN:  Prolonged exposure to the sun can cause red, irritated, burned, and/or itchy skin which can progress to blistering and open sores over the affected area.  Application of ice compresses and aloe gel can soothe the involved skin.  Avoiding excessive sun exposure, liberal use of sun block creams, and hydrating the skin with consumption of good quantities of clear liquids can be helpful.
5. XEROSIS:  Xerosis is the medical term for abnormally dry skin.  Though excessive dryness is more common during the winter, prolonged exposure to air conditioned environments with little humidity can lead to dry and dehydrated skin.  Frequent bathing or showering and the use of strong soaps can remove essential skin oils causing the skin to be dry and itchy.  Applying a moisturizer thoroughly all over the skin immediately after a bath or shower will help in seal in the moisture and keep the water from evaporating, leaving the skin cool and moist.

The board certified allergists and trained staff at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area can answer your questions and concerns regarding many skin conditions and will provide time tested and scientifically validated advice.  Our allergists specialize in both adult and pediatric patients.  We have 3 convenient office locations which all offer on-site parking.  Our offices are located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  The Washington, DC and McLean, VA offices are also Metro accessible.  Please click Request an Appointment and we will answer you within 24 hours on the next business day.  For faster service, please call our office directly.  Black & Kletz Allergy prides itself in providing prompt quality care to the community in a caring professional setting.

Can a Cough Be Due to Allergies?

• July 13, 2015
• BY BLACK & KLETZ ALLERGY

There are many cause of a cough.  Coughing is usually caused by a viral upper respiratory infection (URI), asthma, post-nasal drip, and/or gastroesophageal reflux disease (GERD).  There are however many other conditions which may cause a cough, some of which include other infectious types of upper respiratory infections (i.e., bacterial, fungal, parasitic), occult sinus infection, vocal cord dysfunction, cystic fibrosis, laryngopharyngeal reflux, pneumonia, bronchitis, bronchiectasis, pertussis (whooping cough), croup, foreign body (which can get stuck in one’s airways), pulmonary embolism, neurogenic cough, post-infectious cough, hypersensitivity pneumonitis, sarcoidosis, psychogenic cough (due to a habit or tic), Tourette’s Syndrome, aspiration, cigarette smoking, chronic obstructive pulmonary disease (COPD) (i.e., chronic bronchitis, and/or emphysema), interstitial lung disease, tumors, congestive heart failure, exposure to air pollutants, and the side effects of certain medications such as angiotensin-converting enzyme inhibitors [(i.e., lisinopril (Zestril, Prinivil), enalapril (Vasotec), ramipril (Altace), benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), quinapril (Accupril), trandolapril (Mavik), moexipril (Univasc), and perindopril (Aceon)].

So can allergies play a role in causing a cough?  Yes.  Since asthma is a leading cause of cough and about 80% of individuals with asthma also have allergies, one can see right away that allergies play a large role in causing a cough.  In addition, there is a sub-group of asthmatics who have a condition called cough-variant asthma where sufferers only cough as a result of their asthma.  They do not have the accompanying wheezing, shortness of breath or chest tightness that most other asthmatics experience.  As if this wasn’t bad enough, it is estimated that 75-80% of asthmatics have gastroesophageal reflux disease (GERD), which is also one of the most common causes of a cough.  Allergies also play a major role in predisposing a person to develop a sinus infection (sinusitis) which again often causes a cough.  Immunodeficiency disorders (which are diagnosed and treated by allergists/immunologists) such as hypogammaglobulinemia also predispose people with these disorders to acute sinus infections.  Hypersensitivity pneumonitis is a condition where there is an inflammation of the air sacs (alveoli) of the lungs caused by an allergic reaction to inhaled antigens such as dusts, molds, and chemicals.  Individuals with this condition commonly have certain hobbies and/or occupations that expose them to these antigens.  Once again, cough is a primary symptom of this disease.

In individuals with a persistent cough, many tests can be done in order to diagnose the reason behind the cough.  Some of these tests include blood work, chest X-rays, CT scans of the chest and/or sinuses, allergy testing, pulmonary function tests (PFT’s; breathing tests), rhinoscopy, upper endoscopy (with or without biopsy), esophageal manometry (assesses the function of the lower esophageal sphincter and esophagus), barium swallow, pH monitoring (measures the acidity in the stomach), and bronchoscopy (with or without lung biopsy).  In most cases, the workup usually does not require the last six tests listed above which are generally reserved for difficult cases.  After diagnosing the problem, there are a variety of medications that can be used to treat an individual’s cough.

The board certified allergists at Black & Kletz Allergy have been diagnosing the underlying conditions of coughs and treating individuals with coughs for more than 50 years in the Washington, DC, Northern Virginia, and Maryland metropolitan area.  We treat both adult and pediatric patients and have 3 convenient locations in the DC metro area.  We have offices in Washington, DC, McLean, VA (Tysons Corner, VA) and Manassas, VA, each with on-site parking.  The Washington, DC and McLean, VA offices are Metro accessible.  Black and Kletz Allergy is committed to providing excellent allergy, asthma, and immunology care to the greater Washington, DC and Northern Virginia community.

Allergic Fungal Sinusitis

• June 25, 2015
• BY BLACK & KLETZ ALLERGY

Allergic Fungal Sinusitis (AFS) is a chronic inflammatory condition involving the nose and sinuses caused by an allergic sensitivity to environmental fungi.  It is usually seen in people with normal immune systems as opposed to invasive fungal infections which usually affect people with compromised immune systems caused by conditions which may include diabetes mellitus, certain cancers, HIV infection, and patients receiving chemotherapy or radiation treatment.  It is similar to a condition that affects the lung called Allergic Bronchopulmonary Aspergillosis (ABPA).

Many patients with AFS are atopic, meaning they have a tendency to develop allergic sensitization when exposed to common harmless substances like pollens, dust mites, cats, dogs, and certain foods.  About two-thirds of patients with AFS also have allergic rhinitis and up to half of them also have allergic asthma.  AFS is most commonly seen in young adults with an average age of 22 years.

CAUSE:

When an atopic person breathes in air containing the fungus, it triggers an allergic inflammation of the mucus lining inside the nostrils and sinuses resulting in swelling of the tissues.  This swelling leads to blockage of the sinus drainage pathways causing the mucus secretions (mucin) to accumulate within the sinus cavities.  This, in turn, creates an ideal environment for further reproduction of the fungus.  The sinuses are eventually filled with a viscous and tenacious fungal mucin which has the consistency and appearance of peanut butter.

SYMPTOMS:

1. Nasal congestion
2. Discolored copious nasal secretions
3. Semi-solid nasal crusts
4. Polyp formation in the nose and the sinuses
5. Post-nasal drip
6. Throat irritation
7. Occasional headache or facial pressure
8. Decreased sense of smell

In advanced stages, facial disfigurement and vision disturbances may also be encountered due to extension of the disease to the surrounding areas.

DIAGNOSIS:

1. Total IgE antibody levels in the blood will be elevated several times the normal limits.
2. Skin testing to various fungal organisms.
3. CT scan of the sinuses can demonstrate accumulated fungal mucin in the sinus cavities.
4. Mucin drained from the sinuses needs to be examined for specific histological characteristics under the microscope and cultured in the laboratory to identify the specific type of fungus.

TREATMENT:

1. Fungal mucin in the sinuses needs to be drained out by endoscopic sinus surgery.
2. Systemic and topical steroid medications to reduce the inflammatory changes and shrink the polyps.
3. Environmental control to reduce the exposure to the fungi and molds.
4. Systemic or topical antifungal medications may be used to reduce the amount of fungus.
5. Allergy immunotherapy (allergy shots) with the antigens identified by skin testing to develop tolerance to the fungal allergens and to control the chronic inflammatory reactions.

A comprehensive management plan incorporating medical, surgical, and immunologic care remains the most likely means of providing long-term disease control for allergic fungal sinusitis (AFS).

The board certified allergists at Black & Kletz Allergy in the Washington, DC, Northern Virginia, and Maryland metropolitan area have been treating sinus disease for more than 5 decades.  We have expertise in recognizing and managing individuals with allergic fungal sinusitis.  Black & Kletz Allergy has 3 convenient locations in the Washington, DC area with offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have on-site parking at each location.  In addition, the Washington, DC and McLean, VA offices are accessible by the Metro.  If you suffer from any of the above symptoms, please contact one of our offices to make an appointment.  Alternatively, you can click Request an Appointment and we will contact you within 24 hours of the next business day.  We strive to serve the community in a professional, friendly, and caring manner.

The Asthma and Acid Reflux (GERD) Connection

• June 15, 2015
• BY BLACK & KLETZ ALLERGY

There is a surprising connection between asthma and acid reflux.  Anywhere from 75-80% of asthmatics suffer from acid reflux.  Acid reflux is also known by the name of gastroesophageal reflux disease (GERD).   Acid reflux is a condition where the acidic stomach contents travel in the wrong direction and enter the esophagus (swallowing tube).  This causes a variety of symptoms of which the main one is heartburn.  People with acid reflux commonly feel a burning sensation in the chest and/or throat.  They often complain of a bitter or sour taste in their mouth.  Other symptoms can include wheezing, coughing, belching, abdominal bloating, sore throat, nausea, and/or the feeling that something is stuck in one’s throat.  It is the wheezing and coughing symptoms that cam mimic asthma or in fact be triggered in an asthmatic who has acid reflux or GERD.

Acid reflux occurs because the lower esophageal sphincter, a muscle at the lower part of the esophagus near the entrance to the stomach, becomes too relaxed.  This allows the stomach acid to go backwards into the esophagus which can cause damage to the esophagus and cause a burning sensation, commonly referred to as heartburn.  In addition to causing heartburn, it also can aggravate a person’s asthma in a couple of different manners.  The first way this occurs is a result of small amounts of this acid irritating the airways (like a chemical burn) which can trigger asthma symptoms.  The second way may involve triggering a reflex in the airways to become narrower in order to prevent more acid from entering the airways.  It is this narrowing of the airways which causes an asthmatic to wheeze, cough, and/or feel short of breath.  In addition, some asthma medications can decrease the lower esophageal sphincter pressure thereby relaxing this muscle which subsequently will increase the severity of acid reflux.  Asthma medications in the bronchodilator family such as Albuterol (i.e., Proventil, Ventolin, ProAir, AccuNeb), Levalbuterol (Xopenex), Terbutaline, (i.e., Brethine, Brethaire), Salmeterol (Serevent), Formoterol, (Foradil), Vilanterol, Ipatroprium (Atrovent), and Tiotropium (Spiriva) fall into this category.  There are also asthma medications that are combinations of two medications, one of which is a bronchodilator, which can therefore increase acid reflux disease.  The names of some of these medications include Advair, Symbicort, Dulera, Breo Ellipta, Combivent, and DuoNeb.  Theophylline (i.e., Theo-Dur, Uniphyl, Theo-24, Slo-Bid), an older but still useful oral bronchodilator asthma medication, has also been linked with increasing acid reflux in individuals by causing the relaxation of the lower esophageal sphincter as well.  Interestingly, the chemical structure of Theophylline is similar to caffeine which is another trigger of acid reflux.

The cause of acid reflux disease is a failure of the lower esophageal sphincter to function properly.  There are several risk factors that can contribute to acid reflux disease and some of them include:

• Hiatal hernia – the protrusion of part of the stomach through the diaphragm (a muscle separating the abdomen from the chest) into the chest
• Obesity
• Pregnancy
• Use of certain medications (i.e., bronchodilators, calcium channel blockers, aspirin, prednisone)
• Alcohol use
• Smoking
• Certain foods – caffeine, fatty foods, garlic, onions, spicy foods, and acidic foods (i.e., tomatoes, soda, citrus fruits)
• Diabetes
• Eating before bed
• Eating large meals
• Certain connective tissue disorders – Scleroderma or systemic sclerosis

The diagnosis can be made with a combination of a good history from the individual along with observing relief when prescribed medications to control reflux such as antacids and/or acid-blocking medications.  If there is no improvement in symptoms of acid reflux, there are several procedures that can be performed to help diagnose acid reflux disease.  Some of these procedures include upper endoscopy with or without biopsy, barium swallow, esophageal manometry (checks the function of the lower esophageal sphincter and esophagus), and pH monitoring (checks the acidity in the stomach).

The treatment of acid reflux disease is aimed at minimizing the risk factors mentioned above in addition to prescribing antacids and acid-blocking medications.  By treating the underlying acid reflux disease in the asthmatics that have this condition, the symptoms of asthma (i.e., wheezing, coughing, shortness of breath, and chest tightness) may also be diminished)

The board certified allergists at Black & Kletz Allergy recognize the association between asthma and acid reflux (GERD) and we treat our asthmatics accordingly after a thorough history and physical examination.  Black & Kletz Allergy has 3 offices and has been serving the Washington, DC, Northern, Virginia, and Maryland metropolitan area for more than 50 years.  We have convenient office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA.  We have parking at each location and the Washington, DC and McLean, VA (Tysons Corner, VA) offices are Metro accessible.  If you have asthma, think you have asthma, or have symptoms of wheezing, coughing, shortness of breath, and/or chest tightness, please call us to schedule an appointment.  Alternatively, you can click Request an Appointment and we will respond back to you within 24 hours of the next business day.

Do You Have a Penicillin Allergy?

• May 26, 2015
• BY BLACK & KLETZ ALLERGY

Many people think that they are “allergic” to penicillin, when they may not really be truly allergic.

Penicillin is a very effective and relatively inexpensive antibiotic, used in the treatment of many bacterial infections.  About 1 in 10, 000 people who receive penicillin may have a true allergic reaction, where the immune system considers the antibiotic as a harmful foreign agent and mounts a defensive attack.  The chemical mediators that are released during this process can cause itchy rashes, hives, and/or swelling of the tissues.  In rare cases, life threatening reactions can occur in which difficulty in breathing (i.e., wheezing, shortness of breath), cardiovascular manifestations (i.e., drop in blood pressure, shock) and other serious organ system damage can ensue.

However, two recent studies proved that most people who consider themselves allergic to penicillin can safely receive penicillin.  In one study, 94 percent of 384 people who believed they were allergic to penicillin tested negative for penicillin allergy.  In the second study, penicillin skin testing was performed on 38 people who believed they were allergic to the antibiotic, and all of them tested negative.

Most people with a presumptive history of sensitivity to penicillin are given alternate antibiotics to treat infections.  In some instances, the replacement antibiotic may not be as effective as the preferred penicillin and in addition, the substitute antibiotic is also more expensive.  Such use may also result in some bacteria developing resistance to antibiotics, harming the community at large.  Hence it is important to distinguish between false and true allergy to penicillin and related antibiotics.

A standardized skin testing procedure can differentiate people who are likely to adversely react to penicillin from those who can safely tolerate it.  It involves injecting small amounts of chemical determinants (reagents) of penicillin sensitivity into the layers of the skin, with appropriate positive and negative controls.  A positive test manifests as an itchy, red, raised bump after 15 minutes and confirms true allergy to penicillin and the need to permanently avoid penicillin and related antibiotics.

If the skin test is negative, a related drug, amoxicillin is given by mouth at a standard dose and the person is monitored in a board certified allergist’s office for 1 to 2 hours for any adverse reactions.  If the oral dose is also tolerated, he/she can safely receive penicillin and related antibiotics to treat infections in the future.

The board certified allergists at Black & Kletz Allergy can administer the penicillin skin testing and oral challenge, if needed, and can offer recommendations for appropriate antibiotic use based on the test results.  Please call any of our 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area with questions or concerns related to antibiotic or other medication allergies.  We have office locations in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA and have been serving this area for more than 50 years.  There is parking at each one of our 3 office locations.  In addition, the Washington, DC and McLean, VA offices are also accessible by the Metro.  If you have wondered if your “penicillin allergy” was correct, please call us today or click Request an Appointment and we will contact you within 24 hours of the next business day.  We would be happy to test you for a penicillin allergy, so that you can clarify if you are truly allergic to penicillin.